Florida Department of Financial Services Forms
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Form EAO1 "Request for Assistance" - Florida
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6 votes
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65 KB
2 pages
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Instructions for Form UB-04, CMS-1450 "Institutional Billing Form (Nursing Home Facilities)" - Florida
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26 votes
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217 KB
10 pages
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Instructions for Form UB-04, CMS-1450 "Institutional Billing Form (Ambulatory Surgical Centers)" - Florida
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22 votes
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228 KB
12 pages
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Instructions for Form UB-04, CMS-1450 "Institutional Billing Form (Home Health Agencies)" - Florida
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18 votes
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216 KB
11 pages
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Form DFS-UP-155 "Safe Deposit Box Inventory Form of Property Presumed Unclaimed" - Florida
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28 votes
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93 KB
4 pages
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Form DFS-DO-855 "Statement - Lightning Losses - State Risk Management Trust Fund" - Florida
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61 votes
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78 KB
1 page
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Form DFS-H2-72 "Public Adjuster's Bond" - Florida
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33 votes
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243 KB
2 pages
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Form 09-1 "Application for Drug-Free Workplace Premium Credit Program" - Florida
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11 votes
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16 KB
1 page
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Instructions for Form CMS-1450 "Institutional Billing Form (Hospitals)" - Florida
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7 votes
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275 KB
12 pages
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Instructions for Form CMS-1500 "Health Insurance Claim Form (Ambulatory Surgical Centers)" - Florida
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9 votes
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97 KB
12 pages
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Form DFS-H2-503 "Bail Bond Rate Filing" - Florida
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(4.4 / 5)
32 votes
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181 KB
2 pages
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Form DFS-H2-591 "Mediator Application" - Florida
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(4.7 / 5)
58 votes
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60 KB
4 pages
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Form DFS-H2-376 "Application for Life License and Appointment - U.S. Foreign Military Installation" - Florida
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(4.6 / 5)
84 votes
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168 KB
2 pages
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Form DFS-H2-460 "Request for Extension of Time" - Florida
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80 votes
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114 KB
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Form DFS-H2-501 "Appointment Form" - Florida
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(4.4 / 5)
40 votes
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1 MB
3 pages
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Form DFS-A1-26E "Vendor Direct Deposit Authorization" - Florida
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61 votes
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152 KB
2 pages
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Form DFS-A1-409 "Affidavit Attesting to Forgery" - Florida
