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Get and Sign Pdf Forms For Web Aflac 2014-2021

Sections may result in a delay in processing this claim. • Submit only one treatment date per claim form. • Do not attach receipts, statements or other claim documentation to this form. • Please sign, date and mail/fax the completed form to the Aflac address/fax number shown below. • Please use black or blue ink only and print legibly when completing this form in its entirety. Policy Number: Policyholder Information: All Fields are required. Last Name Suffix Date of Birth...

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