Unum AE-1172-NY 2013-2026 free printable template

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First UNM Life Insurance Company Provident Life and Casualty Insurance Company The Paul Revere Life Insurance Company As part of your enrollment for insurance with UNM, please complete this form and

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How to fill out Unum AE-1172-NY

01

Obtain a blank Unum AE-1172-NY form from the Unum website or your employer.

02

Read the instructions carefully on the form to understand the required information.

03

Fill in your personal details in the designated fields, including your name, address, and contact information.

04

Provide details regarding your employment, such as your job title, department, and the date you began employment.

05

Indicate the reason for filling out the form, including any relevant medical information or claims.

06

Review the filled form for accuracy and completeness before signing.

07

Sign and date the form at the bottom, certifying that all provided information is true to the best of your knowledge.

08

Submit the completed form as instructed, either online or by mailing it to the appropriate Unum address.

Who needs Unum AE-1172-NY?

01

Employees who are applying for short-term or long-term disability benefits through Unum.

02

Individuals who are requesting information regarding their eligibility for benefits.

03

People who need to document a claim for loss of income due to illness or injury.

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What is Unum AE-1172-NY?

Unum AE-1172-NY is a specific form used in New York for reporting certain types of insurance claims or benefits.

Who is required to file Unum AE-1172-NY?

Entities or individuals who are processing insurance claims or benefits that fall under the regulations of New York state are required to file Unum AE-1172-NY.

How to fill out Unum AE-1172-NY?

To fill out Unum AE-1172-NY, you need to provide the required information accurately, including claimant details, policy numbers, and specific benefits being claimed as per the instructions provided on the form.

What is the purpose of Unum AE-1172-NY?

The purpose of Unum AE-1172-NY is to ensure proper documentation and reporting of insurance claims in compliance with New York state regulations.

What information must be reported on Unum AE-1172-NY?

Information that must be reported on Unum AE-1172-NY includes claimant's personal information, policy details, type of claim, and any relevant supporting information required by the form.

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