Woodmen Form 5019 Details

As a modern woodman, there are times when you will be required to fill out a form. This can be for anything from taking a leave of absence to resigning from your employment. It's important that you complete the form correctly so that all your information is conveyed accurately. In this blog post, we'll walk you through the steps of completing the Modern Woodmen 948 form. We'll also provide some tips on how to make sure everything is correct before submitting it.

Here is the information about the PDF you were seeking to complete. It can show you the time it should take to fill out modern woodmen 948 form, what fields you need to fill in, etc.

QuestionAnswer
Form NameModern Woodmen 948 Form
Form Length2 pages
Fillable?No
Fillable fields0
Avg. time to fill out30 sec
Other namesmodern woodmen of america bene4ficiary change form, woodmen form 5019, woodmen life cash surrender, modern woodmen surrender of cash value

Form Preview Example

Request for Change of Beneficiary or Name

Modern Woodmen of America

1701 1st Avenue

Rock Island, Illinois 61201 1.800.447.9811 www.modern-woodmen.org

Insured’s Full Name: _________________________________________________

Social Security No. _____________________ Certificate No. _______________

Please see instructions on reverse before completing. Please print all information in black or dark blue ink.

Line through and initial any errors or corrections. Do NOT use white-out.

I hereby revoke all previous beneficiary designations and request that the proceeds shall be payable to: Principal Beneficiary (Required) – Equally to the surviving principal beneficiaries unless otherwise indicated.

Named Individuals – Enter the requested information for each named individual.

First, Middle Initial, Last

Address

Relationship

Date of Birth

Social Security No.

 

 

 

Living Trust – Name of Trust ________________________________________________________ Date of Trust _________________

Grantor/Executed by ________________________________________ Trustee(s) _________________________________________

Final Beneficiary: Name ________________________________________________________

Relationship

_____________________

Trust under Insured’s Will. Final Beneficiary: Name ___________________________________

Relationship

_____________________

Estate of Insured. If choosing this option, DO NOT enter additional names in the Principal or Contingent Beneficiary section.

Contingent Beneficiary (Optional) – If no principal beneficiary survives the Insured, then equally to the surviving contingent beneficiaries unless otherwise indicated.

Named Individuals – Enter the requested information for each named individual.

First, Middle Initial, Last

Address

Relationship

Date of Birth Social Security No.

Living Trust – Name of Trust ________________________________________________________ Date of Trust _________________

Grantor/Executed by ________________________________________ Trustee(s) _________________________________________

Final Beneficiary: Name ________________________________________________________

Relationship

_____________________

Trust under Insured’s Will. Final Beneficiary: Name ___________________________________

Relationship

_____________________

Estate of Insured. If choosing this option, DO NOT enter additional names in the Contingent Beneficiary section.

Method of Settlement – Complete in all cases

One Sum

Deposit at Interest (Proceeds left with the Society to earn interest)

Other: Specify: _____________________________

(Unless otherwise specifically requested, the beneficiaries shall have the right to change the method of settlement.)

No change of beneficiary shall be effective until such change is acknowledged in writing by the National Secretary. When so acknowledged, the change will take effect on the date this request was signed, subject to any payment made or other action taken by the Society before such acknowledgment.

Signed at (City, State) ____________________________________

Witness X ______________________________________________

 

(Signature of Witness - A person other than a beneficiary)

Witness is:

Agent: Region __________ Agent No. _________

 

Other: Printed Name ________________________

 

Relationship_______________________________

/

 

/

Date __________________________________________________

Month

Day

Year

X___________________________________________________

(Signature of Owner/ Applicant)

Street Address __________________________________________

City, State, Zip __________________________________________

Change of Address Telephone No. _______________________

Form 948 (Rev. 3-12)

*00869*

(SEE PAGE 2 FOR CHANGE OF NAME)

 

 

Request for Name Change

Insured’s Full Name (Print)

Certificate Number

The name of the

Insured

Owner has been changed to: (Print) _____________________________________________________

New complete legal name (First, Middle, Last, Suffix)

The reason for the change is:

Marriage

Adoption

 

Divorce

Other (Specify): _________________________________________________

 

 

 

 

 

If selecting Other, please provide copy of legal documentation.

