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Get Atlanta, GA 30348-5448

The furnishing of forms does not constitute an admission of liability on the part of the Company. INSTRUCTIONS As soon as you learn that an insured person has suffered any of the losses covered under the policy, this form (completed by the policyholder, claimant and the attending physician) should be sent to the address shown above. Include the following material: (a) Group Insurance Application and record card. (b) All available newspaper clippings pertaining to the injury and loss, and a po.

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