Field and/or Section Description
ACORD 188 SC (2003/03)
Associated Auto Insurers Plan of
South Carolina - Endorsement
Voiding Automobile Insurance
while Named Person is Operating
ACORD 188 SC, Associated Auto Insurers Plan of South Carolina -
Endorsement Voiding Automobile Insurance while Named Person is Operating Car, is
used in connection with insurance written through the Associated Auto Insurers Plan of
South Carolina. Refer to the Plan rules to determine how the form should be used.
This endorsement, effective [Blank
Area] 12:01a.m. Standard Time
Enter date: The effective date of the endorsement.
Forms a part of policy Number
Enter identifier: The identifier assigned by the insurer to the policy, or submission, being
referenced exactly as it appears on the policy, including prefix and suffix symbols. If
required for self-insurance, the self-insured license or contract number.
Issued to [Blank Area] (Named
Enter text: The named insured(s) as it/they will appear on the policy declarations page.
By [Blank Area] (Insurer)
Enter text: The insurer's full legal company name(s) as found in the file copy of the policy.
Use the actual name of the company within the group to which the policy has been issued.
This is not the insurer's group name or trade name.
Name of Person to be Excluded
Enter text: The full name of the excluded person.
Sign here: Accommodates the signature of the applicant or named insured.
Enter date: The date the form was signed by the named insured.
I have surrendered my driver's
license to the Department of
Public Safety, or [Checkbox]
Check the box (if applicable): Indicates the driver has surrendered their driver's license to
the department of public safety.
I Have obtained a policy of
insurance (or other security) to
enable me to drive vehicles
Check the box (if applicable): Indicates the driver has obtained a policy of insurance or
other security to enable them to drive vehicles.
Excluded Person or Guardian If a
Sign here: Accommodates the signature of the driver. As used here, this is the signature
of the excluded driver or their guardian if they are a minor.
Enter date: The date the driver signed the form.
The edition identifier of the form including the form number and edition (the date is
typically formatted YYYY/MM).
ACORD 188 SC (2003/03) rev. 05-08-2009
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