separator
Skip to Contentseparator HomeseparatorCheck License StatussepartorContact UssepartorRequest for Assistance
Welcome to the California Department of Insurance
Site tools
Decrease font size Increase font size Site map Help Print-friendly version
Printable Request for Assistance Form

Open the printable Request for Assistance form.

Once filled out, print the completed form and mail along with copies of your supporting documentation to the California Department of Insurance.

Note: You will need Adobe Acrobat Reader in order to view, download, or print the Consumer Request for Assistance form To download the free Adobe Acrobat Reader, please see the "Free Document Readers" link at the bottom of this page.

If you are still unable to view, download, or print the Consumer Request for Assistance form, please contact the Department's Consumer Hotline at 1-800-927-HELP [4357] and our staff will mail a hard copy of the Consumer Request for Assistance form to you.

     

separator