Proof of Insurance Submission

If you have received a citation for No Proof of Insurance, you may complete this form and attach a copy of your insurance card showing that you had insurance coverage at the date and time you received the ticket. This form is for defendants only. Attorneys should follow the instructions at https://www.rockhillmo.net/rock-hill-municipal-division/pages/attorney-instructions.

First Name *

Last Name *

Ticket/Case Number *

Email *

Upload Proof of Insurance *

Provide a clear copy of the insurance card showing you were covered on the date and time the violation occurred.
Files must be less than 5 MB.
Allowed file types: gif jpg jpeg png pdf.

Agreement *

I understand that the insurance I have provided is for the date of the ticket. Any submissions that do not cover the date of the ticket will not be processed and my appearance in court is expected.

I understand that submission of insurance via this form does not guarantee that my case is completely disposed of and closed. It is my responsibility to contact the court if I have not received confirmation via email within 3-5 business days.

Signature *

By typing my name below, I am signing this form electronically and acknowledging that I have read and understand all of the above information, and that all of the information provided is a true and accurate. I further understand that providing fictitious or altered insurance may result in additional charges being issued against me.

Leave this field blank

Welcome to Rock Hill

Departments

Boards & Committees

Business

How Do I Find...

Proof of Insurance Submission