Is an electronic signature valid?

Yes. Electronic signatures are valid under the ESIGN Act (15 U.S.C. §7001) and UETA in most states when the signature shows intent, consent, attribution, and a retrievable record.

Do I need notarization?

Not typically for UM election forms, but some carriers or state rules may require a notarized rejection or witness; confirm with the insurer and state regulator.

How do I correct mistakes?

If an error exists, complete a corrected form with the same signer and date, attach a note explaining the correction, and resubmit so the insurer has a clear audit trail.

Can I revoke a rejection later?

Yes; a later signed UM acceptance or endorsement can change coverage prospectively, subject to underwriting and insurer approval.

Who must sign the form?

The named insured must sign. Agents sign when required by carrier processes; witnesses or notaries sign only if state or carrier rules demand it.

How long to keep a copy?

Retain the signed form for the policy term plus applicable federal or state-required retention periods to support claims and regulatory requests.

Electronic Signature
Templates
Insurance
Insurance UM Option Form

Insurance UM Option Form

This template is fully customizable. Edit the text, fill out the fields, and send it for signature. Give it a try!

INSURANCE UM OPTION FORM

This form documents selection, rejection, or modification of Uninsured Motorist (UM) and Underinsured Motorist (UIM) coverages under the policy identified below. Selections made on this form supersede prior UM/UIM selections for the indicated policy period to the extent permitted by law.

Insured / Applicant Information

Client Name:

Address Date of Birth Contact Phone Email

Policy Details

Insurer Name:

Policy Number

Policy Type: Personal Auto Commercial Auto

Policy Period From: To:

UM / UIM Coverage Selection

Select one of the following options regarding Uninsured/Underinsured Motorist coverage. Election or rejection will be applied in accordance with policy terms and governing law.

Primary Election I reject UM/UIM coverage for bodily injury to the extent permitted by law. I understand this rejection may limit my recovery for injuries caused by uninsured or underinsured motorists. I elect UM/UIM coverage and select the limits below.

Available Limits (select one or specify other) $25,000 per person / $50,000 per accident $50,000 per person / $100,000 per accident $100,000 per person / $300,000 per accident Other limits:

Stacking Options (if applicable in your jurisdiction) Decline stacking of UM/UIM limits Accept stacking of UM/UIM limits

Deductible & Premium

UM Deductible (if applicable) Additional Premium for Selected UM/UIM

If an additional premium applies, the insurer may charge the premium in accordance with the policy; premium adjustments may be prorated for mid-term changes.

Exclusions, Limitations, and Notices

UM/UIM coverage is subject to all policy terms, conditions, exclusions, and limits. The following are common limitations; additional exclusions may apply under the policy:

Coverage does not apply to bodily injury intentionally caused by the insured.
Coverage may not apply to vehicles not listed on the policy unless permissive use provisions apply.
Some states restrict stacking or mandate minimum/maximum limits; the policy and applicable law control.

By signing below the insured certifies they have read and understand the effect of the elected option, including any rejection of coverage. Rejection of UM/UIM may reduce recovery for injuries caused by uninsured or underinsured motorists.

Beneficiary Designation (Death Benefit Only)

Complete only if designating a beneficiary to receive death benefits available under UM coverage where permissible.

Primary Beneficiary Name Relationship Share Percentage Contingent Beneficiary Name

Additional Information / Comments

Agent or Insured Notes

Declaration and Certification

I certify under penalty of perjury that the information provided on this form is true and correct to the best of my knowledge. I understand that knowingly making a false statement may constitute insurance fraud and may result in denial of coverage or other civil or criminal penalties under applicable law.

I acknowledge that the insurer may rely on this election and that changes may be subject to underwriting approval and state law. I authorize the insurer to amend the policy to reflect the selection made herein.

Acknowledgement: I have read and understand the terms above.

Applicant Printed Name:

Signature:

Date:

By signing above, the applicant affirms the selections made on this form and acknowledges receipt of a copy where required by law.

