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Vermont Insurance Division
Department of Banking, Insurance, Securities and Health Care
Administration
How to Get the Insurance Division Complaint Form
You may
download the complaint form in one of two ways below, or you can call to
request a copy via the U.S. mail. The toll-free number is 1-800-964-1784.
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Get form as a
PDF Document
This format requires an Adobe Acrobat Reader. You
will be able to view the form but not fill it out on line. You must
print out the blank document, complete it, sign it and mail it in
with any related documents.
(If you would like to download free Adobe software,
click
here. |
Get form as a
Writeable MS-Word Document If you use MS-Word, this format will
enable you to download the form to your hard drive and fill out the
gray shaded fields provided right on your screen. You must then
print out the completed document, sign it and mail it in along with
any related documents. |
Special Tips
for Using MS-Word
(Worth the Time to Read):
(1) After
downloading individual documents, create backup copies for future
use.
(2) Next, you may want to
print a blank copy of the document.
This will help you see what information you will need and help you
follow the layout of the application.
(3) This is a form-protected
document, so information can be entered ONLY in the shaded form fields.
To move from field to field use your mouse, the arrow keys or press
TAB. Each form field has a
limited number of characters.
(4) You can use your mouse or
the SPACEBAR to mark and unmark a checkbox.
(5) We do not recommend attempting conversions
to MS-Word formats to other formats, as they generally are not
successful.
Due to
security reasons and other practical considerations, we do not use forms
which can be submitted electronically directly from our web site.
Return to Insurance Division Consumer
Information Page
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