Capital Credits Estate Claim Form

To complete the claim on the account of the deceased member, you will need to provide the proper documentation from the Clerk of Superior Court, Estates Division.

You may mail the estate papers to:
Randolph EMC
Attention: Capital Credit Dept.
P. O. Box 40
Asheboro, NC 27204

Deceased Member Information

Date of Death: *

First Name: *

Last Name: *

CIN Number: *

Account Number: *

Account Address 1: *

Account Address 2:

City: *

State: *

ZIP: *

Executor/Administrator Information

First Name: *

Last Name: *

Executor Address 1: *

Executor Address 2:

City: *

State: *

ZIP: *

Executor Phone Number: *

Living Spouse Information

First Name:

Last Name:

Spouse Address 1:

Spouse Address 2:

City:

State:

ZIP:

Date of Claim: *

Claimant's Name: *

Claimant's Phone Number: *

Relationship to Deceased: *

Capital Credits Estate Claim Form

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