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Domestic Partner Affidavit - Anthem 2026
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- Click ‘Get Form’ to open the Domestic Partner Affidavit - Anthem in the editor.
- Begin with Section 1: Employee Information. Fill in your last name, first name, plan identification number, group name, group number, and date.
- Move to Section 2: Declaration of Fact. Carefully read each statement and confirm your eligibility by checking the boxes that apply to you and your domestic partner.
- In Section 3: Change in Domestic Partnership, acknowledge your responsibility to notify the Group of any changes by signing and dating the affidavit at the bottom.
- Ensure both partners sign and provide their addresses and email addresses. If required, complete the Notary Public section for validation.
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| Versions | Form popularity | Fillable & printable |
|---|---|---|
| 2012 | 4 Satisfied (21 Votes) |
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