Get Any Person Who Knowingly Pre - American Fidelity Assurance ...

Filling out the Any Person Who Knowingly Pre - American Fidelity Assurance form online can be a straightforward process. This guide will provide clear and concise instructions on how to properly complete each section of the form to ensure that your request for individual cancer diagnostic benefits is submitted correctly.

Follow the steps to successfully complete your application.

1. Click ‘Get Form’ button to access the form and open it in your browser.
2. Begin by filling out the 'Statement of Insured' section. Enter the patient's full name as it appears on the medical records.
3. Indicate the relationship of the patient to the policyholder by selecting one of the options: Self, Spouse, or Child.
4. Provide the patient's date of birth in the specified format.
5. If the patient is a dependent child aged 21 to 25, include the name of their school. If they are a full-time student, attach a transcript as proof.
6. Complete the policyholder's name field as it appears on the insurance documents.
7. Enter either the policy number (account number) or the social security number of the policyholder in the designated area.
8. Fill in the street address, city, state, and zip code. Check the box if the address has changed.
9. Provide a telephone number where you can be reached.
10. If you wish to have benefits directly deposited into your bank account, complete the Direct Deposit Authorization section by providing your signature and attaching a voided check to initiate the direct deposit.
11. Review all information for completeness and accuracy before submitting.
12. Fax or mail the completed form along with any required attachments, such as bills or receipts.

Start your application online today for efficient document processing.