Download Forms (Members Only)

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The following forms are available for download:

Form: Use this form to: Notes:
Request to Change Beneficiary (Insurance)
  • Change the beneficiary of your certificate
  • All signatures must be notarized
Request to Change Name of Insured
  • Change the name of the insured on your certificate
  • Must provide legal proof of name change as noted on the form
Request to Change Owner
  • Change the owner of your certificate
Operation/Dismemberment Claim
  • Request and document Operation and/or Dismemberment benefit claims
  • Must be completed and signed by the Physician or Surgeon, or:
  • Accompanied by billing information adequate to support claim
Application for Cash Surrender
  • Request cash surrender of life certificates
  • Must be signed by the insured and payer/owner
 
Annuity Disclosure
  • Describes important facts and features of a WSA deferred annuity
  • Includes interest rates, surrender charges and taxes on withdrawals
  • Please read this document if you own a WSA deferred annuity or are considering applying for one
Request to Change Beneficiary (Annuity)
  • Change the beneficiary of your certificate
  • Signature must be notarized
Request to Change Name of Annuitant
  • Change the name of the annuitant on your certificate
  • Must provide legal proof of name change as noted on the form
Annuity Withdrawal Request
  • Request a withdrawal of funds from an annuity
  • Must be signed by the owner of the annuity
  • Includes a copy of IRS Form W-4P, which must also be completed
 
Electronic Funds Transfer (EFT) Authorization
  • Authorize electronic funds transfer to pay your life premiums, annuity deposits, or mortgage payment to WSA
  • Include a voided blank check or deposit slip showing your pre-printed routing transit number and bank codes.
Application for Change of Address
  • Request change of address for certificates and/or payer
  • Must be signed by the insured and payer/owner
 
Scholarship Program Application
  • Includes program requirements and application form
  • Requires additional documentation
  • Subject to a submission deadline
Continuing Education Application
  • Includes program requirements and application form
  • Requires additional documentation
  • Subject to a submission deadline
 
Terms & Conditions/Liability Waiver
  • You must sign and return this form prior to participating in any WSA sponsored event.
  • Requires parent signature for participants under 18 years of age