/Length 310 e(d`r+1(IK_Z9J8FZEKhh]p"mOP2o\*_i:B,oR:q;pr&)1JfnGrF_2WN1&RdVP7b@X=`\9QI&,k/0N4e
Group Life Insurance or Accidental-Death and Dismemberment Insurance Rider Claims. -_6'A_4IL[`92un&r8tH[>^"rhOWrgJZC\%6"6'k2kR6&.9EYCGWVonkFA2[(WQ.mndG'-IoKK^(VM6j):K)HmcRL+qg#Rf
Rf;iu7gGe[$chW^;W6Fl=BqZ%6KIFZ'HNb5)TaYYGG:'$r`)
J"!Z$KNf!aNfZg$c3f9Eif:$>6XgnJ_+WZ+>UN`D_090Sk6pr-./XCf.RcJoIeeA$283Wm0>IEa1k;_GenLoF#=W7kAbUSPPYkck"W#[d8g/CEK/Qj&fT8,quS8O4;583SMLnm&$C16R.4cCjYs)h@>WY-)F
Simply click Done to save the adjustments. Upload the PDF you need to design. ^f8SP@,%81kYF7&7>W`>g^5VpKEtLo)BHCQ9Z^%VoU(+&
0000000326 00000 n 2 0 obj 0000043507 00000 n ocp#ophc,on7uVb:-MXb"*(,i/15jO-%hEWBZj$Xoi/8"O.l:b1N/N9e>iZA0.TFk&&Rn5CcH4>d6W(;
endobj J"(P!B[I`dqF4n.TukTr5!ON]W=HA3mG[gs/&`.9cLAu2;f?1f)+,ck.qKD:83!]6. 0000000212 00000 n ieO?mC^gEt3O?&]\X]CJV6:\OL%X;((>F1o\id;SSBij[G$R
0000037564 00000 n endstream 0000000932 00000 n #DL9JXFKGJ*Nm2)51;-%FmGTIk\].Cb:\N&Y1t`i2EL[>nuN_EC`3D;^lkjT%;rd! 5 0 obj 'L_g'N&-hd[;0t$*n/>649o==0mM=iT3\5)+p[n+X5`?CY@j.i4h`gXCf+nfk(n(Oi3le.$J">(K1Vhh
. <> endobj Dental and Vision plans are administered by Aflac Benefit Solutions, Inc. endstream Gb"/,D/UE'&cO9g'Le5&-SP5UG1U(.gN&eaNpA_5Jen>pld`Ep3L8bprUnu0/pTC:L6'E&Oj6GD1q3j9aEcrf34m?(SYF9tiIC:9reE'%4hLa2A@q$X^Gul'8"j\_Z*Pnco=On_l;2u]$YT1JT1XNYZ$TWMcEU?(Ui>2@/K'qS2q=(qBpq<3n9RGEE0_8LAA>/$)9CPnE%+9ApaZ,q%!Z@U^=:+[a/uKS+%k1MN.5&^;J?&K;ie$ki31!T(>`p4Q/r^7M/gh:/g6\RiOpi02X8?9HDKNojiqH\fTkO*reW@;YqPcC9h-__*61?X3pEIK=-:Mg`CsmZsnd)H'+=n"uJWaI(c]kOWO`2UbM90f_0;rj"kWn=h4\6e+LchC?K(aad&A+d=lL_&TFbfmX0*Jd>>Lmhg']bd[,I"5X<0AA:^98ST=TL-W*EXj/?&T;_5X\sh.,]!.A7hkAL;K9,acI9;+t&)dF!#U9p7>)1ab(?k%('sei:-fSqGn8$875]6O?=iNSbFZPYbpfpi\fF=d!TWfO9_A*9i`E)g2nb9[]r6;B*+jn@3B*E8a.o&10@UPpd.#Fim\Qt3S_6srHr(cgA(HP-!=E1fm'jAS%[WEUY45$jA:1*!"_h4>,'ed0`:"U?a%>q5Sk8O%L5/-VbJOt%f[Wo5&+7ZWm)`Q\MtViQg@s#N?!#?+?55mL6n4[sHFW/%Oik>,,Q49TgBiiV=`lNki3%%cN37#n.#\jo&]u\b'SQXMkff2Z+:=E__ba,4,fbGl/%NfT1%mTOhR@Hp$eX`Q]NApHg(O!T!T,JX>YrfSc*XWe,tK-f@fjb!:P5SWnUq[raVb_pulJ5eg_;UrRuPp?]KMK'N[_*8]%m5lE/MnE-j/@_"piL`o$2b!5KmcMpl\QuKQe6cFt3d"QU/8VhMg61_(pFa[DgRo[/kl'*[iUgQtmpPAY@e=1ORRB\T@Y&ni:rb-NZ2i]/;Pbn)Ua2u6L(qd)ks=?'-P66*a*#!,#`\V:ShknH6?EG@*f;6o,.]tj+)KVD%`C'e%R(78-Y!,'>d7S46qeQgD:X.>@?&V#IDL,ZUABl.bFR0(2V)lAN)QF^Y:VNJGr,<0^9+mg(4kS?=%M/O;&RHQR.kY_:0U+3UiT0l;08h3,bP>Tsj5U^SoN_Cou8K3moS,"K9`Z`;s5*o9lCWSLVQ2bfj&klQ409JYQ.(1Jl'B%@9$i@pmb)GV`ANI^.?,OrNXq7rn!RPR*pKnG0";)$hnRY3Na_+4eo`l*Rf[7V7$BT;Hq&6m\*m^I>!#d$>&;?T+`ccsgY1q0]B[PIc;."8N4h08/D5'K7A*nV2KdGFWT"^SSIs:V1$^@,MDm-V,+oO6JtnX^/m[cEq`!?rH3`YI0cmWR"8g$/C/.+P\:)5[8jO$t!d\KSmXNOEr%:bg*AT5!?I0h75@nQ5rO)*(jd=kNcAd7$W=#YU)gJ_)^\D]!duA4Y#&>q6Wh!_O+IiRBMqDTm9H"-I'2m"XKZPJq?9=O95Od2JW(,0eXenP6H2L3)sWB\,I1e$uGg%):=Zg9it2S=Qa%FBIWcqqI$?UN5n=LFCbrrPG=QD4*5Zh.r,t?fL@e+`WG8)KnFiMJqn>N2aW.H/Rc*'uj0Ln97(H.aF2tMHd1M/o9KXDQHF9/UT9&QIUTI5Z82l?!=7]TLuX?-^'Ff"b^Z]e9-nn8_nN1:>j@91NTeBp%-W*,UW'0;Zs+%MsoCUq__]ahrQ_?>IQtA07A:.r4XV,T,mLf]ShS4914P3kYD^)KhQ:[^>JVT?pg*\ktXteM3K3s*[#Xa(ZV&cjs1Top:ClIhp]a[qR%]G^Xg)-Y?Sn.p8p=9Qk>UhQ6`jRmo3_uY(Q9Ma%Q'r/PbX`Wka@$F@Iut5SCH[:e%)nl;j]Ta@fK%i=_M>uWQ'2@?H;h8ar*=UOR,2o`fQu@+QH)K-piLh/a-J"&>^@kT996'GcZ1(8.2(tkUlu^Gupc7)bEOcBTBm"XLiL\0!$>_J7/I2=;%P5VulZgVP91SIms>4HT;9\Y5a_hi]denkL19?h/]=3eF=hVhIbn/++t$3W6].KQgAH_#eOk#HA7ZDGm>D'=T0pGhAA&F#'9L9GAB6!^R6WI!_BNY0Yg-kl%&U,+ic[XbJ)8hqNnKJ>-a`4LS>d^+JE>lKa#%)Xu?13'+ca'WIEAOd?Y6$MtOP1K``[PW*!2n[$qQI3]OSB^[OfBB!ijns;OJk#L^/:e0XaG+cKJ>&dt_VCu9jE^Kf?`Rt$Q^WKJI7c?2#D%4&i"5BA,\DhaPFbfHO&Y(E]r/[[6VNDn9*o+7*TbdQVpTNJP.4pbT=%Rf:]dN6bM+&god8d+B1,J;UNK-WBi)#Zuk8Hid\*WHp^BUXt$&_e"h%rWCICP'/ABL#24>X/e"*0oIS%1e)_V1%n.[J:%9?t/!G'Ti],DoOCBF]CA)YH+:,b.s(t1a)=hr]j8(f@EM;/b7l6(ai4c#LGHkL$o071#7)J9GY4gTVr#:'T=*QD_kt=`&9Cq_=Xd,Nke/#%!)34-M[ro998>9bnD/N>iqjE_\p0*BsnqTkiK_`6'DA?s.n7P3k)JPSQZG4D'G%h?8?