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0000000000 65535 f endobj <> 23 0 obj /BaseFont /Helvetica Aflac Continuing Short Term Disability Claim Form Initial Disability Claim Form https://www.nova.edu/hr/benefits/forms/aflacdisability2017.pdf Please note: The employer is required to report disability benefits paid on pre-tax plans on Form 941 and the employee's Form W-2. In NY, self-funded plans and absence services are administered by and insurance is offered by American Family Life Assurance Company of NY. -8KU)@AZCLegJ8ge%BBp0g(_Y&;BmiFJfS%>@Gu7. )F9)MP$gjIIV>!H
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File a Group Life Insurance or Accidental-Death and Dismemberment Insurance Rider Claim, File a Universal Life Insurance Claim underwritten by Trustmark Insurance Company Claim, File a Universal Life Insurance Claim underwritten by Trustmark Insurance Company, Do Not Sell or Share My Personal Information. ^D"tO6srOZFP9$! 93^8SlqmQZ!1De"\u*GfeLd;np?nPWYSd67)d]ch=uD%XiFi:dZhC'MhDK8OlZ2*YHmB.O$)Wh[*"R,,
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0000054624 00000 n Create your eSignature and click Ok. Press Done. State-paid family leave View more Life insurance View more Long-term disability insurance View more Short-term disability insurance View more Leave of absence View more Contact us 3. endobj << )qT)jZA=U\YiCp>=mtH$[\__]9X3fUD/SEtnbat`
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