Woman's Life®
connection. community. cause.Service Center
If you have questions or service requests that can not be answered through the following Member Service Forms, please contact our Home Office. Our Member Service Representatives are committed to providing quality service to our membership.
Below are basic service forms that you can download and print using Adobe Reader. If you do not already have Adobe Reader, please click the following button to get your free copy:
Member Service Forms
Click on a form to download:
- A-12 Request for Change in Dividend Option - Release of Dividends
- A-15 Application for Change of Beneficiary
- A-22 Authorization for Release of Information
- A-27 Attorney Appointment Affidavit
- A-40 Affidavit of Lost Certificate
- C-109 Application for Good Health Benefits
- F-202 Request for Automatic Bank Draft Plan
- F-579 Making Future Premium Deposits into Your FPDA
- I-100 Claim for Death Benefit
- I-100i Death Benefit Claim Filing Instructions
- I-621 Direct Deposit Authorization Agreement
- O-316 Help Us Keep Track of Your Address
- W-9 Request for Taxpayer Identification Number and Certification
Please mail completed, signed forms along with any other required documents to:
Woman's Life Insurance Society
Member Service Department
1338 Military Street
PO Box 5020
Port Huron, Michigan 48061-5020