- Insurance Information
- Michigan State Forms
What forms are needed in the state of Michigan?
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.
Michigan Collision Coverage Options: AU MI91 0505
Michigan law requires us to inform you of Collision Coverage options that are available to you. Please review the descriptions of the Collision Coverage options listed on this form, mark the appropriate box/es, sign your name and return it to the Customer Service Center that is listed on your Declarations Page.
Personal Protection Insurance Coverage-Michigan : AU MI48 0308
Use form AU MI48 0308 if your policy declaration page indicates that the insurance company issuing your policy is 21st Century North America Insurance Company or 21st Century Advantage Insurance Company.
Personal Protection Insurance Coverage-Michigan : AU MI48 1110
Use form AU MI48 1110 if your policy declaration page indicates that the insurance company issuing your policy is 21st Century Centennial Insurance Company or 21st Century Premier Insurance Company.
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