Form: Change of Address

Method 1: Submit Electronically

Fill out the form on the lower half of this page – Click here

Please specify the new address below and which certificate(s) this address change will be applicable for and click “Submit” upon completion.


Method 2: Print and Mail

Click here to download a PDF of the Change of Address form.

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Send completed form to:

Polish Roman Catholic Union of America
Attn: Member Services
984 N. Milwaukee Ave.
Chicago, IL 60642-4101

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

1. Owner Information

*Required Field


New Address*:


Phone Number*:
() - x

E-Mail Address*:

/ /

2. Certificate Information
Apply the updated address to all products associated with this account: Life Insurance, Annuities, Loans, and Sales Representative Information.

Please apply the above address change to the following certificate(s)/loan(s):

I understand and agree with the Terms of Use as stated by the PRCUA and the completion of this form is accepted as my digital signature for processing and enrollment.

* Please verify you are a human:


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