American Bankers Insurance Company of Florida
P O Box 4337
Scottsdale, AZ 85261
Phone: 800-423-4403 Fax: 714-712-3845





* Availability of Products Will Vary by State.

W-9 Information

Part 1 - Tax Identification:

Click here for W-9 Instructions 


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Enter your Tax Identification Number (TIN) in the appropriate box.
Note: For individuals, this is your social security number (SSN). For other entities, it is your employer identification number (EIN).

Part 2 - Exemption: If exempt from Form 1099 reporting, check your qualifying exemption reason below:



Part 3 - Signature: I am a U.S. person (including a U.S. resident alien):


Licensing Data Transmittal Authorization

Information and authorization requested in this section applies to all licensed producers who sell flood insurance and is used to ensure producers have appropriate licensing.

Click here for Request Transmittal Procedures 


I understand that if I am a resident of Minnesota/Oklahoma (only) I may obtain a copy of the report ordered, and now indicate my desire to do so by checking this box.

Notice to California Candidates
You have a right to obtain a copy of any consumer report or investigate consumer report obtained by Assurant by checking the box provided below. The report will be provided to you within three (3) business days after we receive the requested reports related to the matter investigated. I request to receive a free copy of this report by checking this box.

General Agent / Managing General Agent Information

Managing General Agent Information

General Agent Information

General Agent or Managing General Agent Section

Managing General Agent Section

General Agent Section

Producing Agency Information

Agency - Complete all sections & include a copy of the Agency License


(*Note: You will be required to provide a copy of your P&C license for each state selected. Licensed NY producers may also be required to provide a broker license.)



Producer/Agent Information

Producing Agent Section - Complete all sections

Note: Each Producing Agent must complete a new producer form and provide a copy of their license(s)


(*Note: You will be required to provide a copy of your P&C license for each state selected. Licensed NY producers may also be required to provide a broker license.)




Flood Continuing Education

Completion of a Flood Training Course is required before an agent can sell Flood policies. Please complete the section below with the pertinent data of the course taken satisfying this requirement.

I attest that I have complied with the minimum flood training requirements set by FEMA and/or the states in which I am licensed to write flood, through an education provider approved by the state(s) in which I'm licensed to write this insurance. I also attest that the information provided on this web form is correct and that I am the individual producer writing this flood policy.

Non-Licensed/Non Producing System Users

Use this section to request view only CSR level access for non-licensed/non-producing users.

First Name
Last Name
Email
Role

Upload Required Document(s)

Before submitting this package, please upload copies of applicable agency and/or producer licenses. You may upload multiple licenses at the same time.

State Requirements:
Licensed NY producers may also be required to upload their broker license.

Note: Missing licenses will delay processing.

Error! Please scroll up to provide one of the below missing required input(s) and try Upload again:
  - Agency Name* (Located at the top of the form)
  - Email for Principal/W9 Signee* (Located in Producing Agency Information Section of form)
Error! Please scroll up to provide one of the below missing required input(s) and try Upload again:
  - Agency Name* (Located at the top of the form)
  - Email for Principal/Contract Signee* (Located in Producing Agency Information Section of form)
Error! Please scroll up to provide one of the below missing required input(s) and try Upload again:
  - Agency Name* (Located at the top of the form)
  - Producer/Agent Email address* (Located in Producer/Agent Information Section of form)
Error! Please scroll up to provide one of the below missing required input(s) and try Upload again:
  - Agency Name* (Located at the top of the form)
  - Producer/Agent Email address* (Located in Producer/Agent Information Section of form)
Error! Please upload copies of applicable agency and/or producer licenses.
Alert! Please include license and all other related documents for each state, as noted above (for each producer).
Note! To re-generate Package, please click Generate Package for Signature(s) button to submit request again.


Note! If you have other producers or non-licensed system users who need to enroll, you can forward this link/URL to them to use to complete New Producer or Add Non-Licensed System User form(s) as applicable.
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