Safe Travels Accidental Death and Dismemberment Claim Form Safe Travels Accidental Death and Dismemb 2025

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Safe Travels Accidental Death and Dismemberment Claim Form Safe Travels Accidental Death and Dismemb Preview on Page 1

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  1. Click ‘Get Form’ to open it in the editor.
  2. Begin by completing the Claimant Section on the front of the form. Fill in your Plan Name, Insured’s Name, Social Security Number, Date of Birth, and your relationship to the insured.
  3. Read and sign the Authorization and Legal notice section located on the back of the form. This is crucial for processing your claim.
  4. Have your doctor complete the Physician’s Statement on the back of this form. Ensure all necessary details are filled out accurately.
  5. Answer all questions thoroughly in the designated sections. Missing information can delay your claim process.
  6. Finally, forward this completed form to your Administrator at the address provided at the top of the form.

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