Manage your PRCUA certificate

The following forms are available online to manage your membership certificates:

 

LIFE INSURANCE 

CURRENT LIFE INSURANCE OWNER

 

      Authorization Disclosure:

•  A014 (Authorization to Disclose Account Information)

      Make a change to a certificate: 

• A008-CB792 (Beneficiary Designation – Change of Name)
• A3790 (Beneficiary Change to Trustee)
• A1025 (Change of Address Form) 

      Certificate replacement request:

• A012-1048 (Affidavit in Case of Loss or Destruction of a Certificate)

      Cash Surrender:

• GO20 (Cash Surrender Request Form)
• A012-1048-SUR (Affidavit in Case of Loss or Destruction of a Certificate for Surrenders)
• ACH (ACH Authorization)
• W-9 (Request for Taxpayer Identification Number)

 

BENEFICIARY OF A LIFE INSURANCE CERTIFICATE

• GO19 (Death Benefit Claim Form)
• A1095 (Proof of Heirship- to be used when all named beneficiaries are deceased)
• A1109 (Affidavit in Case of Loss or Destruction of Deceased Member’s Certificate)
• ACH (ACH Authorization)
• W-9 (Request for Taxpayer Identification Number)

 

ANNUITIES 

CURRENT ANNUITY OWNER

        Authorization Disclosure: 

• A014 (Authorization to Disclose Account Information)
  

       Certificate replacement request:

• A012-1048 (Affidavit in Case of Loss or Destruction of a Certificate)

       Make a change to a certificate:

• A008-CB792 (Beneficiary Designation – Change of Name)
• A3790 (Beneficiary Change to Trustee)
• A1025 (Change of Address Form)

       Request for a distribution:

• A005 (Non-Qualified Annuity Deposit Agreement Distribution Request)
• A010 (IRA Distribution Request)
• A100 (IRA Required Minimum Distribution (RMD)
• ACH (ACH Authorization)
• W-9 (Request for Taxpayer Identification Number)

        Surrender (Close) Annuity:

• GO20 (Cash Surrender Request Form)
• A005 (Non-Qualified Annuity Deposit Agreement Distribution Request)
• A010 (IRA Distribution Request)
• A012-1048-SUR (Affidavit in Case of Loss or Destruction of a Certificate for Surrenders)
• ACH (ACH Authorization)
• W-9 (Request for Taxpayer Identification Number)

       

BENEFICIARY OF AN ANNUITY CERTIFICATE: 

• GO19 (Death Benefit Claim Form)
• W-9 (Request for Taxpayer Identification Number)
• A1109 (Affidavit in Case of Loss or Destruction of Deceased Member’s Certificate)
• ACH (ACH Authorization)

 

***Please be advised – when surrendering an annuity for a lump sum distribution, the original annuity certificate or Affidavit in Case of Loss or Destruction of a Certificate, along with an IRS W-9 form must also be submitted (the links for these forms are available above).

If you have any questions please contact us online or call 1-800-772-8632.