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ONE AND THE SAME NAME AFFIDAVIT Please check the box next to your insurance company s name. American States Central United Life First Unum American General Gold Cross Burial Association Investors Consolidated Unilife Loyal American Manhattan Life Unum Family Life POLICY NUMBER swear/affirm that I and Policy Name Application are one and the same person. Claimant Name Signature Date State of County of Before me notary public s name a notary public on this day personally appeared name...
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