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Get Credit Disability Claim for Finance

E Life Insurance Company _ _ PLEASE READ CAREFULLY BEFORE COMPLETING CLAIM FORM Claims Service Center P.O. Box 45153 Jacksonville, FL 32232 - 5153 1-800-888-2738, Ext. 8390 This form must be completed in full and FAXED to (904) 355-5878 1. Claimant’s Name CREDITOR’S 2. Issue Date Loan Number Amount First Payment Due Certificate Number Waiting Period # of Payments Made Elimination ___________ Days Retroactive ___________ Days 3. How Payable 4. Is there other insurance on this or .

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