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1、Premium Adjustment (if any)$REJECTION OR SELECTION OF UNINSURED MOTORISTS COVERAGE,OFFER OF DEDUCTIBLE(Georgia)Uninsured Motorists Coverage provides insurance for the protection of persons insured under the policy who are legally entitled to recover damages from the owner or operator of an uninsured
2、 motor vehicle because of bodily injury, including death resulting therefrom, and for injury to or destruction of the insured motor vehicle and the personal property owned by the insured which is contained in the insured motor vehicle.Georgia law (Insurance Code Section 33-7-11) permits you to selec
3、t Uninsured Motorists Coverage in limits of liability equal to or higher than the basic financial responsibility limits required by law, or equal to or lower than the limits of Liability Coverage in your policy. Georgia law also alternatively permits you to reject Uninsured Motorists Coverage comple
4、tely.In accordance with the above-mentioned Georgia law, the undersigned insured (and each of them)(Mark applicable item(s) MXM) agrees to purchase Uninsured Motorists Coverage at the following limit of liability:(Enter if a single limit of liability applies.)$each accident(Enter if separate limits
5、of liability apply to Bodily Injury and Property Damage.)I BodMnjury$each accidentProperty Damageagrees that the offer of Uninsured Motorists Coverage is rejected and such coverage is deleted from my policy. agrees that no deductible is to apply to Uninsured Motorists Coverage. requests additional information regarding the deductible amounts available, minimum $250, and the premium cost savings.Signature of InsuredDateSignature of InsuredDatePolicy Number (if known)
