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What forms are needed in the state of Minnesota?

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.

Minnesota law requires you to purchase Uninsured and Underinsured Motorists Coverage. The lowest limits allowed are $25,000 per person/$50,000 per accident. Higher limits are available for an additional premium. If you have not previously completed and signed the Minnesota Uninsured/Underinsured Motorists Coverage Selection of Limits or if you want to make changes to your current coverage, please print and complete this form.

MN Uninsured/Underinsured Motorists Coverage Selection of Limits: AU MN39 0906
Use form Minnesota Uninsured/Underinsured Motorists Coverage Selection of Limits - AU MN39 0906 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 or 21st Century Centennial Insurance Company

MN Uninsured/Underinsured Motorists Coverage Selection of Limits: AU MN39a 0105
Use form Minnesota Uninsured/Underinsured Motorists Coverage Selection of Limits - AU MN39a 0105 if your policy declaration page indicates that the insurance company issuing your policy is 21st Century Premier Insurance Company

Minnesota law requires that you purchase Personal Injury Protection (PIP). If you have not completed and signed a selection form, you will be provided with the Basic PIP Coverage. If you want to make changes to your current coverage, please print and complete this form.

Minnesota Important Options Notice - AU MN48 0115
Use form AU MN48 0115 if your policy declaration page indicates that the insurance company issuing your policy is 21st Century North America Insurance Company, 21st Century Advantage Insurance Company, or 21st Century Centennial Insurance Company.

Minnesota Important Options Notice - AU MN48a 0115
Use form AU MN48a 0115 if your policy declaration page indicates that the insurance company issuing your policy is 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

File Attachments

MN UM/UIM Coverage Selection Form – AU MN39 0906.pdf
MN UM/UIM Coverage Selection Form – AU MN39a 0105.pdf
MN Important Opt. Notice - AU MN48 0115
MN Important Opt. Notice - AU MN48a 0115
 

Topics

General Information
Coverage
State Forms
 

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