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 Below
is list of the forms that you can use to make changes to your certificate. These
forms are in Adobe® Acrobat® format. If you need the free Adobe® Acrobat®
Reader™, you can download it by clicking on the link.
Download the
desired forms to your computer, print them, and read them. After you have
filled out the forms, you should send them to:
Polish Roman Catholic
Union of America
984 N Milwaukee Avenue
Chicago, IL 60642-4101
If you have specific
questions or requests that cannot be completed with the forms below, please
contact one of our offices or email us at
info at prcua.org.
 Change
of Address - Form 1025:(32K) Use this form to change your address only.
Change
of Beneficiary and/or Name - Form CB792:(63K) Use this form to change the
beneficiaries to another individual or estate. This form can also be used to
change your name per marriage, court order, adoption, or any other legal
form of name change. Undertakers cannot be a
beneficiary in Illinois, Indiana, Massachusetts, Michigan, New Jersey, New
York, North Carolina, South Carolinian, Tennessee, or Wisconsin unless it
has been confirmed through a lawyer. Information on the form
should be printed clearly and signed by the member. If the change is for a
juvenile, under age 16, the owner of the certificate must sign the form. The
members signature should be either witnessed by an officer of the society,
a Notary Public, or by two unrelated persons who are not listed as
beneficiaries. Please do not send you insurance/annuity certificate with this
form.
Change
of Beneficiary to Trustee - Form 3790A:(78K) Use this form to change the
primary beneficiary to a trustee. Information on the form should be printed
clearly and signed by the member. If the change is for a juvenile, under age
16, the owner of the certificate must sign the form. The members signature should
be either witnessed by an officer of the society, a Notary Public, or by two
unrelated persons who are not listed as beneficiaries. We require either a
copy of the entire trust or the first and last page of the trust where
all signatures are notarized. The portion of the trust that pertains to Life
Insurance, the names of the co-successors and successors trustees is also
required. If the trust is to be the contingent beneficiary, then the member
must complete the Change
of Beneficiary and/or Name - Form CB792 and designate who is to be the
primary beneficiary.
Affidavit
for Loss of Certificate - Form 1048:(87K) Use this form in case of a
loss of your certificate. Beneficiary changes can be made in the designated
sections on this form. The members signature should be either witnessed by
an officer of the society, a Notary Public, or by two unrelated persons.
Change
of Premium Payment Mode - Form 1142:(52K) Use this form to change the
mode at which your premium payments are made. Available payment modes are
Annual, Semi-Annual, Quarterly, and Monthly. The member should fill out as
much of the form as possible and send it to their Financial Secretary for
his/her signature. |
