Indiana UM and UIM Selection/Rejection Form - ProducerPointers.com 2026

1. Click ‘Get Form’ to open it in the editor.
2. Begin by entering your Policy Number, Policy Effective Date, Company, Producer, and Applicant/Named Insured at the top of the form.
3. In Section I, choose your Uninsured Motorists Coverage option by initialing next to either A (Selection), B (Rejection of Property Damage), or C (Rejection of both). Follow the prompts for Split Limits or Combined Single Limit as applicable.
4. For each selected option, ensure you sign and date where indicated to confirm your choices.
5. Proceed to Section II and indicate your choice for Underinsured Motorists Coverage by initialing next to either A (Selection) or B (Rejection). Again, sign and date as required.

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