Contact Form: Individual Life Policy

To contact American Fidelity's Life Division by e-mail please complete the form below. We are committed to your privacy and understand the importance of protecting your personal information. Please see our privacy policy for more information. An asterisk (*) indicates a required field.

Personal Information

First Name: *

Last Name: *

State of Residence: *

E-mail Address: *

Phone Number: *

Are you a current American Fidelity customer?

Yes
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Preferred contact method

E-mail
Phone

Your Workplace Information

In what type of industry do you work? *

Employer's Name: *

Customer Number:

If applicable. Please provide your customer number or the last four digits of your social security.

Comments/Concerns/Requests

Comments

If you can provide additional information, especially a policy and/or claim number. It helps us address your concern.

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Contact Form: Individual Life Policy

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