Domestic Partner Affidavit - Anthem 2026

1. Click ‘Get Form’ to open the Domestic Partner Affidavit - Anthem in the editor.
2. Begin with Section 1: Employee Information. Fill in your last name, first name, plan identification number, group name, group number, and date.
3. 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.
4. 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.
5. Ensure both partners sign and provide their addresses and email addresses. If required, complete the Notary Public section for validation.

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