 

X_____________________________________________________

Date ______________________________________

 

Signature of Insured or Owner

Month

Day

Year

X_____________________________________________________

Signature of Witness

Witness is Agent: Region _____ Agent No. _______

Other: Printed Name ___________________________________

Instructions for Change of Beneficiary Request – Page 1

The beneficiary designation will remain unchanged until the properly completed form is received and acknowledged in writing at our

Home Office.

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

If a change of beneficiary is desired on more than one

Trust (Inter Vivos Living Trust):

The trust must be in effect

certificate, a separate form should be completed for each

 

at the time the beneficiary designation is completed. It is

certificate.

 

 

 

 

 

necessary to furnish the name of the trust, the date the trust

Designate beneficiary(ies) by selecting the check box next to

 

was executed, who executed it, and the name of the trustee(s).

the appropriate category(ies) and then complete requested

 

A final beneficiary must be named to receive the proceeds if

information.

 

 

 

 

 

the trust is not properly qualified or fails to make claim within

This change of beneficiary form, once acknowledged, will

120 days from the date of death.

 

 

 

 

automatically revoke all prior beneficiary designations.

Trust under Insured’s Will (Testamentary Trust):

The

Therefore, even if a principal or contingent beneficiary is to

 

proceeds paid according to the Insured’s Last Will and

remain, such beneficiary must be renamed on this form.

 

Testament.

 

 

 

 

 

 

 

 

The owner/applicant completing this form cannot specify how

 

A final beneficiary must be named to receive the proceeds if

a beneficiary is to use the proceeds.

 

 

 

the trust is not properly qualified or fails to make claim within

The proceeds for minor beneficiaries are held by the Society

120 days from the date of death.

 

 

 

 

until they attain legal age, unless a court-appointed guardian of

Method of Settlement. All or part of the proceeds may be left

the minor’s estate properly requests payment prior to that time.

 

with Modern Woodmen under a settlement option.

If Deposit

 Beneficiaries for a minor Insured must always have an

 

at Interest or any Other Optional Method of Settlement is

insurable interest in the life of the child. Insurable interest is

 

selected and a principal beneficiary (payee) is eligible to

when an individual is responsible either in whole or in part for

 

receive payment but dies before any of the proceeds have

the care and welfare of the child. A parent or a grandparent is

 

been paid, then, unless otherwise provided, the proceeds will

automatically assumed to have an insurable interest in the

 

be paid to any then surviving principal beneficiaries; if none, to

child’s life.

 

 

 

 

 

any then surviving contingent beneficiaries; if none, in one sum

 Named Individuals:

When naming individual beneficiaries,

 

to the estate of the payee.

If One Sum is selected and a

print the full

names

of the desired principal and contingent

 

beneficiary is eligible to receive payment but dies before any of

 

the proceeds have been paid, then, unless otherwise specified,

beneficiaries,

their

addresses, their

relationships to the

 

 

the proceeds

will

be

paid

in one sum

to the beneficiary’s

Insured, dates of birth and Social Security numbers. Proceeds

 

 

estate.

Deposit

at Interest

may

not be

selected

for

a tax

will be paid

equally

to the surviving

principal

beneficiaries

 

 

qualified certificate, such as an IRA.

 

 

 

unless otherwise indicated. The proceeds will be paid to the

 

 

 

 

 

 

 

 

 

 

 

 

 

 

person(s) named in the contingent beneficiary section only if

Signature Required.

The person having legal control of the

no principal beneficiary survives the

Insured.

If additional

 

certificate should sign the beneficiary change request using his

space is needed, attach a signed and dated sheet. Note: This

or her full name. All signatures must be original.

 

 

space may also be used to name corporations, businesses, or

Date.

The application should be dated with the month, day

charitable organizations. Include address, city, state and

and year it is signed.

 

 

 

 

 

 

taxpayer ID if applicable.

 

 

Witness. The signature should be witnessed by an adult other

 

 

 

 

 

 

than one named as a beneficiary.

 

 

 

 

 

 

 

 

 

Questions:

Please contact

your

Modern

Woodmen

Representative or our Home Office at 1-800-447-9811.

Form 948B (Rev. 3-12)

(SEE PAGE 1 FOR CHANGE OF BENEFICIARY)