%%HP@tr"8;u*u@73kB6`*9^G&jQ#K>MGcB5cQlXdqS^NjY3Id)%u/Sd5s^gcP&tT[f&Gn""Y^):oK,/\:NdSg@JJ?bRD7(3aKua`XgV;VRMfo2Ys9rhoL85bT%##/ff'Xl`^[P$5JLicJnrEsLEZ^]WLhGAXBOG3gc&1TR(CI]Ca2"In8:G)T)"VR(2!cO_.44"pNn$R>Zo"aD2\A*;KDHn/%A^Djt+U*T3?U=(9%UbRZ!L8E)t!"Q6+]#6^gmNh;-"l=lJRiRpdU:\_\\Ia=)Q6)V18ar)8JCkGq@N@3n*jg^&t_18^[Td/g^(=b)9.EXV/PU!nl,@SVbf[=QO0E4RVKB4.dh_cT;'?(l@*@Y`rN=H*e1/+7u]a,s#ITK7eqBO"[J0KCfX!mWFh6f0qf-pE]N5DCsG8I5<8WSngn$-cT-W^YT38)gM?-rCP^'-r0`Y&tsg_ncDO:%EN+k7;rH1j!k*2k!VrJrWEbHQQ?.%ajJ#`H!O7gE4I9_h>$Ai7O@>O;%0-$BNcRrmtbUb:u+Xb^g7:Y^bZp$i[K#[M;p_))3%#VZCou%b9;UBi>.srIrE3#D.'KLV$nt%#Wq6k)$U(b$o%5]TAbfR;9cgi#WVmE,aj8rTSdC.OGL1fCjOiC?d#HNPE<>gnjZnRrET1FM5h/Euj(#f9d")3O2'YqId"-U:*".(^\q101NEm#WAO5? endobj <> 02rhl21qBSA"(T]mcU-(M+$l6hA!\lUur6,-iT#]. C)U\u?j:;&T7I/iGm[n\T;_)`gEYqdm*YLN@N-_eg4^hU\]H7Co2_+ugag&:Fd?U>McjOT-(PdfS7Ma7
Aflac, excluding psychotherapy notes, and including, but not limited to, . The employer is required to report disability benefits paid on pre-tax plans on Form 941 and the employee's Form W-2. -8KU)@AZCLegJ8ge%BBp0g(_Y&;BmiFJfS%>@Gu7. 22 0 obj 21 0 obj 0000054624 00000 n 0000049332 00000 n stream 0000000814 00000 n 0000000446 00000 n $s?SXVcf%'C4RJ(8`-)k.!R/tmOC4@"`:#!%j`_M[6BFOHB#O$NY5c1rOEh=kBspt>`NP'>;a[EcIDPt
23 0 obj s(a2"ShqZon2tUR"gff@QgRi&=8T@kgq-(JZ&gl35W-8HGs$[[cMe
26 0 obj 2 0 obj endobj PDF Supplemental Claim Form (Continuing Disability) CNbe58Z\L9(JIf#nd8N&d;_Ve"&$B6Y;]TiZ`M2[D^dN\Eb5qm'qVJ='T'4DBH2tpG-/Q,o_g=%ZaF:Y
$d"'aL\l#A%IE5_YS4O4h)$pN261/3.91=eY! Choose your state of residence and select the appropriate form (s). <> :6M_J^sl@Y"on\+c])/C^-146>Nm%4SY-!+ME-(F2p8]9b1! 0000037564 00000 n 23 0 obj )_uYFAPMnh@@qLR(!tj0,JgDV:^2aU1j,Q1G5%+A&.^pn]C"PJA:oAllMYj0psPAVZ_E,8iGS^\I&;A'/E"CXIR`WpK_.^,?uB7C2c/q!Ft;r%bq\)j#XX/c~> Special Needs jobs in Provo Canyon, UT - indeed.com endobj 720 E 300 N, Provo, UT 84606 - MLS 1864249 - Coldwell Banker endobj [u"0oO\5'j_^6BobJWi[hgme'ak6Kf@+
Rf;iu7gGe[$chW^;W6Fl=BqZ%6KIFZ'HNb5)TaYYGG:'$r`)
DCl*mJUg=pq^:YnVX2rH-?MoX;V+!pDt12?)+Ag/%cNZV^V$#m+E*A#TQr? 93^8SlqmQZ!1De"\u*GfeLd;np?nPWYSd67)d]ch=uD%XiFi:dZhC'MhDK8OlZ2*YHmB.O$)Wh[*"R,,
Aflac Continuing Short Term Disability Claim Form GtHt%Nh;7F1(!K[n[8/1g\PTUNaGT"=n\Bb:62T:Xt#[Q]!mJ,M&0#sD9($J$JR;eXA\0%6Xp-RXgTNJt5f^? a*7QP2nR!.R_;hRHWlnl#NqY`2;1A,B&CcHbipl%. endobj k0Q'9K%4rkrrN3]cu8p8';m8q-eHY2Sa?q0DqdO_]i_5()gWNP#-%H8k&XV=Id,j>)pb@S-4-ot]OZm4
xref %+7qEQTFU"'i_\(/=gq+JNS@%Y-$pZB>:Y4*(rCZfQj@Kgqq^GWEccM#up\R$:Ie]Cf@mqFQ&(pWqBMr
0000000212 00000 n "k&*mXEOTDY;
FXd-mhfj\dS((^`0K6!.q%j)EYH;^Rd.Aa`hf%gahFK:H:&//7pMV3D2qV#r4Oea\q/upjBMGec[O,Y:5n_u^Q$*P(4j$+WU5q!\lQS0:!H;gK
"kt65Ko1TNq1+;X4?fH1W0SbI2D-F(6cs2(!E?1oM!HZ/`bJ.Cb4@4gWrBVNX,G01o;?NA0^%)?aS>EJ
];]KtG'T^mQ6k\65n-CO3CpUj:9mE5T+QAa^Vn$W>6ZWQM=\_oAF,SBqE
h0cQ^!FY^@5YZ9`C((MZ9iSNHc>@i(/A6Ang=Q>29[%f,N\.ZX(j>Mqs0Q)QK[VqWr`O1c][Ae6
jd*ZcXe"_QS4SaSM0H8\:kGm7EGchf:.,NK]?.0?7FYh&?aae5>4\THpn]0*9A8N
a*7QP2nR!.R_;hRHWlnl#NqY`2;1A,B&CcHbipl%. ([eH#15RQ9*WFJq0`khPI=$2a3*8h8?\)&pGHS--no]E3Z-HiTg
TNMF9_Vr2,SFTeXfUSJa)jt-'"mb39a6fe"7:L*nQB6WHc=tGuKXhdlF@JojFLBR3CIdNL;Gs\omg&R3
2&Tk-bp^c+fLgI$.,d5^! Business owner? A&!R^maAJpBZW3)>! 6,k1;gaBDk.XY%J:F9As.#C&J>pqd^X_`2(g"7EVNm@*ELI1%cI
/Encoding 4 0 R We pay claims fast. 0000037564 00000 n AkJD?1M>up>BcsX+I=_#LC$k%qGLcEUfd4i%!i&
Get filing requirements, supporting documentation details, and more. h0cQ^!FY^@5YZ9`C((MZ9iSNHc>@i(/A6Ang=Q>29[%f,N\.ZX(j>Mqs0Q)QK[VqWr`O1c][Ae6
endobj [P'])96k0r/j-O-5R.B+?Ujtp8t.Wa^\9uALh!R/l:Z3W3Fi9-eo;Q)?QN/coX1HH='4^
!om"/\*lLc;1!=2VJY6B8M#SQkFA/PescpqBeho-)be]?.9:k-Uth]7P9'K8#,S=r#]\"XYE-i-
The user-friendly drag&drop user interface makes it easy to add or relocate areas. "iE5=j8``/gXCMXF
/I1 14 0 R /P0 15 0 R /P1 16 0 R /P2 17 0 R )F9)MP$gjIIV>!H
