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Get Aflac Form Caf001ciwsb

I KNOW that I may request to receive a copy of this Authorization. I AGREE that a photographic copy of this Authorization shall be as valid as the original. I AGREE that this Authorization shall be valid for the duration of my claim. Policyholder s Signature Date Claimant s Signature CAF001CIWSB FRAUD WARNING NOTICES For use with Claim Forms PLEASE READ THE FRAUD WARNING NOTICE FOR YOUR STATE ALASKA A person who knowingly and with intent to injur.

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