Forms

To purchase AMLA Life Insurance, the following forms should be completed and submitted to the AMLA Home Office or Lodge Campaigner:

Application for Insurance Long Form* --OR-- Short Form*

Initial premium payment must accompany application.

Application For Membership -- Membership is simultaneous with the purchase of an insurance certificate (application above) with a face value of $2,000 or more ($3,000 for Single Premium Whole Life). If you already are a member of the AMLA, this is not a required form.

IRS W-9 Form -- This form is for IRS reporting purposes

STOLI Form -- Addendum to AMLA Life Insurance Application and is required by the State of Ohio Department of Insurance.

If you are already a member of the AMLA, and would like to change the beneficiary on an existing AMLA policy, use the link below:

Change of Beneficiary Form -- Fill out this form to change the beneficiary. This form must be completed, submitted and approved at the Home Office.

HINT: If you right-click the mouse over the link to a form, you may select "save link as" to download the form to your computer.

If you have any questions, please call the Home Office at 216-531-1900, or contact your Lodge Campaigner


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