Form HSMV83330 "Florida Insurance Affidavit" - Florida

What Is Form HSMV83330?

This is a legal form that was released by the Florida Department of Highway Safety and Motor Vehicles - a government authority operating within Florida. As of today, no separate filing guidelines for the form are provided by the issuing department.

Form Details:

  • Released on September 1, 2009;
  • The latest edition provided by the Florida Department of Highway Safety and Motor Vehicles;
  • 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 fillable version of Form HSMV83330 by clicking the link below or browse more documents and templates provided by the Florida Department of Highway Safety and Motor Vehicles.

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Download Form HSMV83330 "Florida Insurance Affidavit" - Florida

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FLORIDA INSURANCE AFFIDAVIT
Under penalty of perjury, I __________________________________________ certify that I have
(Name of Insured)
Personal Injury Protection, Property Damage Liability, and, when required, Bodily Injury Liability
Insurance currently in effect with _____________________________________________ under
(Name of Insurance Company)
__________________________ ____________________ covering the following motor vehicle:
(Policy Number)
Company Code Number (5 digits)
_________________________________________________________________________________________________________
Year
Make
Vehicle Identification Number
This insurance company is licensed to issue insurance policies in Florida. I understand that my
driver license, license plate(s) and registration(s) will be suspended effective from the registration
date, if the insurer denies that this policy is in force.
_______________________________________
Signature of Insured
WARNING:
GIVING FALSE INFORMATION IN ORDER TO OBTAIN A VEHICLE REGISTRATION
CERTIFICATE IS A CRIMINAL OFFENSE UNDER FLORIDA LAW. ANYONE GIVING
FALSE INFORMATION ON THIS AFFIDAVIT IS SUBJECT TO PROSECUTION.
HSMV 83330 (Rev. 09/09)
www.flhsmv.gov
FLORIDA INSURANCE AFFIDAVIT
Under penalty of perjury, I __________________________________________ certify that I have
(Name of Insured)
Personal Injury Protection, Property Damage Liability, and, when required, Bodily Injury Liability
Insurance currently in effect with _____________________________________________ under
(Name of Insurance Company)
__________________________ ____________________ covering the following motor vehicle:
(Policy Number)
Company Code Number (5 digits)
_________________________________________________________________________________________________________
Year
Make
Vehicle Identification Number
This insurance company is licensed to issue insurance policies in Florida. I understand that my
driver license, license plate(s) and registration(s) will be suspended effective from the registration
date, if the insurer denies that this policy is in force.
_______________________________________
Signature of Insured
WARNING:
GIVING FALSE INFORMATION IN ORDER TO OBTAIN A VEHICLE REGISTRATION
CERTIFICATE IS A CRIMINAL OFFENSE UNDER FLORIDA LAW. ANYONE GIVING
FALSE INFORMATION ON THIS AFFIDAVIT IS SUBJECT TO PROSECUTION.
HSMV 83330 (Rev. 09/09)
www.flhsmv.gov