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What forms are needed in the state of Oklahoma?

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.

If you have previously rejected this coverage, but have not signed a form for the rejection you must complete, sign and return this form to us immediately. Otherwise your policy will be amended to provide you with the minimum limits required by Oklahoma law ($25,000 per person/$50,000 per accident).

Oklahoma Uninsured Motorists Coverage Law: AU OK39 1209.pdf

Use form AU OK39 1209 if your policy declaration page indicates that the insurance company issuing your policy is 21st Century Centennial Insurance Company, 21st Century Pacific Insurance Company or 21st Century North America Insurance Company.

Oklahoma Uninsured Motorists Coverage Law: AU OK39a 1209.pdf

Use form AU OK39a 1209 if your policy declaration page indicates that the insurance company issuing your policy is 21st Century Indemnity Insurance Company.

Oklahoma Uninsured Motorists Coverage Law: AU OK39b 1210.pdf

Use form AU OK39b 1210 if your policy declaration page indicates that the insurance company issuing your policy is 21st Century Assurance 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

Oklahoma Uninsured Motorists Coverage Law AU OK39 1209.pdf
Oklahoma Uninsured Motorists Coverage Law AU OK39a 1209.pdf
Oklahoma Uninsured Motorists Coverage Law AU OK39b 1210.pdf

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