Form HSMV 83330 at a glance
What it is: HSMV 83330 (Rev. 09/09), the Florida Insurance Affidavit, certifies that insurance is currently in effect on a motor vehicle.
Who signs: The affidavit has a line for the Signature of Insured.
A filled-in Form HSMV 83330 example: an owner certifies her car insurance
How to fill out Form HSMV 83330, box by box
Name of Insured
Under penalty of perjury, you certify that you have Personal Injury Protection, Property Damage Liability, and, when required, Bodily Injury Liability Insurance currently in effect.
Write the Name of Insured after "Under penalty of perjury, I".
Name of Insurance Company, Policy Number and Company Code Number
Write the Name of Insurance Company, the Policy Number and the Company Code Number (5 digits).
This insurance company is licensed to issue insurance policies in Florida.
Year, Make and Vehicle Identification Number
Write the Year, the Make and the Vehicle Identification Number of the motor vehicle covered.
After the insurance and vehicle boxes are filled in, sign on the Signature of Insured line.
More rules for Form HSMV 83330
If the insurer denies that this policy is in force, your driver license, license plate(s) and registration(s) will be suspended effective from the registration date.
Common questions about Form HSMV 83330
Is there a penalty?
HSMV 83330 (Rev. 09/09) warns that giving false information in order to obtain a vehicle registration certificate is a criminal offense under Florida law, and anyone giving false information on this affidavit is subject to prosecution.
Sources
[1] Form HSMV 83330 (Rev. 09/09), Florida Insurance Affidavit, Florida Department of Highway Safety and Motor Vehicles (the Official source link on this page).
