Auto Insurance Information Center

What forms are needed in the state of Mississippi?

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.

Mississippi law requires you to purchase this coverage unless you reject it, in writing, and sign where indicated. The minimum limits allowed by law are $25,000 per person/$50,000 per accident. You may select higher limits up to the amount of Bodily Injury Liability limits that are listed on your Declarations Page. If you have not previously completed and signed the Mississippi Selection/Rejection Of Uninsured Motorist Coverage or if you want to make changes to your current coverage, please print and complete this form.

Mississippi Selection/Rejection Of Uninsured Motorist Coverage: AU MS39 0714

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

Mississippi Selection/Rejection Of Uninsured Motorist Coverage


General Information
State Forms

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