Civil Remedy Notice of Insurer Violations
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The Florida Department of Financial Services maintains Civil Remedy records for five years pursuant to IRS Schedule #230.0001.
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Filing
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Complainant
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Street Address
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Email Address
Complainant Type:


Insured
Last/Business Name     First Name  
Policy # Claim #


Attorney
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Street Address
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Email Address


Violation
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Insurer Name
Street Address
City, State Zip ,
Name of individual responsible for violation (if any):    
Type of Insurance
Reason for Notice
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Statutory provision(s) which the insurer allegedly violated.
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Specific policy language that is relevant to the violation.
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Facts and circumstances giving rise to the violation.
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DFS-10-363
Rev. 10/14/2008