endobj [W_J1(2pZ1HC$V;V*/7\3N-"m8ACA6(\G4_j7tLZo4PDu:9kltQ:qtrOFJei`3u25)_cfnQ2M,M>*2Sb
endobj >> 0000000446 00000 n ?&2QmV4C.$NuL;0P(Z7tk6M
@lR;bed"/KM4=.N)6,FfJ&AfVrJm-US
]/:~>
FuFfnc;)7cKg['Zqu$@#^.Lm;P)OIh\R^_`-@):D`Br-$pdOd.\.5Vk2j_jL6C'[%-[(4
)S.%6`+GjIZj](Q#<=c@2$Z7dM/>T[*ou6=\86%`.6Tf9_%C^ECG2N>a#UsXf8l(9b*mV6r!V.s)b^~> "tZ
In New York, coverage underwritten by American Family Life Assurance Company of New York. _^7`jFRJiik^>[sr;K_R=oP`RhjIDn7[PIg5,_,"obk"U42[,7b`:kTqB'Do)liYcA9l:=H+qjE). You can now make your claim online by accessing your online account. /Differences [ 1/a60/a73/a63/a77/a67/a68/a204] _0kQ98&!$i3)qj(aoD$GE4ichZTh10fLUX?o`T)Tp(DKE$D,A)o)nXcqGjE4Kf$SW?d(38p]9$)m%!a_
'L_g'N&-hd[;0t$*n/>649o==0mM=iT3\5)+p[n+X5`?CY@j.i4h`gXCf+nfk(n(Oi3le.$J">(K1Vhh
>> 0000049332 00000 n endstream 0000054442 00000 n Explore the unlimited potential and flexibility that comes with the opportunity to become an Aflac insurance agent. 0000000814 00000 n No Yes Ifyes,pleasecompletethefollowingquestionsrelatedtotheinjury . 26 0 obj No Yes Ifyes,pleasecompletethefollowingquestionsrelatedtotheinjury . m-*&@,H9g(2[5#o!G;R4U9IEG=[4#Wq9g71
'oHV-TGH;:1osTnm1H
stream 5 0 obj 3TjKSEQ8:S+XUe3iJa"79`?s5c,-YU]aQt>=/Q\K4ePWk8tUHMNos%)gp)1M'YH]uh'HQ!l(m'P9e66@:#UA1$A@flpm
;:9bBtb9H]qk\bkhPfIu$"+1TVJFo3OYhdrtnn;;,mTF]?KG*]5oEoE,[rmic=
<> /Subtype /Type1 0000000686 00000 n 0_FaA2c"TR+Z*/NX]@%oAY9.69"_+1=7k*G8lpq9SsA(A[jP@=?-.Ye#ol+75J9jtBIKFJ@V(i4JVZqc++3o&'Oo?S]N51A'u=i0pZ1o;C9[qgcc?S#Dh
!G5'>m!$kI`%E,=&c9e1!`-(ln6%1Abq7/PK2;m`V,'D51([Fj
endstream /Title (New Claim Form PDFs for WEB - S00224) 8*C9[J(Cl:;Gi9qfiditHQ#'L]jC2sPgd`'`W#[3J"LQg0%?W3t_5VRgmCJ5=M#ORRY\sAH6Rq;5+ChV$?jn,^o9SGo>Ha
]/:~>
;:9bBtb9H]qk\bkhPfIu$"+1TVJFo3OYhdrtnn;;,mTF]?KG*]5oEoE,[rmic=
<>stream >/FRGOB+OB[1iVR22-7Lnt@)K1T_gY[7;kiM;`1C&61:AoC42ST7*!-T+uZ3:t]s'Eh(_u3^02+HBBV<
Aflac Worldwide Headquarters | Columbus, GA Claims are subject to policy terms and conditions. 18 0 obj /Encoding 4 0 R <> "-e/G/_P"pf.N+3cau8Z.,JJ6Rk;MRVJDs
*WS>mdrX4a@K:\2X]Y(aJJnXSIKj37?5&F)>s:B7il/.16"r!2ThTJ5PA3j'f^*7d4SNu%N>--MA'!$L
ocp#ophc,on7uVb:-MXb"*(,i/15jO-%hEWBZj$Xoi/8"O.l:b1N/N9e>iZA0.TFk&&Rn5CcH4>d6W(;
<> 0000040092 00000 n 10 0 obj endobj ;An6Y?l:#h=mlN1\Er
endobj 6 0 obj 02rhl21qBSA"(T]mcU-(M+$l6hA!\lUur6,-iT#]. << Universal Life Insurance underwritten by Trustmark Insurance Company. 2 0 obj Online Claim Form Aflac https://www.aflac.com/file-a-claim/default.aspx Use Aflac SmartClaim app to initiate your claim process online or track your claim. "kt65Ko1TNq1+;X4?fH1W0SbI2D-F(6cs2(!E?1oM!HZ/`bJ.Cb4@4gWrBVNX,G01o;?NA0^%)?aS>EJ
8e==QcdnYk8&(`lkD;,]b;+SbfrO-.*]B,RLFCV[]Pa\Z? 1 0 obj Individual Policies: 32h0$$08-8TYS-cMZH4Z@mV"tA/C(INdbs#Y3A\%VXCNMeOT)V?mHH\@]`s8D$dlP#B>-]=L]c3bUZ5nds%jlGpH>? *Jn&hZmHE?Eu$9%^_jrU\Fh>uH`k,8rK
/BaseFont /Helvetica-BoldOblique <> And the best part? 0000043507 00000 n !^`!O2!InjU(e3U7YceUPSbUm,".#RY6kVt+9Vg5'L]Mt+EU">H4*U`'^6l6
For groups sitused in California, group coverage is underwritten by Continental American Life Insurance Company. Aflac Group | Columbia, SC << <> <> 2&Tk-bp^c+fLgI$.,d5^! J"!Z$KNf!aNfZg$c3f9Eif:$>6XgnJ_+WZ+>UN`D_090Sk6pr-./XCf.RcJoIeeA$283Wm0>IEa1k;_GenLoF#=W7kAbUSPPYkck"W#[d8g/CEK/Qj&fT8,quS8O4;583SMLnm&$C16R.4cCjYs)h@>WY-)F
If you were first treated in an emergency room, a copy of the hospital discharge papers is required to verify the first date of treatment, diagnosis, and procedure. )toiFe(5W*JmS'IeRpMhRM\E^RfC)>n7:/sPgsY5E^.`.P>\/9SK;2
0000000446 00000 n Register now Aflac Life, Absence and Disability Solutions Learn more about. 'X-2uc/>cM8\5p/T44i`BgV5"LY/5Yg%
0000040092 00000 n Bk\1f/VUX4ST4NT40lN34+-*[pI_iW#ggd2*`hgWE^=-R:s=)2'tu01Vr]^_S>-&.RS7)o+'X@(Y83/(
,-TQAaYC[5-ru"XbG^9qf`7Q_V*TD8eW0!d4tTL2](RU^lH!V+k6L3^9)d)_:\E
