- Insurance Information
- Texas State Forms
What forms are needed in the state of Texas?
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.
TX Uninsured/Underinsured Motorists Coverage Selection of Limits: AU TX39 0911
If you have not previously completed and signed for the selection/rejection of Uninsured/Underinsured Motorists Coverage or if you want to make changes to your current coverage, please print and complete this form.
TX Personal Injury Protection Coverage - Rejection of Coverage: AU TX48 0712
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