- Insurance Information
- Kansas State Forms
What forms are needed in the state of Kansas?
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.
Kansas Uninsured/Underinsured Motorists Coverage Selection of Limits: AU KS39 0505
21st Century Premier Insurance Company (55)
Kansas Uninsured/Underinsured Motorists Coverage Selection of Limits: AU KS39a 1212
21st Century Centennial Insurance Company (54)
If you have not previously signed and completed the selection of Uninsured/Underinsured Motorists Coverage Selection of Limits form or if you want to make changes to your current coverage, please print and complete this form.
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