What the Insurance UM Option Form Is and when it matters

The Insurance UM Option Form documents a policyholder's selection or rejection of uninsured/underinsured motorist coverage (UM). Insurers use it to record coverage levels, limits, and any consumer decline of UM protection so the carrier can process claims and set premium obligations. The form typically includes policyholder identity, policy number, effective date, coverage choice, and signatures. It creates an auditable record relied on for claim evaluation, underwriting, and regulatory compliance with state insurance department requirements and federal electronic signature rules where applicable.

Why completing this form accurately protects coverage and claims

A clear, signed UM Option Form proves whether UM coverage applies and which limits are in force; accurate completion reduces disputes, supports timely claim payments, and helps satisfy insurer and state recordkeeping obligations.

Who typically completes and reviews the Insurance UM Option Form

Several parties interact with this form during policy setup and claims processing.

Insurance agents who present coverage options and obtain the policyholder's selection and signature during sale or renewal.
Policyholders (insured drivers) who must confirm acceptance or explicit rejection of UM coverage in writing.
Claims adjusters and underwriting teams who use the signed form to determine available coverage at the time of loss.

Keep copies for all parties — insurer, agent, and insured — to reduce later disputes and support audit trails.

Core elements to include in a professional Insurance UM Option Form

A complete form is concise but comprehensive so it can be relied on for claims, audits, and regulatory review.

Policy ID

Policy number and insurer name displayed prominently to link the choice to the correct contract and claims file.

Named Insured

Full legal name and contact information of the policyholder so identity matches underwriting and claim records without ambiguity.

Effective Date

Clear MM/DD/YYYY effective date for the selection or rejection, which determines when coverage changes take effect.

Coverage Selection

Checkboxes or fields for the chosen UM limits, with explicit language for acceptance or written rejection of offered coverage.

Signature Block

Space for the insured's signature and printed name plus date; include agent signature when applicable and a witness or notary section if required.

Audit Metadata

Fields for submission method, signer authentication, and a unique document ID to support an auditable history.

Key compliance and security points to capture on the form

Encryption: TLS 1.2/1.3 in transit

Data at rest: AES-256 encrypted storage

Legal frameworks: ESIGN and UETA compliance

Health privacy: HIPAA BAA available

Audit trail: Tamper-evident logging

Certifications: SOC 2 Type II and ISO 27001

Potential penalties and risks from incorrect or missing forms

Coverage gap: Unclear choice may leave insured without UM protection

Claim denial: Insurer may dispute coverage at time of claim

Regulatory fines: State insurance departments may assess penalties

Backup withholding: Related tax forms errors can trigger withholding

Contract ambiguity: Unsigned forms can be unenforceable

Recordkeeping failure: Missing logs complicate audits

Common preparation errors that cause delays or disputes

Incomplete policy numbers or mismatched named insured details that prevent matching the form to the correct record and delay claim handling.
Missing or wrong effective dates that create ambiguity about which coverage limits applied at the time of loss and lead to contested claims.
Unchecked or ambiguous coverage boxes where the insured did not clearly accept or decline UM, leading to administrative review and potential litigation.
Failure to capture signer authentication or retain an audit trail when the form was completed electronically, weakening proof of intent.

Step-by-step: complete and submit the Insurance UM Option Form

Follow these steps to create a clear, auditable record of the insured's UM election or rejection.

01

Gather records: Locate the policy number, named insured, and prior endorsements before you begin.
02

Select coverage: Mark the chosen UM limit or check the explicit rejection box on the form.
03

Sign and date: Insured (and agent, if required) must sign and date in the signature block.
04

Submit and retain: Send to insurer per their routing rules and keep a dated copy for records.

Where to file or send the completed Insurance UM Option Form

Choose the submission path your insurer specifies; retain confirmation of receipt for the policy file and your records.

