BUREAU OF CLAIMS ADMINISTRATION

FORMS

(Files are in Adobe Acrobat 5.0 reader version.)

Click on a link below to view form.

 Worker’s Compensation  

              Attendant Care Form.pdf

              DWC-1a Wage Statement.pdf

              Mileage Reimbursement Form.pdf

              DWC-19 Employee Earnings Rpt.pdf

 State Property Insurance Coverage 

             Notice of Property Loss

             Statement - Lightning Losses

             Procedures in the Event of a Loss

             Property Coverage Request Form 

 State Liability

            Automobile Accident Report  (For State Agencies)

           Statement of Accident   (For Auto Claimants)

           General Liability Loss Report 

           Statement of Claim 

           What To Do In Case Of An Automobile Accident "Know Before You Go"

CONSUMER HELPLINE 1-877-693-5236

Florida Department of Financial Services · Division of Risk Management · 200 East Gaines St. · Tallahassee, FL 32399-0336 · LegalNotices

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in response to a public request, do not send electronic mail to this entity. Instead, contact this office by

phone or in writing. Public records from the Department of Financial Services are available by

request.  Public Records Request