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Deletion Form NYHL0046 7B 020508 doc

Deletion Form NYHL0046 7B 020508 doc 2025

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The document is a request form for the deletion of a person from an insurance policy with American Family Life Assurance Company of New York (Aflac New York). It requires the policyholder to provide personal information, the reason for deletion, and details about a new policyholder if applicable. The form must be completed in blue or black ink, signed, and submitted via mail or fax.

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Click ‘Get Form’ to open the Deletion Form NYHL0046 7B 020508 in the editor.
Begin by entering the Name of the Policyholder. Fill in the Last Name, First Name, and Middle Initial (MI) clearly.
Next, input the Policy Number and Policy Type. Ensure these details are accurate for processing.
Provide the Date of Birth of the Policyholder to verify identity.
In the section for Person to be Deleted, enter their Last Name, First Name, MI, and select their Sex (Male or Female).
Indicate their Relationship to the Policyholder and provide their Address.
Select a Reason for Deletion from options such as Divorce, Death, or Request. If applicable, include relevant dates.
Fill in New Policyholder’s Full Name and Birth Date if there is a change in policy ownership.
Finally, ensure you sign and date the form at the bottom before submitting it via mail or fax.

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