Woman’s Life Insurance Society

Service Center

Our Member Service Representatives are committed to providing quality service to our membership. See answers to the most frequently asked service questions. If you have additional questions or service requests that can not be answered through the following Member Service Forms and Instructions, please contact our Home Office.

Below are basic service forms and instructions 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:

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Member Service Forms & Instructions
*Affidavit of Lost Certificate (A-40) May be required if the original certificate is not returned with a surrender request.
*Application for Change of Beneficiary (A-15) Update who receives the death benefit proceeds in the event of a member's death.
Application for Good Health Benefits (C-109) Submit request for Good Health Benefit reimbursement.
*Attorney Appointment Affidavit (A-27) Verify that your Power of Attorney is still valid.
Authorization for Release of Information (A-22) Give us permission to discuss your certificate with a third party.
*Claim for Death Benefit (I-100), Filing Instructions (I-100i) and Settlement Options (I-100n) Inform us of the death of a member and make a claim for the proceeds of the certificate. Each beneficiary must complete a claim form.
*Direct Deposit Authorization Agreement (I-621) Request that regular payments be made from us directly to your bank account (not available for a single sum payment, e.g. lump sum death claim payment).
Help Us Keep Track of Your Address (O-316) Authorize us to contact a friend or relative to obtain your current address.
*Making Future Premium Deposits into Your FPDA (F-579) Make additional contributions to your annuities.
Request for Automatic Bank Draft Plan (F-202) Establish automatic monthly premium payments from your bank account.
*Request for Change in Dividend Option - Release of Dividends (A-12) Make a change to your dividend option or make a withdrawal of dividends.
*Request for Taxpayer Identification Number and Certification (W-9) Confirm your social security number.

*Please mail original form to Home Office.

Please mail completed, signed forms along with any other required documents to:

Woman’s Life Insurance Society®
A Fraternal Benefit Society
1338 Military Street
PO Box 5020
Port Huron, MI 48061-5020
US