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You are a(n):

Topic:

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Insured's name:
*
Company name:
*
First name:
*
Last name:
*
Name:
*
Organization or group name:
*
Agent's name:
*
Agency name:
*
DFS license number:
*

Policy type: *




Policy term:
*
Date of loss:
*

Claim number:


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

Email:

Please enter a valid email address.
Re-enter email:
Please enter a valid email address.
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:

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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
How to contact you:
*
Policy number:
*
Policyholder first name:
*
Policyholder last name:
*
Comment:
*
Please verify all information prior to submitting request.

*

Please complete the required fields.
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If you have a question about your policy, we encourage you first to contact your Agent who can assist you in making the right choices for your property insurance needs.
Under Florida law, e-mail addresses are public records. If you do not want your e-mail address released in response to a public records request, do not send electronic mail to this entity. Instead, contact this office by phone or in writing.




Call Us

Customer Care Center
8 a.m.-5:30 p.m.
Weekdays

888.685.1555
Insurance Referral Service
Florida Market Assistance Plan (FMAP)

8 a.m.-5:30 p.m.
Weekdays
800.524.9023
www.fmap.org
Claims
Report a claim/status of a claim

24 hours a day
866.411.2742
Accounting
1099 Inquiries Only

24 hours a day

Leave a message
866.858.0649 ext. 3720
Deaf/Hard-of-Hearing
Florida Telecommunication Relay Service

24 hours a day
800.955.8771 (TTY)
800.955.8770 (Voice)

www.ftri.org


Write Us

Claim Correspondence
Citizens Property Insurance Corporation
P.O. Box 19700
Jacksonville, FL 32245-9700
Non-Claim Correspondence
Citizens Property Insurance Corporation
P.O. Box 17219
Jacksonville, FL 32245-7219