Get New Claim Form Pdfs For Web - S13270 - Ufadba.org

Filling out the New Claim Form PDFs for WEB - S13270 is an essential step in processing your disability claim through Aflac New York. This guide provides a straightforward approach to complete the form accurately and efficiently.

Follow the steps to fill out the form correctly.

1. Press the ‘Get Form’ button to access the New Claim Form PDFs online and open it in your selected PDF editor.
2. Begin with the policy number section. Enter your policy number accurately to ensure proper processing.
3. Complete the policyholder information. Fill in your last name, suffix if applicable, first name, middle initial, and date of birth in mm/dd/yy format.
4. Provide your contact details, including a reliable telephone number and home address, along with the city, state, and zip code. Indicate if your address is a permanent change.
5. Next, move to the patient information section. Fill in the last name, first name, and date of birth of the patient, alongside their sex and relationship to the policyholder.
6. Review the continuing disability checklist carefully. Answer each question regarding the nature of the disability, ensuring to describe any injuries and provide dates as required.
7. If applicable, fill out the hospital information section, including the name of the hospital, city, and state.
8. Sign the document in the designated area, ensuring that either the policyholder or their designated representative provides the required signature.
9. Once all sections are completed, save your changes. You can then download, print, or share the form as needed.

Complete your documents online to ensure a smooth claims process.