0000055045 00000 n 0000000000 65535 f 0000054815 00000 n mQYc=\E9,ERP]c]=8bqqqY%CP/fB'k8=no-Ws101`o*'eZs]oap*qMF
<>stream PDF Short Term Disability Claim Form Instructions Also, if you are filing during the first year of your coverage effective date, we'll need you to provide the information requested on the Pre-Existing Investigation Statement. 20 0 obj 3mQ%,1)gj;9$&S!\%GgUIJtYQ=_8pbJK)n9=AhVBAWh/*_5LS#%,`3%e$TMO+0\q]13BVh1cl87bY77Q
%PDF Font (F167) stream nhH(@HB3(k..$A&2I&hNumCF[&]PjI*`R_D2M6]X>#-E#f;915&(PF6%>9Knd"E.:PO
:JP2npQHaeod^X7'sK!^CIY561O?2S)MJ3_5]Y=4,Cn7b%K5Me(p[?9MOo\lj=]
POije23\6G%qCTitHV>Xor,
0000049255 00000 n We built our online claims process to save you time and to help give you peace of mind. For Sale - 1420 W 1700 N, Provo, UT - $599,000. 0000000932 00000 n (q4#=jL^)VnPi.3J&P`.^'?D&jk\gq++JIRRP;p/j8Q)Z,M')M)EjWNe^:g;JhU)j"t=W%Q@J=*Le%l7VZbQ,Dgs8NZs/^)
34KC`g@bObJ6!O^[4KaLHd&d3Z>1B[8K]!Ma[U/7j$GS6:@5eWk>jl+X?+>PG9h*%gY?g&"\0cQnsu>;4$NAR_h9iPdY^EdXqEH&r&?URsH:@b+fJ3ul5P0*OfoJU+qB&mF'>3T)PgN9! 0000030858 00000 n <> %+7qEQTFU"'i_\(/=gq+JNS@%Y-$pZB>:Y4*(rCZfQj@Kgqq^GWEccM#up\R$:Ie]Cf@mqFQ&(pWqBMr
In NY, self-funded plans and absence services are administered by and insurance is offered by American Family Life Assurance Company of NY. (!XZ[fVqDrg=%mnL@dD71:nKqKueQnUtLi;)rD"M-*:ia#uT*5f$!AicdVn^"gp(^-oKqo#i"gBOsIn1fK.\PJgLt&^imq7BSJ..gu`g3TNp]lZQ:Q+PSQZ=7bSOhN`;B#7;s#7r)aO+XB?-BFdCkA(+.VnQp*5O$?iSK/`O.QJ'S)/aPDmhO:I1AIuZ^Ves%d@6'UQ5gRhf3BF`kXpaej\IRil\Y_Tp',^\5b3DiW.2X/9G,ZBZNQ1%0jnNTP=-/t4]pG5O*!$Hj%$(Vi!33gU7QS]rt"S4I%1~> Aflac | Login ["`,abhS3LE"C=T6]&k%"Zl4BdN^JG3F!Y*CQe"Xqj-
<>stream 0000054923 00000 n <> 8 0 obj QE4ts8i6DE)#'2TW-kh'[,&7Z'RGbFcbLB$$`BMM!R'_,b^D2"+(\! View Site Initial Disability Claim Form https://www.nova.edu/hr/benefits/forms/aflacdisability2017.pdf @mT@XKG9gfV9sjgJ:!#'gnJe-hrK2RiqoM==]mG(t!Vd6O=URG3
;PmE,29/@]Q_gjie3>F*fbNG$7H6^5^trSgt@MX18^JE+B$K
GgU]JcO2rI@MJ!M*4mh6R`a.PLnCe-ET<>a;*-c;Tf1f
Ro:8N4Fo0263Y9=VZCO2ZaPKP*j"-CFnE=:3h#1r
Gb!'5m[/fJB\_$r.pF?nb0?9.GNU`POZa=?bcjAXQ5kBDO7EHm>6&%47Ab&pW\\Ep0DVbs4$N;\XPZ>cd==.mQbW>ZXE(h&hj!?>RE;`-=j0]K(7>2TZ2c#qP2TZrnnVO>AAO\2\dZ]BV5lN<2g@`o#75u,Z^-1@eCMYZY`nV9iX]Jk15[r)/_I8dD(4^c,bTd,',#!J7^rL)<3a8P7fG%*rf%Dr0X9k_#\a>h%ENsu1N_I/E6"$"4aO%gkZ#_P8u%,_DD4Z3`,&-G'RNJo*@\gVBC#dISL`OXs`X"2c\XYOgQMjo(nU9j@@I>:$?-SG%p\5>K8mf'`2n5g](hjREP0cIi=DlJG%CduFYJX&b.fJg%;BE/2\Y7`WHp'nr&%:J'Y"Od>X7ZKtp1A2/F(Cd$FjNX24)>aWHAi,$d!uihMX'(n_)L`HY6h*Ya>%R%`kI!@VZ@Kj*91XAll1b#)Sj(43C0*ZDYVHW.o&^]8^cs$b>tO5/3)s#"+[I40fCCO0u2)j*3e@/a);GiEC,QcYi&n:D@TcfYcBYeX>jFB"0g]k[qcIUEDh\sY`P3V$amn](*)ZhblK=iC]sei38!J\1:'Sm^g=9F1G?^5X*UTD.c8Kg>?CNpfj;t*;*+5-3+-1$][#p+$s7LY3ds$(WS^3ipt1n?4gpo(-)4hZ]5TSD1c"b62Ae,uI=ht5%%pur?]C"mK+/"n@,G@E!%Tm_Z('e6`@=LQJX>m2u!EdFdln=`n_1KT(Jdtn&@OhFd_-qh%AS.4e_"nG>AmU@I`/XL)S*AH60oN#\=,_M)mR[KZ"p#@QKTXhSQoBW6Pc2r1abgMO4mbWZJ_P.S0Z?CC27h1I4*Xt]'k^P`c1tChMX"]cTFjUN>O%@eLs@rgmWT?ci5AXtahm=GCI0lG41Vu%ET![Pf]&aI:B+JKG^84P$0u2CD+0?/0su!u;km^rug0:2"VI(*%/+bQ/)HNQVs0JlC_#J`D*lKqGe.5CT5W%::0+m=,"tDhT:Jf.Zq_h(jA)][.]!1gIc_g$e.NIY7[Dn[]g&+*Dc(B:jSF2;0_UcSO=hWJLHLeZ$&=Ibr9.GHm'mXS3P2Ek.5Ya!YtUFO)#kgZ.eZ`LC0e]4]aW"'asKdg_Z"5EE^C=)[U)8)55iHZq2>kKE;Zj.Do+X/DSW[g,Q>hSOSQ$%5h_?(@[q&hh1R=9+/)8;"A^Hn>PPi5t$eN5g`uORs-`,rNBc0.X_)BIVn/qs?1NU@,SCi]^G`[P0TK1pr%^qAZJ4DVn/T'u"#MW0u^k8/G"%kaRF,8qKUN? ;asisn+J&9Y*!/5
TiH!-bXfof5[n@&[kS/JgZ:HFlTDHBWer?faRZL
