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Annuity Disclosure

Describes important facts and features of a WSA deferred annuity, including interest rates, surrender charges and taxes on withdrawals

All signatures must be notarized

Change the beneficiary of your certificate

Signature must be notarized

Request to Change Name of Annuitant

Change the name of the annuitant on your certificate

Must provide legal proof of name change as noted on the form

Annuity Withdrawal Request

Request a withdrawal of funds from an annuity

Must be signed by the owner of the annuity.. Includes a copy of IRS Form W-4P, which must also be completed




11265 Decatur St.

Suite 100

Westminster, CO 80234




PO Box 351920

Westminster, CO 80035-1920




(800) 451-7528

(303) 451-1494


(303) 451-5112




WSA Fraternal Life is not licensed in all states. Nothing contained herein should be construed as a solicitation for insurance or annuity products in any state in which WSA Fraternal Life is not licensed.

Click here for a compete list of states in which WSA Fraternal Life is licensed.

Participation in any WSA Fraternal Life event constitutes agreement to the Terms and Conditions for Participation in WSA Events

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