Agent submission: Give the signed form to the selling agent to upload to the carrier's policy system.
Carrier portal: Use the insurer’s secure web portal or designated email address when available for faster processing.
Mail or fax: Send certified mail or insurer-designated fax when electronic options are unavailable; keep proof of delivery.
Retain copy: Keep a dated copy and confirmation for at least the policy term plus retention period.

Electronic submission and platform considerations

Ensure the chosen platform supports required authentication, file formats, and integration with insurer systems.

File formats: PDF, DOCX, and flattened PDF/A accepted
Signer authentication: Email link, SMS code, or stronger KBA available
Integrations: Salesforce, Microsoft 365, NetSuite, Google Workspace

Use platforms that keep an audit trail, support secure storage, and integrate with insurer workflows to minimize manual reconciliation.

Configure a digital workflow for the UM Option Form

Set these workflow parameters before sending to ensure consistent routing and retention.

Field	Configuration
Authentication	Email link or SMS code; choose stronger methods for high-risk transactions
Conditional logic	Show rejection fields only if 'Decline' is checked
Notary / witness	Enable remote notarization workflow where state and carrier permit
Retention	Auto-archive signed copies to secure storage with audit metadata

Timing considerations and expected processing windows

Processing timelines vary by insurer and state; plan submissions early in renewal or before coverage changes take effect.

Submission timing:

Submit at policy issuance, renewal, or prior to effective changes to ensure coverage consistency

Insurer processing:

Carriers typically process forms within business days; confirm expected SLA with the insurer

Claims reference:

Signed forms become part of claim files and may affect payouts and liability determinations

Renewal deadlines:

Provide elections before renewal date to apply changes for the new term

State filings:

Some states require written UM waivers or disclosures at issuance or renewal

Key milestones from form completion to final record

Track these stages so the UM election is visible in policy files and claim handling.

01

Form completion

Insured and agent complete and sign the UM Option Form.

02

Carrier receipt

Insurer acknowledges receipt and attaches form to the policy record.

03

Policy update

System reflects coverage or rejection for future claims and renewals.

04

Claims reference

Signed form is used to apply appropriate limits during claim adjudication.

eSignature vendor pricing and capability snapshot for Insurance UM Option Form workflows

Basic pricing and core capabilities differ across providers; signNow is listed first for direct comparison of starting price, trials, bulk send, audit trails, HIPAA support, and envelope limits.

	signNow	DocuSign	Adobe Sign	PandaDoc	HelloSign
Starting Price	$8/user/mo	$15/user/mo	$14/user/mo	$19/user/mo	$15/user/mo
Free Trial	Yes, 7-day trial	Varies by plan	Varies by plan	Varies by plan	Varies by plan
Bulk Send	Yes	Yes	Yes	Yes	Yes
Audit Trail	Yes	Yes	Yes	Yes	Yes
HIPAA Compliant	Yes	Yes	Yes	No	No
Envelope Cap	No cap	100 envelopes/user/year	Varies by plan	Varies by plan	Varies by plan

Frequently asked questions about the Insurance UM Option Form

Answers address signature validity, notarization, corrections, revocation, and how electronic submissions are treated under U.S. law.

Need help? Contact support

Is an electronic signature valid?
Yes. Electronic signatures are valid under the ESIGN Act (15 U.S.C. §7001) and UETA in most states when the signature shows intent, consent, attribution, and a retrievable record.
Do I need notarization?
Not typically for UM election forms, but some carriers or state rules may require a notarized rejection or witness; confirm with the insurer and state regulator.
How do I correct mistakes?
If an error exists, complete a corrected form with the same signer and date, attach a note explaining the correction, and resubmit so the insurer has a clear audit trail.
Can I revoke a rejection later?
Yes; a later signed UM acceptance or endorsement can change coverage prospectively, subject to underwriting and insurer approval.
Who must sign the form?
The named insured must sign. Agents sign when required by carrier processes; witnesses or notaries sign only if state or carrier rules demand it.
How long to keep a copy?
Retain the signed form for the policy term plus applicable federal or state-required retention periods to support claims and regulatory requests.

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