Request Other Forms or Information

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Please send the following:

Change of Beneficiary Form for my The Hartford coverage

Bank Draft Authorization Form for coverages billed by AmWINS

The Hartford Hospital Claim Form

Chubb Cancer Claim Form

Transamerica Cancer Claim Form

Change my billing/payment mode as of my next premium billing to:

Quarterly

Semi-Annual

Annual

Copy of my certificate of insurance. If you have multiple coverages, please indicate which coverage certificate you need:

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