Applicant Change Form - Modern Woodmen of America - modern-woodmen 2026

1. Click ‘Get Form’ to open it in the editor.
2. Begin with Part One, where the Surrendering Applicant must provide their full name, certificate number, and sign to release all control rights. Ensure the witness also signs.
3. Proceed to Part Two for the Proposed Applicant. Fill in their full name, residence address, and indicate if they live with the Insured. Select whether their support is full or part.
4. Complete the date of birth and Social Security Number fields for the Proposed Applicant. Remember to certify that the Social Security Number is correct.
5. State the reason for the change of applicant and provide any necessary dates, such as the date of death if applicable.
6. Finally, ensure all signatures are completed and witnessed before submitting your form to Modern Woodmen of America.

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