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Send aflac wellness claim form via email, link, or fax. Adobe acrobat document [82.2 kb]. Policyholder name policyholder street address city state zip birthdate american family life assurance company of columbus aflac attn claims department 1932.

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Share your form with others. Each form is a microsoft word paper formatted as well. Adobe acrobat document [121.8 kb].

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Your signature must be notarized only if the claim amount is. You can also download it, export it or print it out. Failure to completeall sections may result in delayed processing of this claim.

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