Easily manage your membership certificates with convenient online forms.

If you have any questions, contact PRCUA Member Services Department at member-services@prcua.org or call (800) 772-8632

    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)

• GO19 (Death Benefit Claim Form)
• A1095 (Proof of Heirship)
• W-9 (Request for Taxpayer Identification Number)
• A1109 (Affidavit in Case of Loss or Destruction of Deceased Member’s Certificate)
• ACH (ACH Authorization)

      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)
• IRS W-4R (Withholding Certificate for Nonperiodic Payments and Eligible Rollover Distributions)

        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)
• IRS W-4R (Withholding Certificate for Nonperiodic Payments and Eligible Rollover Distributions)

• 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).

Just fill out and send the form below. An authorized PRCUA agent will contact you at your convenience.