State Steer Clear Form PDF Details

In order to maintain compliance with state regulations, many businesses are turning to the State Steer Clear Form. The form is a comprehensive report that highlights a business' regulatory obligations and helps them stay in compliance with state laws. Completing the form can be time-consuming, but it's well worth the effort to avoid costly fines and penalties. By taking advantage of the State Steer Clear Form, businesses can protect their bottom line while ensuring compliance with state law.

You'll discover info about the type of form you want to fill out in the table. It will tell you how much time it will require to complete state steer clear form, what parts you will have to fill in, and so forth.

Form NameState Steer Clear Form
Form Length1 pages
Fillable fields0
Avg. time to fill out15 sec
Other namesstate farm steer clear safe driver, statefarm steer clear, steer clear form, state farm steer clear driving program

Form Preview Example

State Farm Mutual Automobile Insurance Company

State Farm Indemnity Company

State Farm Fire and Casualty Company

Statement For Qualification For Steer Clear® Discount

Policyholder’s Name

Qualifying Driver(’s) Name(s)

Policy Number


1.Qualifying driver(s) have maintained an accident-free and moving violation-free driving record in the past three years,*

2.Qualifying driver(s) have completed the educational and driving log requirements in good faith, and

3.All private passenger automobiles in the household are insured with State Farm Mutual Automobile Insurance Company, State Farm Fire and Casualty Company, State Farm Indemnity Company, and or State Farm Guaranty Company.


1.Qualifying driver(s) continue to maintain an accident-free and violation-free driving record.*

2.Qualifying driver(s) should complete Second Education material received prior to 21st birthday.


I have met the initial requirements for the Steer Clear safe driver discount and understand that I will lose the discount if I am involved in an at-fault accident or receive a traffic violation. The discount will also be removed when I am 25 years old or sooner if I am classified as an adult prior to that age.

Signature of Qualifying Driver






Signature of Qualifying Driver






Signature of Qualifying Driver






Signature of Parent/Guardian/Named Insured (if qualifying driver is under age 18)






Agent’s Name and Code



* In some states, certain accidents and moving violations may not disqualify you.

135-3776 a.6 01-16-2008

Watch State Steer Clear Form Video Instruction

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