Instruction Sheet for Claimant Name and/or Address Changes
There are many reasons why you may need to change a name and/or address on a claim. Please review all the instructions carefully that are outlined below and that are included on the appropriate form(s). This includes instructions for completing the form(s) and instructions outlining what supporting documentation is required based on the reason for your change request.
All completed forms and supporting documentation should be submitted to the Department in one of the following ways:
- Electronic Submission (preferable):
- Submit your completed form(s) & supporting documentation via Email using the instructions below:
- Go to: https://attach.fldfs.com/dropoff
- Enter the following Email in the “To” field: Rehab.ClaimsServices@myfloridacfo.com
- Enter the following in the “Subject” field: Name/Address Change Request
- Attach your documents
- Paper Submission:
- Include your completed form and supporting documentation and mail to:
- Florida Department of Financial Services
Division of Rehabilitation and Liquidation
Attention: Claims Dept. – Change of Name and/or Address
325 John Knox Road
Atrium Building, Suite 101
Tallahassee, FL 32303
The Department reserves the right to validate any name and/or address change request received and may request additional information from you.
If you are requesting an address change only, please click here:
Claimant Address Change Only Request Form
If you are requesting a name change, with or without an address change, please click here:
Claimant Name Change Request Form With or Without Address Change
Additional forms may be required for a name change. Please review the Claimant Name Change Request Form With or Without Address Change instructions to determine whether you are required to complete any of the forms linked below:
Name-Address Estate under 5000 Affidavit
Name-Address Inactive or Dissolved Company Affidavit
Name-Address Inactive or Dissolved Company Owner Deceased Estate Affidavit
If you are requesting an assignment of your claim, please refer to the Assignment of Claims page.
If you require additional assistance, please contact the Receiver by using this link: Contact Us.