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(4.3 / 5)
30 votes
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181 KB
2 pages
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Form OFR-S-10-91 "Report of Sales of Securities and Use of Proceeds Therefrom" - Florida
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(4.8 / 5)
104 votes
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14 KB
2 pages
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Form DFS-H2-504 "Professional Bail Bond Agent Financial Statement" - Florida
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(4.8 / 5)
34 votes
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144 KB
3 pages
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Form DFS-A6-692 "Payment of Court-Related Fees, Charges, Costs, Fines, and Other Monetary Penalties" - Florida
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(4.4 / 5)
67 votes
Size:
16 KB
3 pages
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Form DFS-A1-408 "Affidavit for Duplicate Warrant" - Florida
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(4.8 / 5)
45 votes
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118 KB
3 pages
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Form DFS-H2-569 "Registration of Fraternal Benefit Society Representatives" - Florida
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(4.8 / 5)
74 votes
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73 KB
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Form DFS-H2-1541 "Designation or Deletion of Primary Bail Bond Agent" - Florida
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(4.7 / 5)
17 votes
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489 KB
1 page
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Form DFS-H2-1428 "Agent Qualification and Verification of Experience Form" - Florida
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202 votes
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264 KB
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Form DFS-H2-6364 "Designation/Deletion of Primary Adjuster for Adjusting Firm and Filing of Firm, Corporation, or Business Name Change" - Florida
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(4.5 / 5)
47 votes
Size:
113 KB
3 pages
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Form DFS-H2-1783 "Neutral Evaluator Application" - Florida
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40 votes
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44 KB
3 pages
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Form DFS-H2-1088 "Reinsurance Intermediary Application Individual" - Florida
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83 votes
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168 KB
5 pages
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Form DFS-H2-1087 "Reinsurance Intermediary Application Firms" - Florida
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(4.3 / 5)
72 votes
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241 KB
6 pages
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Form DFS-H2-1124 "Designation or Deletion of Supervising Agent for Customer Representatives and Limited Customer Representatives" - Florida
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89 votes
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1 MB
2 pages
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Form DFS-A1-2145 "Object Code Add or Update Request Form" - Florida
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46 votes
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55 KB
2 pages
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Form DFS-H2-1109 "Reduction of Continuing Education Requirement" - Florida
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99 votes
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58 KB
1 page
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Form DFS-H2-1105 "Affidavit of Insurance Activity While Not Properly Appointed" - Florida
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34 votes
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48 KB
1 page
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Form DFS-H2-1543 "Temporary Bail Bond Agent Employment Report" - Florida
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(4.7 / 5)
55 votes
Size:
307 KB
3 pages
