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Usted es un(a):

Tema:

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Insured's name:
*
Company name:
*
Nombre:
*
Apellido:
*
Nombre:
*
Organization or group name:
*
Nombre del Agente:
*
Nombre de la agencia:
*
DFS license number:
*

Policy type: *




Policy term:
*
Date of loss:
*

Número de reclamo:


Policy type:




Please provide the indicated item(s) for the above referenced policyholder:
*
Please select at least one option in this section.

Who is the intended recipient?







Attach representation letter or documentation:
*
Accepted document types: .pdf, .doc, .docx, .jpg


Insured's name:
*
Attention to:
*
Street address:
*
City:
*
State:
*
Zip:
*
Requestor's name:
*
Requestor's phone number:
Please enter a phone number with the following format: 555-555-5555
Email address (Required to receive docs):

Please enter a valid email

Re-enter email address:

Please enter a valid email

Requestor's name:
*
Phone number:
Please enter a phone number with the following format: 555-555-5555
DFS license number (general lines Agents only):

Email address:
Please enter a valid email

Re-enter email address:
Please enter a valid email

Correo electrónico:

Escriba una dirección de correo electrónico válida.
Vuelva a ingresar su correo electrónico:
Escriba una dirección de correo electrónico válida.
Phone:
  Please use this format: 555-555-5555
555-555-5555


Event Information

Title:
*
Location:
Address 1
Address 2
City
Date:
*
Time:

Length of presentation:

Number of attendees:
*
Is this a political event? *




Party to claim: *







What type of claim document requested?: *









Comments:


I acknowledge and agree to this Confidentiality Agreement. *

All documents produced by Citizens Property Insurance Corporation in response to the request for documents shall be subject to this Confidentiality Agreement; 2. All documents produced by Citizens Property Insurance Corporation in response to the request for documents will be clearly marked to show that they are subject to this Confidentiality Agreement; 3. The insured(s) and insured's representatives may review all documents produced in response to the request for documents by Citizens Property Insurance Corporation subject to this Confidentiality Agreement; 4. Unless and until ordered by a court of competent jurisdiction, the insured(s) and insured's representatives will not use any such document, including a summary or description thereof, in any fashion, except in connection with the underlying claim; 5. Unless and until ordered by a court of competent jurisdiction, the insured(s) and insured's representatives shall not distribute any such document, including a summary or description thereof, to anyone other than an expert retained on behalf of the insured in connection with the underlying claim. Any expert retained on behalf of the insured is bound by this Confidentiality Agreement. It is the responsibility of insured(s) or insured's representative to advise any expert retained on behalf of the insured of the requirements of this Confidentiality Agreement.
Select this option to request records from Citizens' Records Custodian.

If you need instructions, or sinkhole pamphlet or any other non-specific policy, claim or loss run report, please choose the option of "Other" from the main menu of the Contact Us page. Thank you.


Date:


Description of records needed:
*

Choose how you would like your documents delivered:

*
Re-enter email address
*

Attention to:

Street address:

City:

State:

Zip:


Please enter a number with the following format: 555-555-5555
Please select a pickup location.









If you would like to receive a call when your documents are ready,
or if we have further questions about your request, please enter your
phone number below:
Please enter a number with the following format: 555-555-5555
Cómo comunicarnos con usted:
*
Policy number:
*
Policyholder first name:
*
Policyholder last name:
*
Comentario:
*
Please verify all information prior to submitting request.

*

Favor de completar las áreas requeridas.
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Si usted tiene una pregunta sobre su póliza (solo inglés), le pedimos que primero se comunique con su Agente que podrá ayudarlo a tomar las elecciones adecuadas para sus necesidades de seguro de propiedad.
Bajo la ley de la Florida, direcciones de correo electrónico son datos públicos. Si usted no desea que su dirección de correo electrónico sea publicado en respuesta a una solicitud de datos públicos, favor de no enviar correo electrónico a esta entidad. Comuniquese con nuestra oficina por teléfono o por escrito.

Otros Recursos*

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Oficinas

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Llámenos

Centro de Atención al Cliente
De 8 a.m. a 5:30 p.m.
Días de semana

888.685.1555
Servicio de Referidos de Seguro
Florida Market Assistance Plan (FMAP)

8 a.m.-5:30 p.m.
Días de semana
800.524.9023
www.fmap.org
Reclamos
Reporte un reclamo/estado del reclamo

24 horas al día
866.411.2742
Contabilidad
Consultas Solo de 1099

24 horas al día

Deje un mensaje
866.858.0649 ext. 3720
Sordo o con audición disminuida
Florida Telecommunication Relay Service

24 horas al día
800.955.8771 (TTY)
800.955.8770 (Voz)

www.ftri.org


Escríbanos


Correspondencia de Reclamo
Citizens Property Insurance Corporation
P.O. Box 19700
Jacksonville, FL 32245-9700
Correspondencia que no es de Reclamos
Citizens Property Insurance Corporation
P.O. Box 17219
Jacksonville, FL 32245-7219