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(e.g. fence, guardrail, mailbox, building, etc.)
If any of the above are applicable, disregard the "To the Vehicle Owner" note.
You are hereby required to return this form to the Department of Motor Vehicles, Financial Responsibility, P.O. Box 1498, Blythewood, SC 29016-0040 with the below portion completed by an authorized agent or representative of your insurance company showing that on the date and time stated above when the motor vehicle was being operated, that it was an insured motor vehicle. If the Department does not receive this form within 15 days from the date of the accident, the owner's registration and/or driving privileges in this site could be suspended.
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