Membership Application Form

Membership Application Form
Member Information
Name

First NameMiddle NameLast Name
Gender
Address

Street Address

Street Address Line 2

CityState

Zip Code
Email
example@example.com
Date of Birth

MonthDayYear
Telephone Number
Please enter a valid phone numberFormat: (000) 000-0000.
Social Security Number
Please do not enter dashes.
Member Status
Are you a US Citizen?
Special notice for non-U.S. citizens: If you are not a U.S. citizen, we need further clarification on your status in becoming a citizen, since the Internal Revenue Service limits enrollment in the Plan to U. S. citizens, unless you are seeking citizenship or paying taxes in the U. S.

You may become a member of the Plan if you provide documentation that you are presently seeking to become a U.S. citizen, have a social security number and file federal taxes in the United States.

Please provide documentation to the Benefits Board in the box provided below if you are in the process of applying for citizenship or provide other qualifying information regarding your tax status (a copy of green card, taxes etc.).
File Upload

Cancelof
Marital Status
Ministerial Status
Ministerial Number
Church of God Organization (Employer)
Position
Organization (Employer) Address

Street Address

Street Address Line 2

CityState

Zip Code
Employment Status
- Investment Selection
- To learn more about the different investment funds, please visit our investment page HERE.
- Trustees
- Large Cap
- Small Cap
- International
- Total Allocation
- Allocation Validation
- TOTAL ALLOCATION MUST BE 100%
- Primary Beneficiary
  
  (If married, must be spouse unless waiver filed)
- Select One:
- NOTICE: The Church of God Benefits Board Ministers' Retirement Plan is a spousal protected plan, the spouse of the member has to be the primary beneficiary unless the spouse waives that right through a spousal waiver acceptable to the Benefits Board.
  
  You can download the applicable form HERE. Please complete the form, including the notary verification section, and upload it in the box below.
- File Upload
  
  Cancelof
- Name
  
  First NameMiddle NameLast Name
- Relationship
- Date of Birth
  
  MonthDayYear
- Social Security Number
  Please do not enter dashes.
- Phone Number
  Please enter a valid phone numberFormat: (000) 000-0000.
- Address
  
  Street Address
  
  Street Address Line 2
  
  CityState
  
  Zip Code
- Secondary Beneficiary(ies)
  
  NOTE: Secondary beneficiaries inherit your account only if the primary beneficiary is deceased. If you would like to name multiple primary beneficiaries and your spouse is deceased or has signed a waiver, please list those beneficiaries below. Please note the percentage that each beneficiary should receive if more than one is named.
- Note: The same person cannot be listed as both a primary and a secondary beneficiary.
- Number of beneficiaries you would like to declare:
- Please Check One: If a secondary beneficiary fails to survive me,
- Secondary Beneficiary - One
- Name
  
  First NameMiddle NameLast Name
- Date of Birth
  
  MonthDayYear
- Relationship
- Social Security Number
  Please do not enter dashes.
- Phone Number
  Please enter a valid phone numberFormat: (000) 000-0000.
- Address
  
  Street Address
  
  Street Address Line 2
  
  CityState
  
  Zip Code
- Share Percentage
- Secondary Beneficiary - Two
- Name
  
  First NameMiddle NameLast Name
- Date of Birth
  
  MonthDayYear
- Relationship
- Social Security Number
  Please do not enter dashes.
- Phone Number
  Please enter a valid phone numberFormat: (000) 000-0000.
- Address
  
  Street Address
  
  Street Address Line 2
  
  CityState
  
  Zip Code
- Share Percentage
- Secondary Beneficiary - Three
- Name
  
  First NameMiddle NameLast Name
- Date of Birth
  
  MonthDayYear
- Relationship
- Social Security Number
  Please do not enter dashes.
- Phone Number
  Please enter a valid phone numberFormat: (000) 000-0000.
- Address
  
  Street Address
  
  Street Address Line 2
  
  CityState
  
  Zip Code
- Share Percentage
- Secondary Beneficiary - Four
- Name
  
  First NameMiddle NameLast Name
- Date of Birth
  
  MonthDayYear
- Relationship
- Social Security Number
  Please do not enter dashes.
- Phone Number
  Please enter a valid phone numberFormat: (000) 000-0000.
- Address
  
  Street Address
  
  Street Address Line 2
  
  CityState
  
  Zip Code
- Share Percentage
- Secondary Beneficiary - Five
- Name
  
  First NameMiddle NameLast Name
- Date of Birth
  
  MonthDayYear
  Date
- Relationship
- Social Security Number
  Please do not enter dashes.
- Phone Number
  Please enter a valid phone numberFormat: (000) 000-0000.
- Address
  
  Street Address
  
  Street Address Line 2
  
  CityState
  
  Zip Code
- Share Percentage
- SECONDARY BENEFICIARY TOTAL SHARES MUST BE 100%
- Secondary Beneficiary Total Shares %
- Beneficiary Validation
- Signature
- I hereby attest that the above information is true and correct to the best of my knowledge.
- Date of Signature
  
  MonthDayYear
- Signature
- Question
- ⚠️ No Submit button?
  
  Please verify the following before proceeding:
Should be Empty:

Membership Application Form

Member Information

Member Status

Investment Selection

Primary Beneficiary

Secondary Beneficiary(ies)

Secondary Beneficiary - One

Secondary Beneficiary - Two

Secondary Beneficiary - Three

Secondary Beneficiary - Four

Secondary Beneficiary - Five

Signature