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What forms are needed in the state of Georgia?

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.

GA Uninsured Motorists Coverage Selection of Limits: AU GA39 0109.pdf
21st Century North America Insurance Company (35)

GA Uninsured Motorists Coverage Selection of Limits: AU GA39a 0109.pdf
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.

GA Medical Payments Coverage Options: AU GA48 0305
21st Century North America Insurance Company (35)

GA Medical Payments Coverage Options: AU GA48a 0207
21st Century Centennial Insurance Company (54)

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

GA UM Coverage Selection Form.pdf
GA UM Coverage Selection Form a.pdf
GA Medical Payments Coverage Form.pdf
GA Medical Payments Coverage Form a.pdf

Topics

General Information
Coverage
State Forms

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