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CONFIDENTIAL INFORMATION RELEASE FORM INSTRUCTIONS Life Insurance / Annuity Products MAILING ADDRESS 11825 N. Pennsylvania St. Carmel, IN 46032 FAX NUMBER: (800) 7576324 INSTRUCTIONS TO COMPLETE Forms

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How to fill out confidential information release form

01

Obtain the confidential information release form from the appropriate organization or source.

02

Fill out your personal information such as full name, date of birth, address, and contact information.

03

Specify the details of the information you are authorizing to be released and to whom it may be released to.

04

Sign and date the form to make it legally binding.

05

Submit the completed form to the designated individual or organization.

Who needs confidential information release form?

01

Individuals who want to authorize the release of their confidential information to a specific person or organization.

02

Healthcare providers who need consent to share patient information with other healthcare professionals.

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What is confidential information release form?

Confidential information release form is a document that allows an individual or entity to authorize the release of their confidential information to a specific party or parties.

Who is required to file confidential information release form?

Individuals or entities who wish to disclose their confidential information to a specific party or parties are required to file a confidential information release form.

How to fill out confidential information release form?

To fill out a confidential information release form, one must provide their personal information, specify the information to be released, and authorize the release to the designated party or parties.

What is the purpose of confidential information release form?

The purpose of a confidential information release form is to authorize the disclosure of sensitive or confidential information to specific individuals or organizations.

What information must be reported on confidential information release form?

The information that must be reported on a confidential information release form includes personal details of the individual or entity authorizing the release, the specific information to be disclosed, and the designated party or parties to receive the information.

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