M-1644m (11/2008)
M-1644m (11/2008)
FLORIDA UNINSURED MOTORISTS COVERAGE ELECTION NOTICE
YOU ARE ELECTING NOT TO PURCHASE CERTAIN VALUABLE COVERAGE WHICH
PROTECTS YOU AND YOUR FAMILY OR YOU ARE PURCHASING UNINSURED MOTORIST
LIMITS LESS THAN YOUR BODILY INJURY LIABILITY LIMITS WHEN YOU SIGN THIS FORM.
PLEASE READ CAREFULLY.
Uninsured Motorist Coverage (UM) provides for payment of certain benefits for damages caused by owners or
operators of uninsured motor vehicles because of bodily injury or death. Such benefits may include payments for
certain medical expenses, lost wages, and pain and suffering, subject to limitations and conditions contained in the
policy. For the purpose of this coverage, an uninsured motor vehicle may include a motor vehicle as to which the
bodily injury limits are less than your damages. 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 offered
by the company, or reject Uninsured Motorist entirely.
Please indicate whether you desire to entirely reject Uninsured Motorist Coverage, or whether you desire this coverage
at limits lower than the Bodily Injury Liability limits of your policy:
# I hereby reject Uninsured Motorist Coverage
I hereby select Uninsured Motorist limits of
ELECTION OF NON-STACKED COVERAGE
(Do not select if you have rejected UM Coverage)
You have the option to purchase, at a reduced rate, a 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 an injury occurs
while occupying someone else's vehicle, or you are struck as a pedestrian, you are entitled to select the highest limits
of Uninsured Motorist Coverage available on any one vehicle for which you are a named insured, insured family
member, or insured resident of the named insured's household. This policy will not apply if you select the coverage
available under any other policy issued to you or the policy of any other family member who resides with you.
If you elect to purchase the stacked form, your policy limit(s) for each motor vehicle are added together (stacked) for all
covered injuries. Thus, your policy limits would automatically change during the policy term if you increase or decrease
the number of autos covered under the policy.
# I hereby elect the non-stacked form of Uninsured Motorist Coverage.
By signing, I understand and agree that selection of the above options applies to my liability insurance policy and future
renewals or replacements of such policy which are issued at the same Bodily Injury Liability limits. If I decide to select
another option at some future time, I must let the company or my agent know.
# #
Named Insured or representative for all insureds Date
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signature
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