- Insurance Information
- Maryland State Forms
What forms are needed in the state of Maryland?
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. Once completed, please send or fax the form to the address or fax number listed below.
Notice to Maryland Policyholders Regarding Credit History: AU MD82 0205
Notice and Waiver of Personal Injury Protection (PIP) Coverage: AU MD48 0111
Notice and Waiver of Increased Limits of Uninsured Motorist Coverage: MIA-PPA-UM-WAIVER 1/1/11r
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