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© 2015 The Travelers Indemnity Company. All rights reserved.
SUPPLEMENTARY COMMERCIAL AUTOMOBILE APPLICATION
OFFER OF ADDITIONAL UNINSURED MOTORIST COVERAGE
AND OPTIONAL UNDERINSURED MOTORIST COVERAGE
SOUTH CAROLINA
Automobile liability insurance coverage pays other motor vehicle drivers and their passengers for damages caused by
you and for which you are legally responsible. There are two types of automobile liability insurance coverage: bodily
injury and property damage. Bodily injury coverage pays for bodily injuries to others inflicted by your motor vehicle.
Property damage coverage pays for damages which your motor vehicle causes to other motor vehicles or property.
Under South Carolina law, an insurance company may refuse to write your automobile liability insurance for a number of
reasons. If an insurance company decides to write your automobile liability insurance coverage, however, it must
provide at least $25,000 of bodily injury coverage for each person whom you may injure in any single accident and
$50,000 of bodily injury coverage for two or more people whom you may injure in any single accident. The insurance
company must also provide at least $25,000 in property damage coverage for each accident you may cause. You may
have seen these limits described as $25,000/$50,000/$25,000 or 25-50-25. These limits are commonly-known as
minimum limits. In order to drive your automobile upon the roads of this State, you must have a least these minimum
limits of insurance, unless you post a satisfactory bond or pay a $550 fee to drive uninsured. There is no requirement
that an insurance company offer higher than minimum limits of automobile liability insurance coverage. If your
insurance company does offer more than the minimum limits, you will be required to pay an additional premium for
those increased limits of protection.
An insurer that writes your automobile liability insurance coverage must also offer two additional coverages which will
protect you in the event you are damaged in an automobile accident by an at-fault driver who either has no automobile
insurance or whose automobile insurance liability limits are less than your damages in that accident. These coverages
are termed additional uninsured motorist coverage and optional underinsured motorist coverage, respectively. You may
also see them referred to as UM and/or UIM. If you decide to purchase either of these coverages, you will be required to
pay an additional premium for each of these coverages.
Uninsured motorist coverage compensate you, or other persons insured under your automobile insurance policy, for
amounts which you may be legally entitled to collect as damages from an owner or operator of an at-fault uninsured
motor vehicle. An uninsured motor vehicle is a motor vehicle which either has no liability insurance coverage or is
operated by a hit-and-run driver. By law, your automobile insurance policy automatically provides uninsured motorist
coverage of $25,000/$50,000/$25,000. There is a $200 deductible for uninsured property damage claims.
You also have the right to buy additional uninsured motorist coverage, in various limits up to the limits of the liability
coverage you have purchased. The limits of additional uninsured motorist coverage which your insurance company is
authorized to write and for which you are eligible are shown on this form, together with the additional premium for those
increased limits. You may not purchase uninsured motorist coverage with limits in excess of your liability limits.
Underinsured motorist coverage compensates you, or other persons insured under your automobile insurance policy,
for amounts which you legally may be entitled to collect as damages from an owner or operator of an at-fault
underinsured motor vehicle. An underinsured motor vehicle is a motor vehicle which is covered by some form of liability
insurance, but which is insufficient to fully compensate you for your damages.
Your automobile insurance policy does not automatically provide any underinsured motorist coverage. However, you
have the right to buy, and your insurance company is required to offer, optional underinsured motorist coverage in
various limits up to the limits of liability coverage you have purchased. The limits of optional underinsured motorist
coverage which your insurer is authorized to write and for which you are eligible are shown on this form, together with
the additional premium for those limits. You may not purchase underinsured motorist coverage with limits in excess of
your liability limits.
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© 2015 The Travelers Indemnity Company. All rights reserved.
If you reject optional underinsured or additional uninsured motorist coverages shown on this form and if you are
involved in an automobile accident that is not your fault, this form may be used by your insurance company as evidence
against you if you make a claim for additional uninsured motorist coverage or optional underinsured motorist coverage.
If you do not complete this form and return it to your insurance company or insurance agent within 30 days, your
insurance company is required by law to add additional uninsured motorist coverage and optional underinsured
motorist coverage, in the same limits as your automobile liability insurance, to your automobile insurance policy. You
will be required to pay an additional premium for each of these coverages and your policy may be canceled for
non-payment of that additional premium.
