Assurant

Accident Claim form
Bank Draft form
Cancer Claim form
Disability Claim form
Heart/Stroke Claim form
Policy Change form

Instructions:

• 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, P.O. Box 13547, Tallahassee, Fl  32317-3547.
• 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.