Service & Forms
Service & Forms
Download common forms and find out about various departments at GBU that you may need to speak with about your policy.
COMMON FORMS
For policy changes and related services, please download, print and complete the proper form. For your convenience you may email the completed form to GBU via our secure message center or mail your completed form to the GBU Home Office. Confirmation of the service provided will be mailed to the policy owner upon completion of the service requested.
All forms listed below are in Adobe PDF format. To download a form for viewing and printing, please click on the desired form. If you cannot find the form you need, or if you have questions relating to your GBU policy, please contact the GBU Home Office.
Important note about Microsoft Edge and fillable forms.
If you are using Microsoft Edge for your internet browser, it does not recognize fillable forms and the form will not display in your browser. To get the form, right click on the link and choose "save target as" and this will allow you to save the form to your computer.
Accelerated Living Benefit Claim Form - Annuity
Accelerated Living Benefit Claim Form - Life
Annuitization Form
Annuity Withdrawal Request Form
Bank Draft Authorization Form
Beneficiary Change Form
Direct Deposit Authorization Form
Life Insurance Death Claim Kit
Lost Policy Form
Non-Qualified Annuity Death Claim
Policy Owner Service Request Form
Qualified Annuity Death Claim
Required Minimum Distribution Service Request Form
Roth IRA Conversion Form
Member Portal Set-Up Instructions
W-4P Form (download most recent version here)
W-9 Form (download most recent version here)
High School Grant Application
College Scholarship Application
New England Fraternal Alliance Scholarship
Pennsylvania Fraternal Alliance Scholarship
Ohio Fraternal Alliance Scholarship
District 2000 Scholarship
Youth 3 Pay Membership Brochure With Pricing
Amended National Bylaws, 2021
WHO DO I NEED TO TALK TO?
Here are the departments within GBU that you may need to assist you with your policy or membership. You can speak with a member in any of our departments by calling 800-765-4428.
Request An Appointment
Customer Service Department
Customer Service Department
This department is responsible for communication and coordination with GBU members and/or their beneficiaries with regard to life insurance policies and annuity contracts.
Contracting and Compliance
This department is responsible for regulatory compliance and contracts.
Underwriting Department
Underwriting Department
This department is responsible for processing submitted life insurance and annuity applications.
Sales Department
Sales Department
This department is responsible for the sale of GBU life insurance and annuity products.
Claims Department
This department is responsible for opening and administering life insurance claims.
Fraternal
Department
Fraternal
Department
This department is responsible for administrating
member benefits offered by GBU.
member benefits offered by GBU.
This department also communicates and coordinates with GBU districts.
SEND A SECURE EMAIL
The protection and privacy of your communications with GBU is very important to us. To ensure your information remains private, GBU offers two-way encrypted email communication via our Secure Message Center.
Send An Encrypted Email