This form may be used by any Assurant Employee Benefits customer to request compensation information paid to their producer.
Customer information
*Company name:
*Policy/Participation/Agreement Number:
*Authorized contact name:
*Authorized contact title:
*Phone number:
*Email:
*Mailing address:
*Please select the time period(s) for which you are requesting the compensation paid information:
Policy year
Prior calendar year
Current calendar year-to-date
Other >>
Click Submit to send to Assurant Employee Benefits.
*Required Fields |