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Anthem Blue Cross Life and Health Insurance Company P.O. Box 9051 Oxnard, CA 930319051 Tel 8666368991 www.anthem.com Date Name Address Care of City, State ZIP Dear Name: ACID Plan Name/Contract Code

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Step 1: Gather all the necessary information such as personal details, contact information, and medical history.

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Anformm blue cross life is a form filled out by individuals to apply for Blue Cross life insurance.

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