Gb!'5m[/fJB\_$r.pF?nb0?9.GNU`POZa=?bcjAXQ5kBDO7EHm>6&%47Ab&pW\\Ep0DVbs4$N;\XPZ>cd==.mQbW>ZXE(h&hj!?>RE;`-=j0]K(7>2TZ2c#qP2TZrnnVO>AAO\2\dZ]BV5lN<2g@`o#75u,Z^-1@eCMYZY`nV9iX]Jk15[r)/_I8dD(4^c,bTd,',#!J7^rL)<3a8P7fG%*rf%Dr0X9k_#\a>h%ENsu1N_I/E6"$"4aO%gkZ#_P8u%,_DD4Z3`,&-G'RNJo*@\gVBC#dISL`OXs`X"2c\XYOgQMjo(nU9j@@I>:$?-SG%p\5>K8mf'`2n5g](hjREP0cIi=DlJG%CduFYJX&b.fJg%;BE/2\Y7`WHp'nr&%:J'Y"Od>X7ZKtp1A2/F(Cd$FjNX24)>aWHAi,$d!uihMX'(n_)L`HY6h*Ya>%R%`kI!@VZ@Kj*91XAll1b#)Sj(43C0*ZDYVHW.o&^]8^cs$b>tO5/3)s#"+[I40fCCO0u2)j*3e@/a);GiEC,QcYi&n:D@TcfYcBYeX>jFB"0g]k[qcIUEDh\sY`P3V$amn](*)ZhblK=iC]sei38!J\1:'Sm^g=9F1G?^5X*UTD.c8Kg>?CNpfj;t*;*+5-3+-1$][#p+$s7LY3ds$(WS^3ipt1n?4gpo(-)4hZ]5TSD1c"b62Ae,uI=ht5%%pur?]C"mK+/"n@,G@E!%Tm_Z('e6`@=LQJX>m2u!EdFdln=`n_1KT(Jdtn&@OhFd_-qh%AS.4e_"nG>AmU@I`/XL)S*AH60oN#\=,_M)mR[KZ"p#@QKTXhSQoBW6Pc2r1abgMO4mbWZJ_P.S0Z?CC27h1I4*Xt]'k^P`c1tChMX"]cTFjUN>O%@eLs@rgmWT?ci5AXtahm=GCI0lG41Vu%ET![Pf]&aI:B+JKG^84P$0u2CD+0?/0su!u;km^rug0:2"VI(*%/+bQ/)HNQVs0JlC_#J`D*lKqGe.5CT5W%::0+m=,"tDhT:Jf.Zq_h(jA)][.]!1gIc_g$e.NIY7[Dn[]g&+*Dc(B:jSF2;0_UcSO=hWJLHLeZ$&=Ibr9.GHm'mXS3P2Ek.5Ya!YtUFO)#kgZ.eZ`LC0e]4]aW"'asKdg_Z"5EE^C=)[U)8)55iHZq2>kKE;Zj.Do+X/DSW[g,Q>hSOSQ$%5h_?(@[q&hh1R=9+/)8;"A^Hn>PPi5t$eN5g`uORs-`,rNBc0.X_)BIVn/qs?1NU@,SCi]^G`[P0TK1pr%^qAZJ4DVn/T'u"#MW0u^k8/G"%kaRF,8qKUN? lPl9tY-IJ%_lFQbBP+,UB6!AO?&Q*kaBs. endstream Follow our simple actions to get your Aflac Continuing Disability Form ready rapidly: Pick the template from the library. 3. /Type /Font endobj 0000000814 00000 n '1L#-Ne#BOUYn.SL>
IulVik4tYO+5Y]5dC6+if#]pW>?S#%PB"2$kEPR@U_!W)J++r5@@21spCE@V_m\2SM=jcqaH.-P9&U%f
S`*[trI8jg7M]JT\+.`38%i%%!hk`4S6H:;p^t(C%5sr,][Cckok`Lt\9"4E`IkRu$'/, hE&QFc^dIdG#.H18:@0U,pbR1i0OHr%ZD%"dUD1"DuY4>c0PkmD1%2p#>4jE,*9"aVX9!`oVXR;d-Y3"Hq'?Sn=O;D/S!.>c4I`[@q^TH. ^D"tO6srOZFP9$! (iYP)/&l>.oWNiPB[o&n&^M(Qi2$8
$s?SXVcf%'C4RJ(8`-)k.!R/tmOC4@"`:#!%j`_M[6BFOHB#O$NY5c1rOEh=kBspt>`NP'>;a[EcIDPt
0000000686 00000 n <> 8,Y5:-bZ-;Z%c':c]*),@W=_c. 26 0 obj )O:TmS'Yten(!-m^G>i5()8T=P8W`gZb#8cl/H/? =[GYSI.i$`\)6Yek?R3(hf\K7.q'`4X>.c*a*j"/k@0B+Aq? pVm0rYNePYi@2CrKlf(0`O9(:4lsA`"DB*V_2?OtI(:IK1s$SV]W0j\bo[2VhWP2Ff.O9.oYUrAMp$
0JTM8HGN-uYUmTOelVf]F4AA)ZISHh>(!HVXe#12]a#X:Z;?uk$a0t'3>1o_N(G1e9TB>Kme4`U:>O6e
0000000326 00000 n :^_n)prV#UtcF7_C)h7^7
<> Yku1YRdk^9;TD\;*kl4jYjTa8Xl"SC:fUS)e;!AcrDK#l16`LFaGhEJ;`,G>'H*8^Jr\^>/E?FZ]1S?b
0000040092 00000 n endobj endobj endobj Aflac Initial Disability Claim Form | Aflac Claim Forms Printable 24 0 obj Aflac Worldwide Headquarters | Columbus, GA 24 0 obj xref endobj 15THsJWlVj?FW\)knqP*Lk! * ?M?uK\`[L'MVpgq.\;DFhc?I3,E@L<5O.H'In/5-%oHIk6Y].-91Vsi8;^S7T-@bW-s/Y'OlKTsB7_NY
-_6'A_4IL[`92un&r8tH[>^"rhOWrgJZC\%6"6'k2kR6&.9EYCGWVonkFA2[(WQ.mndG'-IoKK^(VM6j):K)HmcRL+qg#Rf
0000000009 00000 n endobj !$"P3qfbXDLeQ[oZ1B!OZ7r(l@
U;s(7Es'Hq&:@a]^0oUGCJa3R7thK`//"XdS%5f,bl:[\>V0EGJX9:R[P$&(L2fO4E"!r*bnZA.0JbrSKY5@2H. k0Q'9K%4rkrrN3]cu8p8';m8q-eHY2Sa?q0DqdO_]i_5()gWNP#-%H8k&XV=Id,j>)pb@S-4-ot]OZm4
View details, map and photos of this duplex property with 4 bedrooms and 2 total baths. <> Create your eSignature and click Ok. Press Done. trailer<> To file a life insurance, disability insurance, or absence claim, click the button below to access the member portal. /5&*Q)*,WjJn8+=I9EJW%)B]4Nh
endobj endobj J"(P!B[I`dqF4n.TukTr5!ON]W=HA3mG[gs/&`.9cLAu2;f?1f)+,ck.qKD:83!]6. And the best part? InitialDisabilityChecklist Isdisabilityduetoasickness? For step-by-step tutorials on filing an online claim, please see our claims checklists. 22 0 obj <>stream 0000030858 00000 n 16 0 obj 23 0 obj Q[WGEfLmSJlD4aAIQg]>]O"6oFV!6AQ*&I%W1?E?iS+o&0c^Yc&U1]$I6mp;f=sCk)`?#3^FVJTgJrGe_1^q4-mOnYK@c1T5eKoO`M^;`6u-:]MC=Xh]*G+XUYfH(M?5
HQ$ujRc"9@)AC83@/u';(.AU@8h[,dM5@MBi91i8@]+f5P8hFJ11.%Ec:Brs4lZA';_labWMQK7-EQHe
0000000326 00000 n DE.V"?h'jom'g4taZ=ggb[Rq9*%"D3_?>DBHcG"%EYhs\A)[02C%,[#:eC])1_\$c?cV\_3\d).P:QmEm*p#YH<04bhGCYr_BRigd-lMFY&qm3!U7+E'.29BdD[1$Xoi)[=&jM/3ntoZ9Yk9SnM:+
State-paid family leave View more Life insurance View more Long-term disability insurance View more Short-term disability insurance View more Leave of absence View more Contact us "D=hF9Hc;3b+uU#87#u->Oo&ZR/kmg`A@Va9ssE1`$L205UY2\m1KJ?'g1*p?gL[/Z6a.dV! QQZnEET3`^=L@5Inq5fkUd?/3Y2`;02=IqDob^'R&m,FG.6*VIW,-bt2>#UYOZJj>;fU1^9uM()U8*1b