In the future, if you wish to increase or to decrease your limits of additional uninsured motorist coverage or optional
underinsured motorist coverage, you must contact either your insurance agent or your insurance company. You will not
be presented with another copy of this form by your insurance agent or insurance company upon the renewal of your
automobile liability insurance policy. You will not be presented with another copy of this form by your insurance agent
or current insurance company when you extend, change, supersede, or replace your automobile liability insurance
policy.
Please read this form carefully. Your insurance agent or your insurance company must answer any questions which you
may have. If you have any further questions, you may contact the Department of Insurance at:
Office of Consumer Services
South Carolina Department of Insurance
Capital Center
1201 Main Street
Suite 1000
Columbia, SC 29201
Post Office Box 100105 Columbia, South Carolina 29202-3105
(803) 737-6180
(800) 768-3467
E-mail Address: consumers@doi.sc.gov
I select limits equal to the automobile insurance liability policy limits.
I select $100,000 each accident (CSL).
I select $250,000 each accident (CSL).
I select
$350,000
each accident (CSL).
I select
$500,000
each accident (CSL).
I select
$1,000,000
each accident (CSL).
I select the following limit:
Offer of Additional Uninsured Motorist Coverage
Minimum Uninsured Motorist Coverage limits of $25,000/$50,000/$25,000 split limits or $75,000 combined single limit
are automatically provided by your insurance policy. The Uninsured Motorist Coverage limits will be either split (each
person/each accident/each accident) or a combined single limit (CSL), consistent with the automobile insurance
liability limits on your policy.
If you select additional Uninsured Motorist Coverage, an additional premium will be charged.
Please see attached
Appendix A for applicable premium rates for minimum and increased limits.
Do you wish to purchase additional Uninsured Motorist Coverage? Yes No
If your answer is "no", you must sign here:
If your answer is "yes", specify the limits you desire. These limits
cannot
exceed your automobile insurance liability
limits.
N-3570 (10/15)
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© 2015 The Travelers Indemnity Company. All rights reserved.
Applicant's Acknowledgement
By my signature, I acknowledge that I have read - or I have had read to me - the above explanations and offers of
additional uninsured motorist coverage and optional underinsured motorist coverage. I understand that the above
explanations of these coverages are intended only to be brief descriptions of additional uninsured motorist coverage
and optional underinsured motorist coverage, and that payment of benefits under either of these coverages is subject
both to the terms and conditions of my automobile insurance policy and the laws of the State of South Carolina.
My signature below further acknowledges that I understand the coverages as they have been explained to me, and the
type and amounts of coverage marked on the preceding pages have been selected by me. This is the type and amount
of insurance coverage I wish to purchase
Type or print your name:
Your signature:
Your address:
Today's date:
I select minimum limits of $25,000/$50,000/$25,000 or $75,000 CSL. The Underinsured Motorist
Coverage limits will be either split (each person/each accident) or a combined single limit (CSL),
consistent with the automobile insurance liability limits on your policy.
I select limits equal to the automobile insurance liability policy limits.
I select $100,000 each accident (CSL).
I select $250,000 each accident (CSL).
I select
$350,000
each accident (CSL).
I select
$500,000
each accident (CSL).
I select
$1,000,000
each accident (CSL).
I select the following limit:
Offer of Optional Underinsured Motorist Coverage
Minimum Uninsured Motorist Coverage limits of $25,000/$50,000/$25,000 split limits or $75,000 combined single limit
are automatically provided by your insurance policy. The Uninsured Motorist Coverage limits will be either split (each
person/each accident) or a combined single limit (CSL), consistent with the automobile insurance liability limits on your
policy.
If you select optional Underinsured Motorist Coverage, an additional premium will be charged.
Please see attached
Appendix A for applicable premium rates for minimum and increased limits.
Do you wish to purchase optional Underinsured Motorist Coverage? Yes No
If your answer is "no", you must sign here:
If your answer is "yes", specify the limits you desire. These limits cannot exceed your automobile insurance liability
limits.
click to sign
signature
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