Fillable aflac flex form

Description
Flex One /Flexible Spending Account Claim Form Please fax this signed and completed form to 1-877-353-9256. For Customer Service please call 1-877-353-9487. 1. Participant Information and Signature By submitting this claim form I participant named below request reimbursement from my Flexible Spending Account s as listed below. I agree to the Terms and Conditions stated below I certify and warrant to Aflac that...
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