Form FR-19 "Delaware Insurance Certification" - Delaware

What Is Form FR-19?

This is a legal form that was released by the Delaware Department of Insurance - a government authority operating within Delaware. As of today, no separate filing guidelines for the form are provided by the issuing department.

Form Details:

  • Released on September 1, 2007;
  • The latest edition provided by the Delaware Department of Insurance;
  • Easy to use and ready to print;
  • Quick to customize;
  • Compatible with most PDF-viewing applications;
  • Fill out the form in our online filing application.

Download a printable version of Form FR-19 by clicking the link below or browse more documents and templates provided by the Delaware Department of Insurance.

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Download Form FR-19 "Delaware Insurance Certification" - Delaware

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DELAWARE INSURANCE CERTIFICATION
Name of Insurance Company
NAIC Code
Policy Number
Name and Address of Insured
This company certifies that it has issued to the insured a
vehicle liability insurance policy at least equal to the limits
required by the Delaware Motor Vehicle Laws and this
policy is in force on this certification date and/or has been in
force for the period stated below.
BY
Signature of Authorized Representative
Please enter all dates of coverage from the verification date
indicating lapses if applicable.
Certification Date
(Verification date can be found on the insurance audit letter sent
to the vehicle owner)
Phone Number
Effective Date of Coverage
Expiration Date of Coverage Year & Make
Vehicle Identification No.
From:
To:
From:
To:
From:
To:
FR Case No.
Rev 09/07 FR-19
DELAWARE INSURANCE CERTIFICATION
Name of Insurance Company
NAIC Code
Policy Number
Name and Address of Insured
This company certifies that it has issued to the insured a
vehicle liability insurance policy at least equal to the limits
required by the Delaware Motor Vehicle Laws and this
policy is in force on this certification date and/or has been in
force for the period stated below.
BY
Signature of Authorized Representative
Please enter all dates of coverage from the verification date
indicating lapses if applicable.
Certification Date
(Verification date can be found on the insurance audit letter sent
to the vehicle owner)
Phone Number
Effective Date of Coverage
Expiration Date of Coverage Year & Make
Vehicle Identification No.
From:
To:
From:
To:
From:
To:
FR Case No.
Rev 09/07 FR-19