Aflac Direct Deposit Online – Fill Out and Use

Ge n e r a l Accou n t Tr a n sa ct ion & D ir e ct D e posit Au t h or iza t ion

for AFL St ock Pla n Liqu ida t ion s For m

PARTI AL W I TH D RAW AL – CON TI N UE D I V I D EN D REI N V ESTM EN T SELECTI ON S:

□Issue Stock Certificate for _______________________ Whole Shares

FULL W I TH D RAW AL – TERM I N ATE D I V I D EN D REI N V ESTM EN T, BAN K D RAFT AN D D ED UCTI ON S SELECTI ON S:

□Issue stock certificate for whole shares and sell fractional share

( You r f in a n cia l in st it u t ion m u st b e a m e m be r of t h e Au t om a t e d Cle a r in g H ou se ( ACH ) n e t w or k . )

Aflac Incorporated (the Company) is authorized to deposit the proceeds from the liquidation of my shares held in the AFL Stock Plan by electronic funds transfer to the financial institution account indicated by the A T T A CH E D V OID E D D O CU M E N T . The Company is authorized to initiate corrections to any amounts transferred in error and any claim against the Company or the financial institution involved is waived with respect to the operation of this service. The Company and the financial institution reserve the right to terminate this service at any time.

Th is in f or m a t ion w ill n ot be m a in t a in e d on y ou r a ccou n t . I t w ill be r e qu ir e d e a ch t im e y ou r e qu e st a dir e ct de p osit of fu n ds fr om a sa le of st ock fr om y ou r AFL St ock Pla n .

N OTE: Checks and/or deposit slips from financial institutions such as sa vin g s & loa n s, t r u st ba n k s, cr e d it u n ion s, and fe de r a l sa vin g s ba n k s do not always contain the correct information for ACH deposit. Please verify with your financial institution that the bank routing number and the bank account number shown on your attached voided document are the correct numbers to be used with the ACH Network.

In cor r e ct in for m a t ion w ill de la y t h e r e ce ipt of y ou r fu n ds.

□Checking account – At t a ch a V oide d Ch e ck

□Savings account – At t a ch a V oide d D e posit Slip

You r n e t pr oce e ds w ill be se n t t o t h e fin a n cia l in st it u t ion t h a t you spe cifie d 3 bu sin e ss da ys a ft e r t h e t r a de da t e . Be ca u se t h e fu n ds go t o t h e Fe de r a l Re se r ve for pr oce ssin g, ple a se a llow a n a ddit ion a l 1 – 2 bu sin e ss da ys for t h e ba n k t o cr e dit t h e fu n ds t o you r a ccou n t .

______________________________________________________________________________________________________________________________

N ot a r iz a t ion of Sh a r e h olde r Sign a t u r e ( s)

Notarized signatures of ALL SH AREH OLD ERS are required I F the name(s) on the financial institution account to receive funds is N OT EX ACTLY the same as the name(s) on your Aflac Incorporated stock account.

FAX TH I S COM PLETED FORM TO SH AREH OLD ER SERV I CES 7 0 6 . 5 9 6 . 3 4 8 8