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73409101 P.O. Box 2612 • Birmingham, Alabama 35244 N A C …

To evaluate your insurability, the Insurer named above (the Insurer) has requested that you provide a [sample of your body fluids and/or tissues]biological specimenfor testing and analysis to determine the presence of human immunodeficiency virus (HIV) antibodies.

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  Biological, Fluid, Tissue, Fluids and or tissues

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Transcription of 73409101 P.O. Box 2612 • Birmingham, Alabama 35244 N A C …

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