Form 5c uiia 2026

1. Click ‘Get Form’ to open it in the editor.
2. Begin by reviewing the list of equipment providers. Check all appropriate boxes next to the companies you wish to include as additional insured on your Auto Liability policy.
3. Fill in your Motor Carrier's Company Name, Address, Phone, and Email Address in the designated fields.
4. Ensure that an authorized insurance agent signs the form in the provided signature field and includes the date.
5. Complete the insurance agent's email address field for further communication.
6. Review all entries for accuracy before submitting. Once completed, fax the form to your insurance agent as instructed.

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