Fr44 Florida Form in PDF
Content Navigation
The FR44 form is a crucial document for Florida drivers who need to meet specific insurance requirements after certain violations, such as DUI offenses. This form serves to ensure compliance with Florida's Financial Responsibility Law, mandating liability insurance coverage of at least $100,000 for bodily injury per person, $300,000 for total bodily injury per accident, and $50,000 for property damage. To complete the FR44, individuals must provide personal information, including their name, address, and driver’s license number, along with details about their insurance policy, such as the insurance company name, policy number, and effective date. It is essential to submit the completed form to the Bureau of Financial Responsibility, as it certifies that the driver holds the required insurance coverage. The FR44 can apply to both owner’s policies, which cover specific vehicles, and operator’s policies, which provide coverage for vehicles not registered in the insured’s name. This form remains in effect until it is canceled or terminated according to Florida's financial responsibility regulations, ensuring ongoing protection for drivers and other road users.
Form Example
FLORIDA DEPARTMENT OF
HIGHWAY SAFETY AND MOTOR VEHICLES
Division of Driver Licenses
Bureau of Financial Responsibility
2900 Apalachee Parkway, MS98
Tallahassee, Florida
|
|
|
FLORIDA |
|
|
|
|
||
|
|
UNIFORM FINANCIAL RESPONSIBILITY |
|
|
|||||
|
|
|
CERTIFICATE |
|
|
|
|
||
Purpose: |
Use this form to comply with Florida’s Financial Responsibility Law, Section 324.023, Florida |
|
|||||||
|
Statutes for motor vehicle liability insurance coverage of 100k/300k/50k. |
|
|
||||||
Instructions: |
Send completed form to the Bureau of Financial Responsibility at the above address. |
|
|
||||||
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
INSURED PERSON INFORMATION |
|
|
|
|
|||
|
|
|
|
|
|
|
|
|
|
INSURED NAME (Last) |
(First) |
|
(Middle) |
(Suffix) |
|
||||
|
|
|
|
|
|
|
|
|
|
STREET ADDRESS |
|
|
|
CITY |
|
STATE |
ZIP CODE |
|
|
|
|
|
|
|
|
|
|
||
DRIVER LICENSE NUMBER |
|
BIRTH DATE (MM/DD/YYYY) |
|
|
|||||
|
|
|
|
|
|
|
|||
|
|
|
|
|
|
||||
|
|
INSURANCE COMPANY INFORMATION |
|
|
|||||
|
|
|
|
|
|
|
|
|
|
INSURANCE COMPANY NAME |
|
|
|
FR CASE NUMBER |
|
|
|||
|
|
|
|
|
|
|
|
||
NAIC CODE |
|
POLICY NUMBER |
|
|
|
CERTIFICATION EFFECTIVE DATE |
|
||
|
|
|
|
|
|
|
|
|
|
This certification is effective on the above certification Effective Date and continues until cancelled or terminated in accordance with the financial responsibility laws and regulations of Florida. The insurance certified is provided by an:
OWNER’S POLICY – Applicable to the following described vehicle(s) and subject to the terms and conditions defined in the owner’s policy.
VEHICLE YEAR |
VEHICLE MAKE |
VEHICLE IDENTIFICATION NUMBER (VIN) |
|
|
|
VEHICLE YEAR |
VEHICLE MAKE |
VEHICLE IDENTIFICATION NUMBER (VIN) |
|
|
|
VEHICLE YEAR |
VEHICLE MAKE |
VEHICLE IDENTIFICATION NUMBER (VIN) |
|
|
|
VEHICLE YEAR |
VEHICLE MAKE |
VEHICLE IDENTIFICATION NUMBER (VIN) |
|
|
|
OPERATOR’S POLICY – Applicable to any vehicle not registered/titled to the above listed person and subject to the terms and conditions defined in the operator’s insurance policy.
The company signatory certifies that it has issued to the above named insured a motor vehicle liability policy as required by the financial responsibility laws of Florida, which policy becomes effective on the above Certification Effective Date.
|
AUTHORIZED REPRESENTATIVE SIGNATURE |
DATE |
|
|
|
|
|
74751 (S) (12/07)
Document Breakdown
| Fact Name | Description |
|---|---|
| Purpose | The FR-44 form is used to comply with Florida’s Financial Responsibility Law, ensuring drivers have the required motor vehicle liability insurance coverage. |
| Coverage Requirements | This form mandates a minimum insurance coverage of $100,000 for bodily injury per person, $300,000 for bodily injury per accident, and $50,000 for property damage. |
| Governing Law | The FR-44 is governed by Section 324.023 of the Florida Statutes, which outlines the financial responsibility requirements for motor vehicle operators. |
| Submission | Completed forms must be sent to the Bureau of Financial Responsibility at the address provided on the form. |
| Effective Date | The certification is effective on the specified date and remains valid until it is canceled or terminated according to Florida's financial responsibility laws. |
| Insured Information | The form requires detailed information about the insured person, including name, address, driver’s license number, and birth date. |
| Insurance Company Details | Information about the insurance company, including the company name, policy number, and NAIC code, must also be provided on the form. |
| Policy Types | The FR-44 can be issued as either an owner's policy, which covers specific vehicles, or an operator's policy, which applies to vehicles not registered to the insured. |
Popular PDF Forms
Ifta Florida Login - Enter your U.S. DOT number and IRP account number if available, essential for businesses on the road.
How to Get a Governor's Pardon in Florida - The application includes instructions for obtaining and submitting all necessary supporting documents.
Contract to Lease Florida - Details the procedure and tenant rights in case of property damage or destruction, ensuring fairness in unforeseen circumstances.