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LIFE - HEALTH - DENTAL - MEDICARE -AFLAC

IMPORTANT NOTE:  When shopping for a Medicare Advantage or Medicare Drug Plan (Part D), The Centers for Medicare and Medicaid Services requires agents to document the scope of a marketing appointment prior to any sales meeting to ensure understanding of what will be discussed between the agent and the Medicare beneficiary (or their authorized representative). All information provided on this form is confidential and should be completed by each person with Medicare or his/her authorized representative.

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