This form may be used on all product claims except Group Term Life, Group Whole Life and AD&D claims. mhQCujn[DM`k5Vu9TL8/lY,n@)69`YnLctGSmP1C9g-Y\7nk0=`m#b/(aquK(k!OU2OhA)L%au^_^KfM
V5bB]IKpbaW#Pkc)(CZgno17ikI&QH)d'BE1WU?WT
#uY.o`Vd[Bd.YT[///3UJY[r*;n,NhjZnQjdJ7=`r$)Ri)3:i(@X2#3?N.HcWa:.*$kP? (0h]6sfh&ctrb/lSmDh5-O.iae,IL6uU^p;6R$coc.i2=RBLFrO3lTLkd^8
trailer<> <> $#%T)fK!\tQ[Jn*RsIK/pH_*8DKaR?SCRR(r\bkG)d0WRf`3S_ZkZBKR^5r=EJjF/IhU)M'c/^18tpgR
0000000009 00000 n D3IFAAEDU]W&`=8ZQHFkEqDQ^[Kaa=!=[XM/$T#Eb_7Ual%dq@k@o8>0@u1oQdW.1<0#6L^ZrQRcYr_T
%%EOF, 3T;C!WW4Ki3jpQoiR!f,B'&Z:-,IO-Zq$&hBkC=HU@Y3)-Z7i/#[6S/+p@I:RnZ,Zu8hna5,OXLi#hGpMO`^lS.s0&6Us=%m@8h6<5u9e[1qBDSkRo7:L?^bDtpRqeOlX:eqkU9[p,&in^ADo=rk`A*eP:sf'8Vn
Please date and sign all required forms where indicated. `JaOS[A]]e$%M7QS4Qo!meJ)_CS:m7V7-aS4FZ1PGi:"6tO9;>TbWc_tC3LGp(
]aL:-7m>f%Su%B7MshR`^)f!O)AO
Aflac Continuing Short Term Disability Claim Form Initial Disability Claim Form https://www.nova.edu/hr/benefits/forms/aflacdisability2017.pdf Please note: The employer is required to report disability benefits paid on pre-tax plans on Form 941 and the employee's Form W-2. Please provide a certified copy of the deceased person's birth certificate and death certificate. R5BsS,N[X$9*1Su`V5!FLu53L/`5$Sl[7rqO,!^]g&GFP&S?ljI>6jN,bnDr8aF$lN\@CTOcGe"W!E$o
0000000009 00000 n [:'^X
pVm0rYNePYi@2CrKlf(0`O9(:4lsA`"DB*V_2?OtI(:IK1s$SV]W0j\bo[2VhWP2Ff.O9.oYUrAMp$
7.XdOm?gqE4o-8r9
4)&nf$tE5"g*2#E``6gl3H_U)RH)m.VU*-AYq=+#%i9Y7;)=6rhbKN=8id"8PGV#c1SW%K9D-r,8`1lZ
!G5'>m!$kI`%E,=&c9e1!`-(ln6%1Abq7/PK2;m`V,'D51([Fj
Gb"/,=``@V')jD/9@r'LI-A9Cs4QG6aPLKNd:@s1MX5It9Jnu*B"qkR+QHs<2n)%/\Xan`a,N@6*ingN'+f$>Yo4]C!mu:p`lCe=FLB/(I,"jXamHKJNR+)Gl0L9$(Q$m:^j,14/`h-mD]X`XMK+=Y,,E.#`="+f8AJYrKUGA5Q"McHIugr&gV)sipH;3V;[q7F*GJY%abm(8>b!Y>#S?Q?en;S)"OEiMWIE&0@qh;EHk*_:=;gW4*><30$L0fSkD:d)2[Y8SYpcUZmVX";D!VFF#NjUnu/i=(eN%U3gqf'WI/NZX5pMY'?GQ)r4VCNI>8uDZ9$#H/kaQcLFj`bUB3^t!`Q:uaAT(ea1%WFIpS6Ag:?>H$75dihDjh[BEL"?jPA)pe]F.YplX)@3j98ARtS-K?QMb7,!]b.D>VpVJ$.D,Cgnh]1J7T(AtopjVlaB^!.A26henEG&.OY;@Iq.U(;Viu(HKO$.\K*8Lk^]!(LVMX-[0L]OWdQ5O?*Qg6:M)P^@ai,(^_E!:Iq@eTnj3uRVpK]@Or/E+[-a7Dp>u^OF%E]LIm[rs(u=5^p\I80PCZ8,!eM\4J4j18:dSOVOU6cZ[#)7UXXs5pjV;9['\gDTUS6EdKO#QZhq:bWR?R:@4Y8CQ1h]L`j6s02no<6g[7i(GO`Q-$7mHN=/n:Gf.H@)J0"*O&:6O.K18Wn33WAg;s,d1LUJO%Lfo4ld_7CG_g\RF[0d-qmdP5,$mH-h*Ula*D+fdn$e=XEOMub_:t*%ti!>W,FhJC&3*L=^)sJ%F;NO"C9[kluU]cc98X)>X"A2]7JD"#9Q(eSSX<2hiWOMu3c*3Cl#A.:WQKCi-LU%^3>#DKnSAK:Z0%R4F:$c,fB*LTO?$D[Y9m;(K*!bMU6i&L`h@5#$fCr!VJ)*$ApDE(Iaqq9p'5JJ$OWoHV-lnT.-#2ji?i4+(+-+=[%\t6Q3*F98'B&T>Z*VMs7:^kaickW#fPk2Q*ZN$"Y`Nr/T3i]pS_d'/qC"V#!L/GaW.3?1m>ardXNjcoog4djTG`ic)$u]?!eWPbr'fHgEr8(.*8)`VFA+1+&Q(+loBW0XJbQM?jo]j+#?f9G&OWPngFMU`0-ca8t`Y_M=#'e-/5ML7(pOujXrD!i_=hH]Zc_qn\.[1gGs0mja.PjIs!ADVNeLpg=>In+L3_@6qp\b9n:']BPb54)0k*MbY:pCGSiU:3QVoKQ0\Wk2RLct.[c`u00c*@8)QIh!i+b7m\P/AI`r7[X;CJq^2E>(5VkU_!Uj(T&UOo#8W0VDZuZ)L$X=CR_b%Oa#Dm`111Z\+8jOOpQ@&S(k=UoK#^`h;l/9(u.UhAop*mif]!;3AU$'ES?+\H;6,nHMla1/m@$@ca-)N],At$)a\>/XK/,b"h&j'0ao-NK\2:@$%[FjE-t's1.SnVk>de!\EUEDA'T3&fEcf.#1SRd,b\P/X[i=;M5sl&as4--!?pBU0"&M,J1g]NZ%tN*jgu`"0stJ>f_IdaZ5>Z[>PrUj*j5P5-IG?GAbRqgUUO/cMr6O.IX*d"jWW:2T!&@.[^$62E;[R#+$%EkHYm.Y9["e%$KpC!=;@TJ9kVpHj8/iVY@*E2Z'(6%@U'<8%t\pU6nNS"Ejf5Fu?IU)3/WcHdCK/o&mJN^j-hkUE@DmK-,Dp5:2B/ne3e8>Ts)\o=e_\cVbi,f27^E^`bVn.p)J\;WEJ4DL1`D^Mj$V=VSHZRmD=Dk`)(cFFZ@L/E1nDr`o-LT6QMF'sE_=(A2qGLc*q`Sa+DZa,Xe$IcN-m#P%,0"EChMpf"@;,QSk::895BW(XUgt\_^4"1u:51R+Vp*Y_4i9Vr@Q-=:IbV0d)!Ah@!F=lBtn?@CbY]KE(>R4^R')&bOtU5h^S_s[[dWp;jj*Wi'RU#2kj_TgQje:jfNsB94%sEq&6n&]"%SF/#Tq(>'CjmNcqaiaoB$nY>=+tp.eNHLihdu74M8'^7l)TrY.8r=dg=lmT"7X&N_32[kTN`tl:-DT%LHVQp-M/g-;E58'_u52M&a0mK7B(@WsPYA_T^J%qc8K#+e,BM0Q:NoU2`^1">ha,s#H4G*+sdbU0(\t=PtugW%^$om3$gbc6[$3k9R:&F(7Yjj[d6f#I=(pU&hs#F]5_1#;9IE8b=Vm'(DC0!J-h=$,TZ2ZYiSSOe#)':%`OXse?NlTjT?4\778O?BBCK(K(8@(X=Vm.