Accident Disability Claim form
Accident Wellness Benefit Claim form
Bank Draft form
Cancer/Other Illness Claim form
Critical Illness Claim form
Policy Change form
Policy Change form 1
SHOP Claim form
Wellness Claim form
- After completing the appropriate form(s), you may fax it (them) to State Securities Corp. at 850-385-6913, or . . .
- After completing the appropriate form(s), you may mail it (them) to State Securities, 1836 Hermitage Blvd, Ste. 100, Tallahassee, Fl 32308.
- If you have any questions on completing the forms or if there is a form you cannot find, please call State Securities Corp. at 800-277-2300.