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Membership, Security, Community Service
Important Forms 

Important Member Forms

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You will find below the most commonly requested forms. You may download the form you need and return it to the Home Office for processing. If you have any questions about which form to use or how to complete it, please call the Member Care Department at the Home Office at 800-992-1894. We would be happy to help you.

Death Claim

PDF Claim for Death Benefits

This form should be used when submitting a death claim. If there are multiple beneficiaries, each beneficiary must complete a separate claim form.

PDF Statement of Heirship for Life Insurance

Use this form to establish heirship when all designated primary and contingent beneficiaries predecease the insured.

PDF Statement of Heirship for Annuities

Use this form to establish heirship when all designated primary and contingent beneficiaries predecease the owner of an annuity.

PDF Annuitant/Owner Change

Use this form to request a change of annuitant and owner for non tax qualified annuities as permitted under Section 72(s) of the Internal Revenue Code for spousal beneficiaries.

Change of Beneficiary

PDF Change of Beneficiary

This form should be used when submitting a change of beneficiary on a certificate.

PDF Separate Beneficiary Designations

This form is to be used with a non-qualified annuity if the annuitant and owner are two separate individuals and unique beneficiary designations are desired.

Change of Ownership

PDF Transfer of Ownership

This form is required to change the owner on any certificate number beginning with 356000 and up.  Original signature is required.

PDF Absolute Assignment

This form is required to change the owner on any certificate number below 356000.  Original signature is required.

PDF Collateral Assignment

This form is required to assign the certificate as collateral.  Original signature is required.

Premium Payment

PDF Automatic Withdrawal Authorization

This form is used to establish automatic monthly premium payments from the member's bank account.

PDF Check Draft Authorization

Use this form when faxing or e-mailing a check.  PLEASE REMEMBER TO VOID THE ORIGINAL CHECK.  DO NOT MAIL THE ORIGINAL CHECK IF THIS FORM HAS BEEN USED.

General Service

PDF Request for Service

Use this form to request service on a certificate including member name changes, address changes, loans on life insurance, annuity withdrawals, automatic Required Minimum Distributions from IRAs, etc.

TSA Loan

PDF TSA Loan - Harvest Annuities

This form is used to request a TSA loan from our Harvest Annuities.

PDF TSA Loan - Non-Harvest Annuities

This form is used to request a TSA loan from our older annuity products.

Miscellaneous

PDF Substitute Form W-9

Complete and submit this form to the Gleaner Home Office to confirm your correct social security number.

Note: A PDF reader is required to view the forms. You may download a free PDF reader here.