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II. Have your physician complete Section 3. Submit the form to us at the address or fax number listed below. Your cooperation will facilitate payments promptly when they are due. Any person who knowingly, and with intent to defraud any insurance company, files a statement of claim containing any false, incomplete or misleading information may be subject to criminal penalties. Clear Form Anthem Life & Disability Insurance Company Disability Claims Service Center P.O. Box 105426 Atlanta, GA 30.
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