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Form DFS-A3-1932 "Fica Refund Request or Ops Fica Alternative Retirement Plan Contribution Refund Request" - Florida
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(4.6 / 5)
75 votes
Size:
202 KB
2 pages
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Form DFS-H2-1542 "Statement of Surrender Form" - Florida
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60 votes
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114 KB
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Form DFS-H2-1509 "Temporary Bail Bond Agent Mandatory Employment Verification" - Florida
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81 votes
Size:
38 KB
1 page
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Form DFS-H2-1564 "Bail Bond Agent Notice of Change of Address" - Florida
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60 votes
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57 KB
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Form DFS-F1-PW-2 "Preferred Worker Reimbursement Request" - Florida
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(4.8 / 5)
11 votes
Size:
11 KB
1 page
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![Form EAO1 "Request for Assistance" - Florida](https://data.templateroller.com/pdf_docs_html/1763/17639/1763938/form-eao1-request-for-assistance-florida.png "Form EAO1 "Request for Assistance" - Florida")
![Instructions for Form UB-04, CMS-1450 "Institutional Billing Form (Nursing Home Facilities)" - Florida](https://data.templateroller.com/pdf_docs_html/1763/17639/1763932/instructions-for-form-ub-04-cms-1450-institutional-billing-form-nursing-home-facilities-florida.png "Instructions for Form UB-04, CMS-1450 "Institutional Billing Form (Nursing Home Facilities)" - Florida")
![Instructions for Form UB-04, CMS-1450 "Institutional Billing Form (Ambulatory Surgical Centers)" - Florida](https://data.templateroller.com/pdf_docs_html/1763/17639/1763930/instructions-for-form-ub-04-cms-1450-institutional-billing-form-ambulatory-surgical-centers-florida.png "Instructions for Form UB-04, CMS-1450 "Institutional Billing Form (Ambulatory Surgical Centers)" - Florida")
![Instructions for Form UB-04, CMS-1450 "Institutional Billing Form (Home Health Agencies)" - Florida](https://data.templateroller.com/pdf_docs_html/1763/17639/1763931/instructions-for-form-ub-04-cms-1450-institutional-billing-form-home-health-agencies-florida.png "Instructions for Form UB-04, CMS-1450 "Institutional Billing Form (Home Health Agencies)" - Florida")
![Form DFS-UP-155 "Safe Deposit Box Inventory Form of Property Presumed Unclaimed" - Florida](https://data.templateroller.com/pdf_docs_html/525/5253/525351/form-dfs-up-155-safe-deposit-box-inventory-form-property-presumed-unclaimed-florida.png "Form DFS-UP-155 "Safe Deposit Box Inventory Form of Property Presumed Unclaimed" - Florida")
![Form DFS-DO-855 "Statement - Lightning Losses - State Risk Management Trust Fund" - Florida](https://data.templateroller.com/pdf_docs_html/1784/17847/1784715/form-dfs-do-855-statement-lightning-losses-state-risk-management-trust-fund-florida.png "Form DFS-DO-855 "Statement - Lightning Losses - State Risk Management Trust Fund" - Florida")
![Form DFS-H2-72 "Public Adjuster's Bond" - Florida](https://data.templateroller.com/pdf_docs_html/1784/17841/1784129/form-dfs-h2-72-public-adjuster-s-bond-florida.png "Form DFS-H2-72 "Public Adjuster's Bond" - Florida")
![Form 09-1 "Application for Drug-Free Workplace Premium Credit Program" - Florida](https://data.templateroller.com/pdf_docs_html/1763/17639/1763933/form-09-1-application-for-drug-free-workplace-premium-credit-program-florida.png "Form 09-1 "Application for Drug-Free Workplace Premium Credit Program" - Florida")
![Instructions for Form CMS-1450 "Institutional Billing Form (Hospitals)" - Florida](https://data.templateroller.com/pdf_docs_html/1763/17639/1763929/instructions-for-form-cms-1450-institutional-billing-form-hospitals-florida.png "Instructions for Form CMS-1450 "Institutional Billing Form (Hospitals)" - Florida")
![Instructions for Form CMS-1500 "Health Insurance Claim Form (Ambulatory Surgical Centers)" - Florida](https://data.templateroller.com/pdf_docs_html/1763/17639/1763925/instructions-for-form-cms-1500-health-insurance-claim-form-ambulatory-surgical-centers-florida.png "Instructions for Form CMS-1500 "Health Insurance Claim Form (Ambulatory Surgical Centers)" - Florida")
