Signature. Date. DE-INSURED CERTIFICATE. Make sure the insurer holds an Arizona Certificate of Authority.FULL Last Name: FULL First Name: Middle Initial: AZ License No. (if applicable):. To de-insure, your vehicle, complete a De-Insured Certificate for Arizona form. Submit the form in person at an MVD office or mail it to: Motor Vehicle Division. Attach this form to the application completed for the aforementioned applicant and forward both forms to the Plan in accordance with the application. This letter is to put your company on notice that this claim may result in an uninsured or underinsured motorist claim to be made on behalf of our clients. Motor vehicle insurance policy; reduction of rate for older person completing accident prevention course; course requirements. After becoming a Colorado resident, you have 90 days to register your vehicle. Bodily Injury Liability (BIL) pays for injury or death to others.