Printable blank Aflac Cancer Wellness Claim Form

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What is Aflac Cancer Wellness Claim Form? 

Aflac is an American Family Life Assurance Company and the largest provider of insurance services in the United States. You can submit the Aflac Cancer Wellness Claim form if you want to insure your life in case of finding cancer. 

What I need Aflac Cancer Wellness Claim Form for? 

Aflac uses forms so that clients can insure their lives from death or serious illnesses. If you decide to insure your life in case of cancer, then you need to fill out the Aflac Cancer Wellness Claim form. Be very attentive because any mistake can be the reason for denying insurance or delay in processing this claim. 

Filling out Aflac Cancer Wellness Claim Form

The form has two pages: the first page provides you with the basic rules and instructions on how to fill the form, the second form is actually the application. The blank fields, you need to fill (all fields are required):

  • Policy number;
  • Policyholder information (full name, date of birth, telephone number, home address);
  • Patient information (full name, gender, relationship);
  • Treatment and Physician Information (all treatment and examination dates, including mammogram, pap smear, etc.)

On the bottom of the document, you need to put your signature and date. 

Organizations that work with Aflac Cancer Wellness Claim Form

American Family Life Assurance Company. 

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