Important Information

Here are your Security Verification Farms. Please destroy your old
forms when the new forms become effective.

GEICO�
geico.com
Oklahoma Security Verification Form
1-800-841-3000 Due to space limitations on the Verification Form, only the Named
Insured and the Co-Insured are listed. For a full list of Drivers covered
GOVERNMENT EMPLOYEES INSURANCE COMPANY under this policy, please reference the Driver's Section on your
2280 N Greenville Ave, Richardson, TX 75082 Declarations Page, which is included with your insurance packet.

NAIC Code: 41491 Please notify us promptly of any change in your address, to be sure
you receive all important policy documents. Prompt notification will
ci�,f�Qnal
x Deommercial enable us to service you better.
An authorized Oklahoma insurer has issued SQ. t]
x (JW#ih D Q_perator's Liabili� Insurance
Policy to comply with the Compulsory lnsurarn:¢ Law,:¢:'Oklahoma.
······ · Expiration Date
If you would like additional Verification Forms, you can log into your
Polley Number Effective bate policy online at geico.com or call us at 1-800-841-3000
4402632493 08-04-16 01-16-17
Year Maka Vahlcla ID No.
2016 TOYOTA RAV4 XLE 2T3RFREV4GW487093
Insured:
HAN JIN SHI AND YU HUA YANG

Excluded Driver(s): None

WARNING (1) Oklahoma st.ate law requires a cUITeI1t copy of the owner's security
verification form must be surrendered to the motor license agent or other registering
agency upon application or renewal for a motor vehicle license plate. (The foregoing
do= not apply with respect to an Ope rator's Lillbility ln,,urance Policy.)

(2) Oklahoma law requirfl.'> the other copy of the owner's security verification form to
be carried in the motor vehicle at all times, and produced by an y driver of the vehicle
upon request for inspection by any peace officer or representative of t h e Department
of Public Safety. In case of an accident, the security verification form shall be shown
upon request of any p erson affected by an acci dent. NOTE: lf the named i nsured has
been issued an Ope rator's Liability Insurance Poli cy , this Security Verification form
applies in lieu of an Owner's Se curity Verification form.

Exrunine policy exclusioru, carefully. This form does not constitute any part of
your insurance policy.

What to do at the time of an accident

• Do not admit fault

• Do not reveal the limits of your liability coverage to anyone

• Exchange contact information; get year, make, model, plate number,

insurance carrier and policy number of all involved. Also,
identify witnesses and collect contact information

• Contact the police or call 911 if applicable

• Contact GEICO by calling 1-800-841-3000 to report the accident

U-4-0K (12-09)