M-3980a Maryland (10/93)
MARYLAND NOTICE
Regarding
Uninsured Motorists Coverage
(Bodily Injury and Property Damage)
UNINSURED MOTORISTS COVERAGE is included in your policy at the minimum limits required by the
State Financial Responsibility Law, to provide protection for persons who are legally entitled to recover
damages because of bodily injury (including resulting death) or damage to property (property damage)
from an owner or operator of an uninsured motor vehicle or those whose Liability limits are less than the
limits of your Uninsured Motorists Coverage.
Higher limits of Uninsured Motorists Coverage may be purchased at an additional premium provided that
the limits selected do not exceed the bodily injury liability limits of the policy.
To be certain that the policy is issued with the Uninsured Motorists Coverage limits that you want, please
indicate your desired coverage limits below and sign and date this form, where provided, as your
indication of approval of the limits selected.
COVERAGE PURCHASE OPTION
I have had this coverage fully explained to me and I wish to purchase Uninsured Motorists Coverage at
the following limits, which do not exceed the Liability Coverage limits of my policy:
Split limit policies – Uninsured Motorists Coverage
$ per person, $ per accident Bodily Injury and $ per accident
Property Damage* Uninsured Motorists Coverage;
or,
Single limit policies – Uninsured Motorists Coverage
$ per accident combined single limit Bodily Injury and Property Damage* Uninsured Motorists
Coverage.
Date Signed Signature of Named Insured (Representing all Insureds)
*Property Damage Uninsured Motorists Coverage is subject to a $250 per accident deductible.
Until you advise us otherwise in writ
ing, your choice as indicated above, will continue regardless of any
addition or change in Auto coverage on your current policy or addition of any scheduled Autos and will be
carried forward on all future renewal policies without additional notice.
M-3980a Maryland (10/93)
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