Unum claim form pdf

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Use this claim form to submit a disability claim to Unum. This form should be used for the following types of claims only: • Long Term Disability, or any Claim form. You complete this section. Mr Mrs Miss Dr Other: Date of birth: Full name: Home address: Postcode: Name of employer: Unum Dental membership Use this claim form to apply for disability benefits with Unum. This form should be used for the following types of claims only: • Short Term Disability. Unum Life Insurance Company of America Provident Life and Accident Insurance Use this claim form to submit a Voluntary Benefits Accident claim to Unum. We offer a variety of downloadable forms to make it easy to do business with us. Search our forms library or access our electronic signature and IRS forms Use this claim form to submit the following types of claims to Unum: • Voluntary Benefits Health Screening Benefit. • Voluntary Benefits Wellness Benefit.Use this claim form to submit a disability claim to Unum. This form should be used for the following types of claims only: • Long Term Disability. We can only process claim forms that are accompanied by full proof of payment. post: Unum Dental, Milton Court, Dorking, Surrey RH4 3LZ. Please remember to attach your receipt when sending your claim to Unum Dental. Claim form. Declaration - to be signed by patient (or by member if patient is