Insurance Carrier Forms

Assurant (Fortis)

Assurant Request for Administrative Supplies

Assurant Change Form

Assurant HIPAA Authorization for Release of Protected Health Information Form

Assurant Authorization for Release of Records

Assurant Dental Claim Statement

Assurant Group Life and AD&D Claim Form - Employee Life Form #KC2176G

Assurant Group Life and AD&D Claim Form - Employee Life-Form #KC2176H

Assurant Group Life and AD&D Claim Form - Accidental Death Form #KC2176G

Assurant Group Life and AD&D Claim Form - Accidental Death Form #KC2176H

Assurant Group Life and AD&D Claim Form - Dependent Life Form #KC2176G

Assurant Group Life and AD&D Claim Form - Dependent Life Form #KC2176A

Assurant Dental Employee Application 

Assurant Disability - Long Term Disability Claim Form

Assurant Disability - Long Term Disability Claim Form Addendum

Assurant Disability - Short Term Disability Claim Form

Assurant COBRA DENTAL - Request to Elect Dental COBRA Form