Homepage Free Louisiana Military Discount Form
Structure

The Louisiana Military Discount form is an essential tool for active military personnel seeking to benefit from reduced rates on personal automobile liability insurance. This form requires the completion of several sections, including personal details such as the full name, date of birth, and home address of the active military member. It also includes spaces for information about the spouse and any licensed dependents, with an option to indicate if these sections do not apply. To verify eligibility, applicants must attach a copy of their Permanent Change of Station (PCS) Orders or confirm that such documentation has been submitted previously. By signing this form, the active military personnel certifies their status and acknowledges the accuracy of the information provided. It is important to note that any false statements could lead to serious legal consequences. For those with questions, assistance is readily available through insurance agents or by contacting the Louisiana Department of Insurance directly.

Sample - Louisiana Military Discount Form

Form Characteristics

Fact Name Details
Purpose The Louisiana Application for Military Discount allows active military personnel to apply for discounts on personal automobile liability insurance.
Eligibility To qualify, applicants must be active military personnel and permanently based in Louisiana, as defined by LSA-R.S. 22:1482.
Required Information All sections of the form must be completed, including personal details, spouse information, and dependent information, if applicable.
Permanent Change of Station (PCS) Applicants must attach a copy of their PCS orders or confirm that such orders have been previously submitted.
Certification By signing the form, the applicant certifies that the information provided is true and acknowledges the potential for civil and criminal penalties for false statements.
Contact Information If there are questions regarding the form, applicants can contact the Louisiana Department of Insurance at (800) 259-5300 or (225) 342-5900.
Governing Law The form is governed by LSA-R.S. 22:1482 and Regulation 81, which outline the eligibility and requirements for military discounts.
Signature Requirement The form must be signed by the active military personnel, confirming their status and the accuracy of the provided information.
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