Auto insurers who use the Safe Driver Insurance Plan may send this SDIP Statement to the policyholder of any policy for which the Merit Rating Board reported an at-fault accident or traffic law violation during the five-year period immediately preceding the policy effective date.

This is an example of an SDIP Statement:

Safe Driver Insurance Plan (SDIP) Statement

MRB Process Date :

Policyholder Name
Policy # : 2008200820082008
Policy Effective Date : Jan 1, 2010
City, State, Zip Code
Policy Expiration Date : Jan 1, 2011

Agent :

Dear Policyholder:

This statement contains each listed operator's driving history record maintained by the Massachusetts Merit Rating Board (MRB) as of the process date shown above. The driving history information below includes one line for each at-fault accident and each traffic violation, one line for the Starting Date, and one line for the operator's SDIP Points or Credit Code. The Surcharge Date Column contains the date of surcharge notice for at-fault accidents and the court judgment date for traffic violations. This column on the Starting Date Line contains the beginning date of the listed operator's 6-year policy experience period or a later date if the operator has fewer than 6 years of driving experience.

This statement is being provided in compliance with Regulation 211 CMR 134.15. The SDIP points or credit code for the operators listed on this policy will determine surcharges or credits if this policy was assigned through the Massachusetts Automobile Insurance Plan (MAIP). If this policy was obtained through the voluntary market, the insurance company's merit rating plan will determine how these driving history records are used.

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