The page an adjuster sends after a total loss: you appoint the insurance company as your attorney-in-fact for transferring ownership, applying for title, or applying for registration on the one wrecked vehicle, with full authority to sign on my (our) behalf all papers and documents. It exists so the claim can close without chasing you for every later signature - and its footnote carries a genuinely unusual rule about electronic signatures.
Written against 78-011 (Rev 09/22), issued under the vehicle's owner or owners, appointing the insurer as attorney-in-fact.
Read the scope line before signing: this appoints the insurer for the described unit only, and the description is one VIN wide. An insurer's packet that arrives with the vehicle line blank should go back with the line filled - by you.
Two documents, and they are not the same thing. Take the blank 78-011 from the dor.ms.gov copy so you get the revision that is current today, then print our 78-011 guide and keep it beside you while you fill theirs in.
This is the actual 78-011, rendered from the PDF the Mississippi Department of Revenue, Motor Vehicle Services publishes and completed end to end: letterhead, every field, and the blocks at the foot.
Amber — you write it
Grey — not yours to fill
Numbered — explained below
The actual 78-011 at Rev. 09/22, granted for one flood-damaged sedan. The two ticked purposes are the claim's whole business - transfer and title - and registration is deliberately left unticked, because the insurer has no business registering anything in the owner's name. Paper copy, so the notary block at the foot is completed; the form's own asterisk reserves the no-notary shortcut for the insurer's electronic channel.
Field by field
Every line, in the order you meet it
1
You fill this in
The insurer, named as your attorney
The company's name into the appointment line, its name again with the date of total loss in the boxes beneath.
Watch out: The date of total loss comes from the claim, not from memory - it is the date the salvage machinery reads from.
2
You fill this in
The purpose ticks, no more than needed
Tick transferring ownership and making application for title; leave registration unless the claim genuinely requires it.
Watch out: A power of attorney is measured by its ticks. Grant the two the settlement needs and keep the third.
3
You fill this in
The vehicle line
Year, make and the full identification number of the totalled unit.
Watch out: Fill it yourself before signing - an open vehicle line on a signed power is the one blank on this page worth being paranoid about.
4
You fill this in
Every owner, every lane
Printed name, signature and date for each owner the certificate carries.
Watch out: A co-owned car needs the co-owner's lane completed too, and the insurer will bounce the packet otherwise - their seventy-two-hour clock makes them fussy, not lenient.
5
Somebody else fills this in
Notary, unless the insurer goes electronic
On paper, the notary seals, dates and signs with commission expiry. Electronically, the footnote waives it - for insurance company submissions only.
Watch out: If an adjuster tells you no notary is needed, that is true of their channel, not of a paper form in your envelope. When in doubt, swear it.
At a glance
What goes where
On the form
What to put in it
The appointment
I (we) hereby appoint (name) as my (our) attorney-in-fact - with the bracketed instruction that an insurance company total loss completes the boxes immediately below: insurance company name and date of total loss.
The purpose ticks
Three checkable purposes: transferring ownership for the described unit, making application for title for it, and making application for registration for it.
The vehicle
Year (YYYY), make and identification number - one line, one unit.
The signature block
Three repeating lanes of owner's printed name, owner's signature and date (MM/DD/YYYY) - room for every owner the certificate names.
The notary section
Embosser or black ink rubber stamp seal, subscribed and sworn before me with day and year, state, the notary public's signature, printed name and commission expiry.
The electronic-signature footnote
The asterisk under everything: electronic signature is permissible ONLY for insurance company submissions to the Mississippi Department of Revenue related to a total loss vehicle - and notarization is not required if signing electronically.
What gets this one rejected
•A wet signature with no notary. On paper, the block at the foot is mandatory - the electronic exemption belongs to the insurer's e-submission channel, not to a scanned pen stroke.
•One owner signing for two. The lanes repeat three times because every owner on the certificate signs; a jointly titled wreck needs both names, joined however the title joins them.
•A blank date of total loss. The bracketed instruction makes the insurer's boxes part of the appointment - a power against an undated loss is a power against nothing in particular.
•Purposes left unticked. The insurer can only do what the ticked lines grant; an appointment with no purpose selected authorises a name and nothing else.
•Signing it before the settlement is agreed. This power lets the company move the title; the moment to grant that is when the cheque amount is settled, not when the adjuster first calls.
Rules that decide whether it is accepted
•What happens on the paper side. The FAQ's accident answer is the seller's half: you must sign the back of the title and give the title to your insurance company so they can apply for a salvage title. This power of attorney is the belt to those braces - it lets the insurer complete whatever the claim's paperwork still needs once the certificate is out of your hands.
•The insurer's own deadline. The salvage regulation gives the company seventy-two hours from obtaining your certificate to apply for the salvage title. An adjuster pressing you for the signed title and this power in the same envelope is not being pushy - they are on the clock.
