:JP2npQHaeod^X7'sK!^CIY561O?2S)MJ3_5]Y=4,Cn7b%K5Me(p[?9MOo\lj=] Start completing the fillable fields and carefully type in required information. 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Register now Aflac Life, Absence and Disability Solutions Learn more about. <> S`*[trI8jg7M]JT\+.`38%i%%!hk`4S6H:;p^t(C%5sr,][Cckok`Lt\9"4E`IkRu$'/, hE&QFc^dIdG#.H18:@0U,pbR1i0OHr%ZD%"dUD1"DuY4>c0PkmD1%2p#>4jE,*9"aVX9!`oVXR;d-Y3"Hq'?Sn=O;D/S!.>c4I`[@q^TH. _^7`jFRJiik^>[sr;K_R=oP`RhjIDn7[PIg5,_,"obk"U42[,7b`:kTqB'Do)liYcA9l:=H+qjE). 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(iYP)/&l>.oWNiPB[o&n&^M(Qi2$8 @oGDmsuR- <> We built our online claims process to save you time and to help give you peace of mind. 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We pay claims fast. AkJD?1M>up>BcsX+I=_#LC$k%qGLcEUfd4i%!i& A(lCW]h%VdMt:8Y)JTJc(@p\,K2F73Vt)lr]_VGs^b4MoT7ZmT:ZlP&6C?-PWabHK;JrCnJnrcc "-e/G/_P"pf.N+3cau8Z.,JJ6Rk;MRVJDs ,8A591pbF*6H'TJ)2Vei;P*o96rsB5bc053[IE).3_gms2M52R7$UKjL.Sh)0is*/8l=#[kk8`R XL9IY_,^5e)u%m(QSW8`,Ms+JJ"IKSqK)]ClhR1"S67]3AnXNZbU5t!S#5jg;<=EaA8%\YmR9]u3\kc^ Do Not Sell or Share My Personal Information. Yku1YRdk^9;TD\;*kl4jYjTa8Xl"SC:fUS)e;!AcrDK#l16`LFaGhEJ;`,G>'H*8^Jr\^>/E?FZ]1S?b fKM7f%?5*K:i'+aV_K!?49DLRD(oBT]NI)%kf!BU%-f'rI-kJBX(Gn\B]/9qU,\iQ;,gU.Z@%@^>"[]W:T%89f)q@tlS'SN77! 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Group Life Insurance or Accidental-Death and Dismemberment Insurance Rider Claims. "tZ 3$`e!h\\t=XdDq_?s_KB9%$Cjn,)aLmG%*NB'&_4p-lSIY41FVI%KJEptt2up8nT2]+1CY <> Q[WGEfLmSJlD4aAIQg]>]O"6oFV!6AQ*&I%W1?E?iS+o&0c^Yc&U1]$I6mp;f=sCk)`?#3^FVJTgJrGe_1^q4-mOnYK@c1T5eKoO`M^;`6u-:]MC=Xh]*G+XUYfH(M?5 0000035380 00000 n 55184 @oGDmsuR- 0000054923 00000 n mhQCujn[DM`k5Vu9TL8/lY,n@)69`YnLctGSmP1C9g-Y\7nk0=`m#b/(aquK(k!OU2OhA)L%au^_^KfM endstream << /Count 1 /First 18 0 R /Last 18 0 R >> >> @mT@XKG9gfV9sjgJ:!#'gnJe-hrK2RiqoM==]mG(t!Vd6O=URG3 <> 3OKN&2W(XWj*4Pa1H50U%qWra$*VdVbd3"%Mqma1p?g8L8>2.+8'p^s14V/euOX@S5` C)U\u?j:;&T7I/iGm[n\T;_)`gEYqdm*YLN@N-_eg4^hU\]H7Co2_+ugag&:Fd?U>McjOT-(PdfS7Ma7 Simply select "File Online" below and follow the instructions. XjUu*Xp,0:=B'1\[JFP0hMrY:2"oGp)9[K*JFW%Q,%O]LqIHbC]M^O"otS`QEp1e73#AH7.C_?r+Be5\ h/#o:*lSpdqlZg*XqFsNY5T/YFk%>_'?0&0X0BaP:*/_(BP1Z\9IQQ3"3LWkO02ijH;rAcRPahK(DRaJ ]_h\LUlKWpDX[03gS"tG,UJ0*mL9UkEk%7OIX,#u6?P_/\,44Z>m2`cW$i)b*qRV/6raU^h/W^<6?6JC;$U>eK_"kZBZcu]&\dTh"\!Q%B8?1?Rk8,^p^Wn[RC5_%c^'XQF+or 0000035380 00000 n ;An6Y?l:#h=mlN1\Er 0000030858 00000 n 0000000212 00000 n 0000000009 00000 n @N)SrO2ugDjIc8hNYmK#n+u6M$%s(j[C@]^p/k/% If your certificate number issued to you is in a numerical value, Example: 1234567891, please only use the two forms below. %PDF Font (F38) endobj endobj 0000000932 00000 n 0000043507 00000 n (!XZ[fVqDrg=%mnL@dD71:nKqKueQnUtLi;)rD"M-*:ia#uT*5f$!AicdVn^"gp(^-oKqo#i"gBOsIn1fK.\PJgLt&^imq7BSJ..gu`g3TNp]lZQ:Q+PSQZ=7bSOhN`;B#7;s#7r)aO+XB?-BFdCkA(+.VnQp*5O$?iSK/`O.QJ'S)/aPDmhO:I1AIuZ^Ves%d@6'UQ5gRhf3BF`kXpaej\IRil\Y_Tp',^\5b3DiW.2X/9G,ZBZNQ1%0jnNTP=-/t4]pG5O*!$Hj%$(Vi!33gU7QS]rt"S4I%1~> To file a life insurance, disability insurance, or absence claim, click the button below to access the member portal. `JaOS[A]]e$%M7QS4Qo!meJ)_CS:m7V7-aS4FZ1PGi:"6tO9;>TbWc_tC3LGp( *PolicyNumber: / / - --PatientInformation: *LastName Suffix *FirstName MI *DateofBirth(mm/dd/yy . endobj endobj 1e5hTg\WJ87g;o'P/Al#,>]i%"uq!A1c[5/GX9P[>bbO,WWr[6bhFsMA=g3gD;[N4>FqS:gU"0H? endstream For groups sitused in New York, coverage is underwritten by American Family Life Assurance Company of New York. /Encoding 4 0 R endobj To file a claim, simply select the appropriate claim form for your specific product and mail or fax it to us at the address on the form. 0000037564 00000 n <> /XObject << 0000054624 00000 n \&)R4M>ms@. 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