• About Us
  • Contact Us
Auto Insurance Information Center

What forms are needed in the state of Colorado?

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

Colorado Uninsured Motorists Coverage Selection of Limits:

AU CO39 0105 - for customers in 21st Century North America Insurance Company (35) and 21st Century Advantage Insurance Company (36)

AU CO39b 0105 - for customers in 21st Century Premier Insurance Company (55)

AU CO39c 0611 - for customers in 21st Century Centennial Insurance Company (54)

If you have not previously completed and signed the selection/rejection of Uninsured Motorists Coverage Selection of Limits form or if you want to make changes to your current coverage, please print and complete this form.

Colorado Medical Payments Coverage Options

AU CO48 0109

Colorado law requires every automobile liability insurance policy to provide minimum Medical Payments Coverage benefits to pay for reasonable health care expenses incurred for bodily injury caused by an automobile accident, regardless of fault, unless you reject this coverage in writing.

Once completed, please mail or fax the form to the address or fax number listed below.

Physical Mailing and Overnight Address:

Overnight - Correspondence
21st Century Insurance
3 Beaver Valley Rd - 4th Floor
Wilmington, DE 19803

Fax number: 1(866) 447-2611

File Attachments

Colorado Medical Payments Coverage Options AU CO48 0109.pdf
Colorado Uninsured Motorists Coverage Selection of Limits AU CO39 0105.pdf
Colorado Uninsured Motorists Coverage Selection of Limits AU CO39b 0105.pdf
Colorado Uninsured Motorists Coverage Selection of Limits AU CO39c 0611.pdf

Topics

General Information
Coverage
State Forms
 

^ Back to Top

Get a Free Auto Insurance Quote:

You're just a click away from seeing how 21st Century can save you money on your auto insurance.

Insurance underwritten by affiliated and non-affiliated companies of 21st Century Insurance, Wilmington, DE. Copyright © 2012 Farmers Insurance.