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.
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Question | Answer |
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Form Name | Modern Woodmen 948 Form |
Form Length | 2 pages |
Fillable? | No |
Fillable fields | 0 |
Avg. time to fill out | 30 sec |
Other names | modern woodmen of america bene4ficiary change form, woodmen form 5019, woodmen life cash surrender, modern woodmen surrender of cash value |
Request for Change of Beneficiary or Name
Modern Woodmen of America
1701 1st Avenue
Rock Island, Illinois 61201 1.800.447.9811
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
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. |
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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 ______________________________________________
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(Signature of Witness - A person other than a beneficiary) |
Witness is: |
Agent: Region __________ Agent No. _________ |
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Other: Printed Name ________________________ |
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Relationship_______________________________ |
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Date __________________________________________________ |
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Month |
Day |
Year |
X___________________________________________________
(Signature of Owner/ Applicant)
Street Address __________________________________________
City, State, Zip __________________________________________
Change of Address Telephone No. _______________________
Form 948 (Rev. |
*00869* |
(SEE PAGE 2 FOR CHANGE OF NAME) |
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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 |
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Divorce |
Other (Specify): _________________________________________________ |
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If selecting Other, please provide copy of legal documentation. |
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X_____________________________________________________ |
Date ______________________________________ |
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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. |
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If a change of beneficiary is desired on more than one |
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Trust (Inter Vivos Living Trust): |
The trust must be in effect |
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certificate, a separate form should be completed for each |
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at the time the beneficiary designation is completed. It is |
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certificate. |
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necessary to furnish the name of the trust, the date the trust |
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Designate beneficiary(ies) by selecting the check box next to |
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was executed, who executed it, and the name of the trustee(s). |
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the appropriate category(ies) and then complete requested |
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A final beneficiary must be named to receive the proceeds if |
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information. |
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the trust is not properly qualified or fails to make claim within |
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This change of beneficiary form, once acknowledged, will |
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120 days from the date of death. |
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automatically revoke all prior beneficiary designations. |
Trust under Insured’s Will (Testamentary Trust): |
The |
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Therefore, even if a principal or contingent beneficiary is to |
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proceeds paid according to the Insured’s Last Will and |
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remain, such beneficiary must be renamed on this form. |
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Testament. |
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The owner/applicant completing this form cannot specify how |
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A final beneficiary must be named to receive the proceeds if |
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a beneficiary is to use the proceeds. |
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the trust is not properly qualified or fails to make claim within |
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The proceeds for minor beneficiaries are held by the Society |
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120 days from the date of death. |
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until they attain legal age, unless a |
Method of Settlement. All or part of the proceeds may be left |
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the minor’s estate properly requests payment prior to that time. |
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with Modern Woodmen under a settlement option. |
If Deposit |
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Beneficiaries for a minor Insured must always have an |
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at Interest or any Other Optional Method of Settlement is |
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insurable interest in the life of the child. Insurable interest is |
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selected and a principal beneficiary (payee) is eligible to |
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when an individual is responsible either in whole or in part for |
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receive payment but dies before any of the proceeds have |
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the care and welfare of the child. A parent or a grandparent is |
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been paid, then, unless otherwise provided, the proceeds will |
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automatically assumed to have an insurable interest in the |
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be paid to any then surviving principal beneficiaries; if none, to |
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child’s life. |
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any then surviving contingent beneficiaries; if none, in one sum |
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Named Individuals: |
When naming individual beneficiaries, |
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to the estate of the payee. |
If One Sum is selected and a |
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print the full |
names |
of the desired principal and contingent |
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beneficiary is eligible to receive payment but dies before any of |
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the proceeds have been paid, then, unless otherwise specified, |
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beneficiaries, |
their |
addresses, their |
relationships to the |
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the proceeds |
will |
be |
paid |
in one sum |
to the beneficiary’s |
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Insured, dates of birth and Social Security numbers. Proceeds |
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estate. |
Deposit |
at Interest |
may |
not be |
selected |
for |
a tax |
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will be paid |
equally |
to the surviving |
principal |
beneficiaries |
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qualified certificate, such as an IRA. |
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unless otherwise indicated. The proceeds will be paid to the |
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person(s) named in the contingent beneficiary section only if |
Signature Required. |
The person having legal control of the |
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no principal beneficiary survives the |
Insured. |
If additional |
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certificate should sign the beneficiary change request using his |
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space is needed, attach a signed and dated sheet. Note: This |
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or her full name. All signatures must be original. |
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space may also be used to name corporations, businesses, or |
Date. |
The application should be dated with the month, day |
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charitable organizations. Include address, city, state and |
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and year it is signed. |
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taxpayer ID if applicable. |
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Witness. The signature should be witnessed by an adult other |
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than one named as a beneficiary. |
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Questions: |
Please contact |
your |
Modern |
Woodmen |
Representative or our Home Office at
Form 948B (Rev. |
(SEE PAGE 1 FOR CHANGE OF BENEFICIARY) |