# Selection Of Bodily Injury Uninsured/Underinsured Motorists Coverage AND Property Damage Uninsured/Underinsured Motorists Coverage

By completing this section, you are selecting BOTH Bodily Injury Uninsured/Underinsured Motorists Coverage AND Property Damage Uninsured/Underinsured Motorists Coverage in connection with your automobile liability policy.

Please indicate your choice by initialing next to the appropriate item(s) in 1. OR 2., and signing below:

## Initials

1. I select Bodily Injury Uninsured/Underinsured Motorists Coverage AND Property Damage Uninsured/Underinsured Motorists Coverage at limits equal to my Liability Coverage.
OR
2. I select Bodily Injury Uninsured/Underinsured Motorists Coverage AND Property Damage Uninsured/Underinsured Motorists Coverage at the following limit(s):
(Choose one Split Limits Bodily Injury option AND one Property Damage limit option, OR one Combined Single Limit option from the following:)

| Split Limits Bodily Injury | (Initials) | Property Damage | OR | Combined Single Limit |
|---------------------------|------------|-----------------|----|-----------------------|
| $50,000/100,000           |            | $25,000         |    | $125,000              |
| $100,000/300,000          |            | $50,000         |    | $200,000              |
| $250,000/500,000          |            | $100,000        |    | $250,000              |
| $300,000/500,000          |            |                 |    | $300,000              |
| $500,000/500,000          |            |                 |    | $350,000              |
| $500,000/1,000,000        |            |                 |    | $500,000              |
| $1,000,000/1,000,000      |            |                 |    | $1,000,000             |
| $1,000,000/2,000,000      |            |                 |    | $2,000,000             |

(Other) | (Other) | (Other)

Signature of Applicant/Named Insured | Date

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© ISO Properties, Inc., 2005
IL U 040 08 05