![Form DFS-H2-503 "Bail Bond Rate Filing" - Florida](https://data.templateroller.com/pdf_docs_html/1784/17841/1784131/form-dfs-h2-503-bail-bond-rate-filing-florida.png "Form DFS-H2-503 "Bail Bond Rate Filing" - Florida")
![Form DFS-H2-591 "Mediator Application" - Florida](https://data.templateroller.com/pdf_docs_html/1784/17841/1784134/form-dfs-h2-591-mediator-application-florida.png "Form DFS-H2-591 "Mediator Application" - Florida")
![Form DFS-H2-376 "Application for Life License and Appointment - U.S. Foreign Military Installation" - Florida](https://data.templateroller.com/pdf_docs_html/1784/17841/1784122/form-dfs-h-2-376-application-life-license-and-appointment-u-s-foreign-military-installation-florida.png "Form DFS-H2-376 "Application for Life License and Appointment - U.S. Foreign Military Installation" - Florida")
![Form DFS-H2-460 "Request for Extension of Time" - Florida](https://data.templateroller.com/pdf_docs_html/1784/17841/1784118/form-dfs-h-2-460-request-extension-time-florida.png "Form DFS-H2-460 "Request for Extension of Time" - Florida")
![Form DFS-H2-501 "Appointment Form" - Florida](https://data.templateroller.com/pdf_docs_html/1784/17841/1784137/form-dfs-h2-501-appointment-form-florida.png "Form DFS-H2-501 "Appointment Form" - Florida")
![Form DFS-A1-26E "Vendor Direct Deposit Authorization" - Florida](https://data.templateroller.com/pdf_docs_html/1765/17650/1765011/form-dfs-a-1-26e-vendor-direct-deposit-authorization-florida.png "Form DFS-A1-26E "Vendor Direct Deposit Authorization" - Florida")
![Form DFS-A1-409 "Affidavit Attesting to Forgery" - Florida](https://data.templateroller.com/pdf_docs_html/1765/17650/1765013/form-dfs-a-1-409-affidavit-attesting-to-forgery-florida.png "Form DFS-A1-409 "Affidavit Attesting to Forgery" - Florida")
![Form OFR-S-10-91 "Report of Sales of Securities and Use of Proceeds Therefrom" - Florida](https://data.templateroller.com/pdf_docs_html/591/5915/591535/form-ofr-s-10-91-report-sales-securities-and-use-proceeds-therefrom-florida.png "Form OFR-S-10-91 "Report of Sales of Securities and Use of Proceeds Therefrom" - Florida")
![Form DFS-H2-504 "Professional Bail Bond Agent Financial Statement" - Florida](https://data.templateroller.com/pdf_docs_html/1767/17674/1767405/form-dfs-h-2-504-professional-bail-bond-agent-financial-statement-florida.png "Form DFS-H2-504 "Professional Bail Bond Agent Financial Statement" - Florida")
![Form DFS-A6-692 "Payment of Court-Related Fees, Charges, Costs, Fines, and Other Monetary Penalties" - Florida](https://data.templateroller.com/pdf_docs_html/1765/17650/1765008/form-dfs-a-6-692-payment-court-related-fees-charges-costs-fines-and-other-monetary-penalties-florida.png "Form DFS-A6-692 "Payment of Court-Related Fees, Charges, Costs, Fines, and Other Monetary Penalties" - Florida")
![Form DFS-A1-408 "Affidavit for Duplicate Warrant" - Florida](https://data.templateroller.com/pdf_docs_html/1765/17650/1765012/form-dfs-a-1-408-affidavit-duplicate-warrant-florida.png "Form DFS-A1-408 "Affidavit for Duplicate Warrant" - Florida")
![Form DFS-H2-569 "Registration of Fraternal Benefit Society Representatives" - Florida](https://data.templateroller.com/pdf_docs_html/1784/17841/1784135/form-dfs-h2-569-registration-fraternal-benefit-society-representatives-florida.png "Form DFS-H2-569 "Registration of Fraternal Benefit Society Representatives" - Florida")
![Form DFS-H2-1541 "Designation or Deletion of Primary Bail Bond Agent" - Florida](https://data.templateroller.com/pdf_docs_html/2021/20219/2021912/form-dfs-h2-1541-designation-or-deletion-of-primary-bail-bond-agent-florida.png "Form DFS-H2-1541 "Designation or Deletion of Primary Bail Bond Agent" - Florida")
![Form DFS-H2-1428 "Agent Qualification and Verification of Experience Form" - Florida](https://data.templateroller.com/pdf_docs_html/1784/17841/1784128/form-dfs-h2-1428-agent-qualification-and-verification-experience-form-florida.png "Form DFS-H2-1428 "Agent Qualification and Verification of Experience Form" - Florida")
