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If you move after submitting a Proof of Claim form, it is your responsibility to inform the Liquidator of your new address.  Failure to do so may result in your claim being barred from participating in any distribution of assets.  You may change your address using the form below or submit, in writing, your new address to The Office of the Ohio Insurance Liquidator.

            (Bold) Required Field
 
Your Name
Your E-mail
Company Name
Liquidator Number
 
Original Address Information
Original Address 1
Original Address 2
Original City
Original State
Original Zip Code
 
New Address Information
New Address 1
New Address 2
New City
New State
New Zip Code
New Home Phone
New Work Phone
 
Comments
 
    

 
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Change Of Address Form