
FLORIDA DEPARTMENT OF
HIGHWAY SAFETY AND MOTOR VEHICLES
Division of Driver Licenses
Bureau of Financial Responsibility
2900 Apalachee Parkway, MS98
Tallahassee, Florida 32399-0585
FLORIDA
UNIFORM FINANCIAL RESPONSIBILITY
CERTIFICATE FR-44
Purpose: Use this form to comply with Florida’s Financial Responsibility Law, Section 324.023, Florida
Statutes for motor vehicle liability insurance coverage of 100k/300k/50k.
Instructions: Send completed form to the Bureau of Financial Responsibility at the above address.
FR-44
INSURED PERSON INFORMATION
INSURED NAME (Last) (First) (Middle) (Suffix)
STREET ADDRESS
CITY
STATE
ZIP CODE
DRIVER LICENSE NUMBER
BIRTH DATE (MM/DD/YYYY)
INSURANCE COMPANY INFORMATION
INSURANCE COMPANY NAME
FR CASE NUMBER
NAIC CODE
POLICY NUMBER
CERTIFICATION EFFECTIVE DATE
This certification is effective on the above certification Effective Date and continues until cancelled or terminated in
accordance with the financial responsibility laws and regulations of Florida. The insurance certified is provided by an:
OWNER’S POLICY – Applicable to the following described vehicle(s) and subject to the terms and conditions defined
in the owner’s policy.
VEHICLE YEAR
VEHICLE MAKE
VEHICLE IDENTIFICATION NUMBER (VIN)
VEHICLE YEAR
VEHICLE MAKE
VEHICLE IDENTIFICATION NUMBER (VIN)
VEHICLE YEAR
VEHICLE MAKE
VEHICLE IDENTIFICATION NUMBER (VIN)
VEHICLE YEAR
VEHICLE MAKE
VEHICLE IDENTIFICATION NUMBER (VIN)
OPERATOR’S POLICY – Applicable to any vehicle not registered/titled to the above listed person and subject to the
terms and conditions defined in the operator’s insurance policy.
The company signatory certifies that it has issued to the above named insured a motor vehicle liability policy as required by
the financial responsibility laws of Florida, which policy becomes effective on the above Certification Effective Date.
AUTHORIZED REPRESENTATIVE SIGNATURE
DATE
74751 (S) (12/07)