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REQUEST FOR CHANGE American Family Life Assurance …

Form H-L0046 1 (R 10/18) REQUEST FOR CHANGE American Family Life Assurance Company of Columbus (herein referred to as Aflac) ATTENTION: POLICYHOLDER SERVICES (PHS) Worldwide Headquarters 1932 Wynnton Road Columbus, GA 31999 For information call toll-free ( ) Toll-Free Fax: Pre-tax After-tax Name of Policyholder/Certificateholder SSN Last Name First Name MI Suffix Policy/Certificate Number Policy/Certificate Type Dat

REQUEST FOR CHANGE American Family Life Assurance Company of Columbus (herein referred to as Aflac) ATTENTION: POLICYHOLDER SERVICES (PHS) Worldwide Headquarters • 1932 Wynnton Road • Columbus, GA 31999 For information call toll-free 1.800.99.AFLAC (1.800.992.3522) Toll-Free Fax: 1.800.448.8922 Pre-tax After-tax

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