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Get FL AIG AGLC108250-FL-2015 2017

of New York, 175 Water St, New York, NY 10038 A member of American International Group, Inc. (AIG) Mailing Instructions: Send form(s) to P.O. Box 305355 • Nashville, TN 37230-5355 Faxing Instructions: Fax form(s) to 1-844-930-0370 The insurance company checked above (“Company”) is responsible for the obligation and payment of benefits under any policy that it may issue. No other company is responsible for such obligations or payments. Policy Number(s) ___________________________________.

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