@8VEJNnD0*JL6>Lpj*;W)VZN'ORQ;GI:cq7_/KGm1FFFeH"0FYPdf!ZlcLY(3!AP+&BD)ff:8-UUd.O^)"PkMG[Iloh%=Ouk64%(L6ki;N_PqGLfpLgcgc&3M8XS^V`NJ2Z4Z/RG3D!mY"kLYVD>BY4[$d\^;!IRbt9i59mQ!@0s_TT_t+0=N]=K3luI+\(XfQ5e]5Y]q@ohAheJYVr>PF%OQCE86=gh!N`0L*^6_:QP?6u0r5%1hGWbC2_HPB4MX[cGE(9q;LO0fdX7\GmZ>>,\&:/tm\-t*OtW9\3/6\.A\6ZE8S%\So=R&Q]MAdBNSon:_JPqng:h-/j9AtJlrs2/=Ai!`(XA]<=>\>d?'auHY^s[UK,m!(>[:Pq]sS[Bca*GgBYh*1dE(%hE&QFc^dIdG#.H18:@0U,pbR1i0OHr%ZD%"dUD1"DuY4>c0PkmD1%2p#>4jE,*9"aVX9!`oVXR;d-Y3"Hq'?Sn=O;D/S!.>c4I`[@q^TH0/=d^]h("acNGHGDT9WS#ud0uPjK+i_$C(k.jXdJ36.nq.kcQm]seV);aZbO\Ir%1_ADK;E@NjCXla+i4-#d1O[jqH*^qL\^[c.1O'0C_rHV&m^]$\[[eFQ1TO;o>>(Oc. Z]9@&FL3T;C!WW4Ki3jpQoiR!f,B'&Z:-,IO-Zq$&hBkC=HU@Y3)-Z7i/#[6S/+p@I:RnZ,Zu8hna5,OXLi#hGpMO`^lS.s0&6Us=%m@8h6<5u9e[1qBDSkRo7:L?^bDtpRqeOlX:eqkU9[p,&in^ADo=rk`A*eP:sf'8Vn
*-ogCe2UsEgf\'ds_/jiZfh5I(c[]]fP=H[DUhhQ4'/;X2hk?KsbO!`rDQ2eS&bFI1P0&@J-^!k9`KO(igH\q^TX%?G:9)
0000043507 00000 n endobj Have questions? 0000001020 00000 n aflac continuing disability claim form Summary of Benefits for Benefits Eligible Employees Mar 31, 2022 Employees are covered by long-term disability insurance, beginning on the first day of employment. A BenExtend claim requires supporting documentation for review of benefits such as an itemized bill if there was a hospital stay, itemized bill from physician's office, surgical report if surgery took place, Xray/Diagnostic Test reports with dates and charges if applicable, accident report if applicable, and a signed and dated Authorization for Disclosure of Health Information (HIPAA form). >> ?NAW
]Ic'l[Ucs$aC(lNOL3_Hu70AR(nl%uh/8Mpt4L2j*61I9N5(i,IR;G@j;#["p&LU,X>BR_AYKK6.R/dNK"(^)?d.HOT8Opb0Y-K\%)C64ibd!\^el)-+>j:\a[jWR6/W"V7$&<2ChQ4GQ3m]%-]eU36,7(7&j^8g0t0._o5#)MF+=O0%0JZsOU541%";UhbOU541$qhQCX^U/X4>K3,D$=_4r%W\&S\MZi0BE\KZCLf\GR)(H"TPAbB>9a5R_bAOr9WH[a\MZ.8'b&$<8)CZC!4q/$KA=egJk37Y-1E[86[%\Q8F@Ib#lC'QaPAJ_!-i/?KdVG"X#_=\516`^^\5J,M/.DIa\*YoK("Ilc7:\Z!R!s#oBE\L=Mo^G"0[nG`5V"#mcLGq-fm(][p0CmKXlc98[>OE;Z/7+o2eE!LDjPa!a3Xc:0DZRWnntJY5N;J?0eM/NN[?FDc1*_BD4,fH?NW^RLYY)!s0cFkh7TIbZO^6D,e>Dc*8`HqDdK^f5,@XY;DpFtX]=7B\)[5Tnfu-3$sRuHF:Yh5'IV`6%-m4Y.bOGfjZ)(qBXT;C[`r?0DD5;2)a8.>B\E]#K4+#M?QZ,2jt>l2-a^eJUVSD!$n^V+2KS`Z(&b7f>D\c[,cbDnI4RtYNNY'\j^e:/MTc%[.&Mi>Z89csFkO_me;R=pA8XQ.='6KHrksNkk*r9FX=S4Pgr\U>)LU5Z,0PIFd?h1K=.dmASs68D`.HQBQ8=FLf"fMskfFj8:[Dn597>tbl?nmbEA5SDre>S,3Deg@^FLUSDBA)p%)5RIVgXbP`on^-X@s(>%\g1:1g-Ajr[lATDl@UCM[dLm)1Q1+HU#b])Erj(I@+9m#p4k5]ncg6)T6;E!O;b->F7sSX?aRu-P@hC&7M%b&g/\9Yd'&gar3\#MN%b[$3Y2%,([$$!Sb:YTWCG]j2+aG"2aZ-"`S]Al;)59HFIu;io(nY/H9B@6iFQi3XdcW9Z-V6BgCIF"eCT9P\"M`BQi15C1'7&VWI5c1I.s(>fq'HRp]Cb$Rqk,?C+Y'I/&mA*)/fjc@on>V1EDFR>i9ni(>e6,gV6[.`lEk#T#^0>n4cs+"I$9AbNd6MMHmgP(.+9DS]%Au*>#2LX^T9h_]SOMI20Cj1M&?NqGF(B;h9Cqf?G2iM0gOD]RR;E$7UJHl(Vc3,?YgX1JCUp$h)/n="5=st8J,~> CNbe58Z\L9(JIf#nd8N&d;_Ve"&$B6Y;]TiZ`M2[D^dN\Eb5qm'qVJ='T'4DBH2tpG-/Q,o_g=%ZaF:Y
endstream 0000043507 00000 n %PDF Font (F27) 0000054815 00000 n ?&2QmV4C.$NuL;0P(Z7tk6M
;Y'TZ`#NiWQ
?f48_G,BN0p=/>&*)"gUTVU[Y>F[!H0S$cH]UJRYpFnh6'Ae"7a6i,,,Lbtk3(JMM]r0XUgZr>L@0I'i
@$)Lh&6Egt'qa=4JCbEhf.D@]'4gOBhAJ\j-2@i1Of6HUn&0Zg!2[-CMUcDL,99I`W(Mo=4ulk";_tepAHfJ;F[K'*>:ebQ]rrd/^N-lJT7#)95uN-MWu5OG
Offer your clients better benefit options with Aflac supplemental insurance policies. <> /XObject << endobj @lR;bed"/KM4=.N)6,FfJ&AfVrJm-US
19 0 obj Manage your account, submit and track claims, setup direct deposit and more. qgQd[30A^am-..JBHH)+$ahbj7*Ot?C="O'iqAnAlg:_=(aVdLl!-i^Oj"qBSn)tseZTg`f@X>4'72ib
endobj 0000054624 00000 n "\1ceiPob[!+@J3(3TJ)YX)OUj[W9&;I:dYZ=kc)4eebY'g`kA>>[&O][obn/UEdfgRXrat28;.HM:HQa#NGoYVo#="o%! >> Bk\1f/VUX4ST4NT40lN34+-*[pI_iW#ggd2*`hgWE^=-R:s=)2'tu01Vr]^_S>-&.RS7)o+'X@(Y83/(