![Form DFS-H2-6364 "Designation/Deletion of Primary Adjuster for Adjusting Firm and Filing of Firm, Corporation, or Business Name Change" - Florida](https://data.templateroller.com/pdf_docs_html/1784/17841/1784123/form-dfs-h-2-6364-designation-deletion-primary-adjuster-adjusting-firm-and-filing-firm-corporation-or-business-name-change-florida.png "Form DFS-H2-6364 "Designation/Deletion of Primary Adjuster for Adjusting Firm and Filing of Firm, Corporation, or Business Name Change" - Florida")
![Form DFS-H2-1783 "Neutral Evaluator Application" - Florida](https://data.templateroller.com/pdf_docs_html/1784/17841/1784127/form-dfs-h2-1783-neutral-evaluator-application-florida.png "Form DFS-H2-1783 "Neutral Evaluator Application" - Florida")
![Form DFS-H2-1088 "Reinsurance Intermediary Application Individual" - Florida](https://data.templateroller.com/pdf_docs_html/1784/17841/1784144/form-dfs-h2-1088-reinsurance-intermediary-application-individual-florida.png "Form DFS-H2-1088 "Reinsurance Intermediary Application Individual" - Florida")
![Form DFS-H2-1087 "Reinsurance Intermediary Application Firms" - Florida](https://data.templateroller.com/pdf_docs_html/1784/17841/1784142/form-dfs-h2-1087-reinsurance-intermediary-application-firms-florida.png "Form DFS-H2-1087 "Reinsurance Intermediary Application Firms" - Florida")
![Form DFS-H2-1124 "Designation or Deletion of Supervising Agent for Customer Representatives and Limited Customer Representatives" - Florida](https://data.templateroller.com/pdf_docs_html/1784/17841/1784132/form-dfs-h2-1124-designation-or-deletion-supervising-agent-customer-representatives-and-limited-customer-representatives-florida.png "Form DFS-H2-1124 "Designation or Deletion of Supervising Agent for Customer Representatives and Limited Customer Representatives" - Florida")
![Form DFS-A1-2145 "Object Code Add or Update Request Form" - Florida](https://data.templateroller.com/pdf_docs_html/1765/17650/1765009/form-dfs-a-1-2145-object-code-add-or-update-request-form-florida.png "Form DFS-A1-2145 "Object Code Add or Update Request Form" - Florida")
![Form DFS-H2-1109 "Reduction of Continuing Education Requirement" - Florida](https://data.templateroller.com/pdf_docs_html/1784/17841/1784119/form-dfs-h2-1109-reduction-continuing-education-requirement-florida.png "Form DFS-H2-1109 "Reduction of Continuing Education Requirement" - Florida")
![Form DFS-H2-1105 "Affidavit of Insurance Activity While Not Properly Appointed" - Florida](https://data.templateroller.com/pdf_docs_html/1784/17841/1784139/form-dfs-h2-1105-affidavit-insurance-activity-while-not-properly-appointed-florida.png "Form DFS-H2-1105 "Affidavit of Insurance Activity While Not Properly Appointed" - Florida")
![Form DFS-H2-1543 "Temporary Bail Bond Agent Employment Report" - Florida](https://data.templateroller.com/pdf_docs_html/1784/17841/1784149/form-dfs-h2-1543-temporary-bail-bond-agent-employment-report-florida.png "Form DFS-H2-1543 "Temporary Bail Bond Agent Employment Report" - Florida")
![Form DFS-A3-1932 "Fica Refund Request or Ops Fica Alternative Retirement Plan Contribution Refund Request" - Florida](https://data.templateroller.com/pdf_docs_html/1765/17650/1765010/form-dfs-a-3-1932-fica-refund-request-or-ops-fica-alternative-retirement-plan-contribution-refund-request-florida.png "Form DFS-A3-1932 "Fica Refund Request or Ops Fica Alternative Retirement Plan Contribution Refund Request" - Florida")
![Form DFS-H2-1542 "Statement of Surrender Form" - Florida](https://data.templateroller.com/pdf_docs_html/1784/17841/1784133/form-dfs-h2-1542-statement-surrender-form-florida.png "Form DFS-H2-1542 "Statement of Surrender Form" - Florida")
![Form DFS-H2-1509 "Temporary Bail Bond Agent Mandatory Employment Verification" - Florida](https://data.templateroller.com/pdf_docs_html/1784/17841/1784198/form-dfs-h2-1509-temporary-bail-bond-agent-mandatory-employment-verification-florida.png "Form DFS-H2-1509 "Temporary Bail Bond Agent Mandatory Employment Verification" - Florida")
![Form DFS-H2-1564 "Bail Bond Agent Notice of Change of Address" - Florida](https://data.templateroller.com/pdf_docs_html/1784/17841/1784126/form-dfs-h2-1564-bail-bond-agent-notice-change-address-florida.png "Form DFS-H2-1564 "Bail Bond Agent Notice of Change of Address" - Florida")
![Form DFS-F1-PW-2 "Preferred Worker Reimbursement Request" - Florida](https://data.templateroller.com/pdf_docs_html/1763/17639/1763936/form-dfs-f1-pw-2-preferred-worker-reimbursement-request-florida.png "Form DFS-F1-PW-2 "Preferred Worker Reimbursement Request" - Florida")
