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Get Aflac S00224 2010

ING CLAIM FOR (check all that apply): Disability due to an Accident Cancer Policy Number Disability due to a Sickness Accident Policy Number Disability due to Pregnancy / Complications Short-Term Disability/ Sickness Disability Rider Policy Number Hospital Indemnity Policy Number Disability due to Cancer Hospital Intensive Care Policy Number Life Policy Number INSTRUCTIONS: Be sure to include your policy number(s) on all documents. Complete and sign Section A: Policyholder/Patient Infor.

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