Form HSMV83330 "Florida Insurance Affidavit" - Florida

What Is Form HSMV 83330?

Form HSMV 83330, Florida Insurance Affidavit, is a document that can be used when individuals want to confirm the fact that they have insurance that covers their motor vehicle. The purpose of the document is to verify that the individual has certain types of insurance policies that are current and valid.

Individuals can be required to file the affidavit in different situations, such as transferring a title when buying a motor vehicle in Florida, or moving to Florida and obtaining a new title for their car. The document is required when an individual wants to receive a vehicle registration certificate. In addition to the affidavit, individuals are usually required to attach proof of their insurance in Florida - their insurance card or their auto policy.

This form was issued by the Florida Department of Highway Safety and Motor Vehicles (HSMV) and was last revised on September 1, 2009. Form HSMV 83330 is available for download below.

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Form HSMV 83330 Instructions

The affidavit is supposed to be completed by an insured individual. The HSMV 83330 Form consists of several statements and gaps that must be completed. These gaps include the following:

  1. The Insured. In the first part, the individuals must designate their full name.
  2. Insurance Details. Here the individual is required to provide information about their insurance. It includes the name of the insurance company, the auto policy number, and the company code number.
  3. Information About the Motor Vehicle. Individuals are supposed to describe the insured motor vehicle in this section of the affidavit. They must state its year, make, and vehicle identification number.
  4. Signature. To state that all the information the individual has presented in the document is true and correct, they must sign the form.

The affidavit also contains a warning: if the individual is providing false or incorrect information on the form they might be subject to prosecution.

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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