Address change request formPage 1 of 1 ADDRESS_CHANGE (04/20) Fs/f Long Term Care Claims Address...
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Page 1 of 1 Fs/f ADDRESS_CHANGE (04/20) Long Term Care Claims Address change request form Metropolitan Life Insurance Company Things to know before you begin • Use this form for changing the mailing address of correspondence SECTION 1: Claimant's information (Please print name of insured and address below) Regarding the MetLife Long-Term Care coverage for: First name Middle name Last name Group or Policy Number Date of birth (mm/dd/yyyy) I would like to request to change the mailing address for all correspondence for the claimant listed above to the following new address: Address City State ZIP Additionally, the home phone number should be listed as Signature of Claimant Date (mm/dd/yyyy) Signature of POA or Executor (if applicable) Date (mm/dd/yyyy) SECTION 2: How to submit this form Mail: MetLife Long Term Care Claims P.O. Box 14407 Lexington, KY 40512-9800 Fax: 866-722-1180 Email: [email protected]
Transcript of Address change request formPage 1 of 1 ADDRESS_CHANGE (04/20) Fs/f Long Term Care Claims Address...
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Page 1 of 1 Fs/fADDRESS_CHANGE (04/20)
Long Term Care Claims
Address change request form Metropolitan Life Insurance Company
Things to know before you begin • Use this form for changing the mailing address of correspondence
SECTION 1: Claimant's information (Please print name of insured and address below) Regarding the MetLife Long-Term Care coverage for:
First name Middle name Last name
Group or Policy Number Date of birth (mm/dd/yyyy)
I would like to request to change the mailing address for all correspondence for the claimant listed above to the following new address:Address City State ZIP
Additionally, the home phone number should be listed as
Signature of Claimant Date (mm/dd/yyyy)
Signature of POA or Executor (if applicable) Date (mm/dd/yyyy)
SECTION 2: How to submit this formMail: MetLife Long Term Care Claims P.O. Box 14407 Lexington, KY 40512-9800
Fax: 866-722-1180
Email: [email protected]
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ADDRESS_CHANGE (04/20)
..\Desktop\Forms\2017\Feb\3 Feb\18330 Internal Rebranding Standards\Source\Files\MetLife_RGB_25in_300dpi.jpg
Long Term Care Claims
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ADDRESS_CHANGE (04/20)
10.0.2.20120224.1.869952.867557
Address change request form
Metropolitan Life Insurance Company
Things to know before you begin
• Use this form for changing the mailing address of correspondence
SECTION 1: Claimant's information (Please print name of insured and address below)
Regarding the MetLife Long-Term Care coverage for:
I would like to request to change the mailing address for all correspondence for the claimant
listed above to the following new address:
..\..\..\..\Medlife Logo\Icon_SignHere_RGB_BLUE.jpg
..\..\..\..\Medlife Logo\Icon_SignHere_RGB_BLUE.jpg
SECTION 2: How to submit this form
Mail:
MetLife
Long Term Care Claims
P.O. Box 14407
Lexington, KY 40512-9800
Fax:
866-722-1180
Email:
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CurrentPageNumber: NumberofPages: FirstName: MiddleName: LastName: Owner_DateOfBirth: _Line1: _City: _State: _Zip: Owner_FullPhone: SignDate1:
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