I already have a 21st Century Insurance policy and I have been asked to complete new Florida coverage selection forms. What forms do I need to complete?

The necessary forms and a brief description are listed below. You can open a .pdf version of these forms by clicking on the desired form in the 'File Attachments' section below.

Election of Uninsured Motorist Coverage Florida: AU FL39b 1104

Florida law requires that automobile liability policies include Uninsured Motorist Coverage at limits equal to the Bodily Injury Liability limits in your policy unless you select a lower limit, or reject Uninsured Motorist Coverage entirely. Please print and complete this form.

Election of Non-Stacked Coverage: AU FL50b 1104

You have the option to purchase, at a reduced rate, non-stacked (limited) type of Uninsured Motorist Coverage. Under this form, if injury occurs in a vehicle owned or leased by you or any family member who resides with you, this policy will apply only to the extent of coverage (if any) which applies to that vehicle in this policy. If you do not elect to purchase the non-stacked form, your policy limit(s) for each motor vehicle are added together (stacked) for all covered injuries. Please print and complete this form by indicating your election of stacked or non-stacked coverage.

Once completed, please send or fax the form(s) to the address or fax number listed below.

Mailing Address:

21st Century Insurance
PO Box 15510
Mail Drop: CF 2-8
Wilmington, DE 19850-5510

Physical Address for Overnight Mailing:

Overnight - Correspondence
21st Century Insurance
3 Beaver Valley Rd - 1st Floor
Wilmington, DE 19803

Fax Number: 1 (877) 846-3618

File Attachments

Election of UM Coverage FL.pdf
Election of Stacked/Non-Stacked UM.pdf


State Forms

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