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 60622-4101

If you have specific questions or requests that cannot be completed with the forms below, please contact our Home Office, the Philadelphia Office, 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.