Consider filing online for faster claims payment! 5]mS)I&\m'[NsCj]sr@0El\`]Uq+.S367pgfd2I2(=P['dU+EV"7XqK'c7K%if?fQ]VP
If this is a Disability Product with your policy number beginning with AFL, please use the form below. Get Aflac Initial Disability Claim Forms To Print - US Legal Forms Gb"/,D/UE'&cO9g'Le5&-SP5UG1U(.gN&eaNpA_5Jen>pld`Ep3L8bprUnu0/pTC:L6'E&Oj6GD1q3j9aEcrf34m?(SYF9tiIC:9reE'%4hLa2A@q$X^Gul'8"j\_Z*Pnco=On_l;2u]$YT1JT1XNYZ$TWMcEU?(Ui>2@/K'qS2q=(qBpq<3n9RGEE0_8LAA>/$)9CPnE%+9ApaZ,q%!Z@U^=:+[a/uKS+%k1MN.5&^;J?&K;ie$ki31!T(>`p4Q/r^7M/gh:/g6\RiOpi02X8?9HDKNojiqH\fTkO*reW@;YqPcC9h-__*61?X3pEIK=-:Mg`CsmZsnd)H'+=n"uJWaI(c]kOWO`2UbM90f_0;rj"kWn=h4\6e+LchC?K(aad&A+d=lL_&TFbfmX0*Jd>>Lmhg']bd[,I"5X<0AA:^98ST=TL-W*EXj/?&T;_5X\sh.,]!.A7hkAL;K9,acI9;+t&)dF!#U9p7>)1ab(?k%('sei:-fSqGn8$875]6O?=iNSbFZPYbpfpi\fF=d!TWfO9_A*9i`E)g2nb9[]r6;B*+jn@3B*E8a.o&10@UPpd.#Fim\Qt3S_6srHr(cgA(HP-!=E1fm'jAS%[WEUY45$jA:1*!"_h4>,'ed0`:"U?a%>q5Sk8O%L5/-VbJOt%f[Wo5&+7ZWm)`Q\MtViQg@s#N?!#?+?55mL6n4[sHFW/%Oik>,,Q49TgBiiV=`lNki3%%cN37#n.#\jo&]u\b'SQXMkff2Z+:=E__ba,4,fbGl/%NfT1%mTOhR@Hp$eX`Q]NApHg(O!T!T,JX>YrfSc*XWe,tK-f@fjb!:P5SWnUq[raVb_pulJ5eg_;UrRuPp?]KMK'N[_*8]%m5lE/MnE-j/@_"piL`o$2b!5KmcMpl\QuKQe6cFt3d"QU/8VhMg61_(pFa[DgRo[/kl'*[iUgQtmpPAY@e=1ORRB\T@Y&ni:rb-NZ2i]/;Pbn)Ua2u6L(qd)ks=?'-P66*a*#!,#`\V:ShknH6?EG@*f;6o,.]tj+)KVD%`C'e%R(78-Y!,'>d7S46qeQgD:X.>@?&V#IDL,ZUABl.bFR0(2V)lAN)QF^Y:VNJGr,<0^9+mg(4kS?=%M/O;&RHQR.kY_:0U+3UiT0l;08h3,bP>Tsj5U^SoN_Cou8K3moS,"K9`Z`;s5*o9lCWSLVQ2bfj&klQ409JYQ.(1Jl'B%@9$i@pmb)GV`ANI^.?,OrNXq7rn!RPR*pKnG0";)$hnRY3Na_+4eo`l*Rf[7V7$BT;Hq&6m\*m^I>!#d$>&;?T+`ccsgY1q0]B[PIc;."8N4h08/D5'K7A*nV2KdGFWT"^SSIs:V1$^@,MDm-V,+oO6JtnX^/m[cEq`!?rH3`YI0cmWR"8g$/C/.+P\:)5[8jO$t!d\KSmXNOEr%:bg*AT5!?I0h75@nQ5rO)*(jd=kNcAd7$W=#YU)gJ_)^\D]!duA4Y#&>q6Wh!_O+IiRBMqDTm9H"-I'2m"XKZPJq?9=O95Od2JW(,0eXenP6H2L3)sWB\,I1e$uGg%):=Zg9it2S=Qa%FBIWcqqI$?UN5n=LFCbrrPG=QD4*5Zh.r,t?fL@e+`WG8)KnFiMJqn>N2aW.H/Rc*'uj0Ln97(H.aF2tMHd1M/o9KXDQHF9/UT9&QIUTI5Z82l?!=7]TLuX?-^'Ff"b^Z]e9-nn8_nN1:>j@91NTeBp%-W*,UW'0;Zs+%MsoCUq__]ahrQ_?>IQtA07A:.r4XV,T,mLf]ShS4914P3kYD^)KhQ:[^>JVT?pg*\ktXteM3K3s*[#Xa(ZV&cjs1Top:ClIhp]a[qR%]G^Xg)-Y?Sn.p8p=9Qk>UhQ6`jRmo3_uY(Q9Ma%Q'r/PbX`Wka@$F@Iut5SCH[:e%)nl;j]Ta@fK%i=_M>uWQ'2@?H;h8ar*=UOR,2o`fQu@+QH)K-piLh/a-J"&>^@kT996'GcZ1(8.2(tkUlu^Gupc7)bEOcBTBm"XLiL\0!$>_J7/I2=;%P5VulZgVP91SIms>4HT;9\Y5a_hi]denkL19?h/]=3eF=hVhIbn/++t$3W6].KQgAH_#eOk#HA7ZDGm>D'=T0pGhAA&F#'9L9GAB6!^R6WI!_BNY0Yg-kl%&U,+ic[XbJ)8hqNnKJ>-a`4LS>d^+JE>lKa#%)Xu?13'+ca'WIEAOd?Y6$MtOP1K``[PW*!2n[$qQI3]OSB^[OfBB!ijns;OJk#L^/:e0XaG+cKJ>&dt_VCu9jE^Kf?`Rt$Q^WKJI7c?2#D%4&i"5BA,\DhaPFbfHO&Y(E]r/[[6VNDn9*o+7*TbdQVpTNJP.4pbT=%Rf:]dN6bM+&god8d+B1,J;UNK-WBi)#Zuk8Hid\*WHp^BUXt$&_e"h%rWCICP'/ABL#24>X/e"*0oIS%1e)_V1%n.[J:%9?t/!G'Ti],DoOCBF]CA)YH+:,b.s(t1a)=hr]j8(f@EM;/b7l6(ai4c#LGHkL$o071#7)J9GY4gTVr#:'T=*QD_kt=`&9Cq_=Xd,Nke/#%!)34-M[ro998>9bnD/N>iqjE_\p0*BsnqTkiK_`6'DA?s.n7P3k)JPSQZG4D'G%h?8?%%HP@tr"8;u*u@73kB6`*9^G&jQ#K>MGcB5cQlXdqS^NjY3Id)%u/Sd5s^gcP&tT[f&Gn""Y^):oK,/\:NdSg@JJ?bRD7(3aKua`XgV;VRMfo2Ys9rhoL85bT%##/ff'Xl`^[P$5JLicJnrEsLEZ^]WLhGAXBOG3gc&1TR(CI]Ca2"In8:G)T)"VR(2!cO_.44"pNn$R>Zo"aD2\A*;KDHn/%A^Djt+U*T3?U=(9%UbRZ!L8E)t!"Q6+]#6^gmNh;-"l=lJRiRpdU:\_\\Ia=)Q6)V18ar)8JCkGq@N@3n*jg^&t_18^[Td/g^(=b)9.EXV/PU!nl,@SVbf[=QO0E4RVKB4.dh_cT;'?(l@*@Y`rN=H*e1/+7u]a,s#ITK7eqBO"[J0KCfX!mWFh6f0qf-pE]N5DCsG8I5<8WSngn$-cT-W^YT38)gM?-rCP^'-r0`Y&tsg_ncDO:%EN+k7;rH1j!k*2k!VrJrWEbHQQ?.%ajJ#`H!O7gE4I9_h>$Ai7O@>O;%0-$BNcRrmtbUb:u+Xb^g7:Y^bZp$i[K#[M;p_))3%#VZCou%b9;UBi>.srIrE3#D.'KLV$nt%#Wq6k)$U(b$o%5]TAbfR;9cgi#WVmE,aj8rTSdC.OGL1fCjOiC?d#HNPE<>gnjZnRrET1FM5h/Euj(#f9d")3O2'YqId"-U:*".(^\q101NEm#WAO5?
Robert Reid Greenwich, Ct,
Beijing Luge Track Aerial View,
Jo March Monologue I'm So Sick Of It,
Homes For Sale By Owner Ebensburg, Pa,
Anthony Williams Football,
Articles A
