UNINSURED/UNDERINSURED MOTORIST PROPERTY DAMAGE COVERAGE REJECTION
Section 1:
WARNING: DON'T REJECT UNINSURED/UNDERINSURED PROPERTY DAMAGE COVERAGE WITHOUT READING THE REVIEW OF UNINSURED/UNDERINSURED MOTORIST
COVERAGE ABOVE.  THE INSURANCE AGENT WHO SOLD YOU THIS POLICY WILL EXPLAIN ANY LANGUAGE YOU DON'T UNDERSTAND AND WILL PROVIDE ANSWERS
TO ANY QUESTIONS YOU MAY HAVE ABOUT UNINSURED/UNDERINSURED MOTORIST COVERAGES OR LIMITS BEFORE YOU SIGN THE REJECTION LINE BELOW.
I have read and I understand the above information any by my signature below I elect to waive and reject Uninsured/Underinsured
Motorist Property Damage Coverage from my policy.
X_______________________________  Date: ________  X__________________________________________________________________  Date: _________
 VEH #1 (Signature of Applicant)                   (Signature of Parent or Legal Guardian if Applicant is under 18 years of age.)
X_______________________________  Date: ________  X__________________________________________________________________  Date: _________
 VEH #2 (Signature of Applicant)                   (Signature of Parent or Legal Guardian if Applicant is under 18 years of age.)