ACORD Forms: 61 - 70

1 - 30 31 - 60 61 - 70
71 - 90 91 - 120 121 - 137
138 - 150 151 - 180 181 - 404
Form Number State Name/Description
61 AK Alaska Auto Supplement, UM/UIM Cov. Selection Form
61 AZ Arizona Personal Auto Supplement
61 AR Arkansas Auto Supplement Uninsured/Underinsured Motorists Coverage Selection; Personal Injury Protection Selection
61 CA California Auto Supplement Mandatory Uninsured Motorists Bodily Injury Coverage Offer
61 CO Colorado Auto Supplement Summary of Coverages
61 CT Connecticut Auto Supplement UM Coverage
61 DE Delaware Auto Supplement Uninsured Motorists Coverage Selection Form
61 FL Florida Auto Supplement Rejection/Election of UM Coverage
61 GA Georgia Auto Supplement UM Coverage and Medical Payments Coverage Mandatory Offer and Explanation
61 IL Illinois Auto Supplement Uninsured/Underinsured Motorists Coverage
61 IA Iowa Auto Supplement UM and UIM Selection/Rejection
61 LA Louisiana Homeowners Supplement - Loss Settlement
61 MD Maryland Auto Supplement Summary of Coverages
61 NV Nevada Auto Supplement Mandatory Offer of Medical Payments Coverage and Uninsured Motorists Coverage
61 NJ New Jersey Auto Supplement Coverage Selection Form
61 NY New York Auto Supplement Optional Basic Economic Loss (OBEL) Coverage
61 NC North Carolina Auto Supplement Selection/Rejection Form Uninsured Motorists Coverage Combined Uninsured/Underinsured Motorists Coverage
61 OK Oklahoma Auto Supplement Election of Non-Stacked Coverage
61 OR Oregon Auto Supplement Uninsured Motorists Coverage Selection Form
61 PA Pennsylvania Auto Supplement Summary of Coverages
61 RI Rhode Island Auto Supplement Uninsured/Underinsured Motorists Bodily Injury Coverage Rejection Notice and Warning
61 SC South Carolina Auto Supplement Purchasing Automobile Ins Offer of Additional Uninsured and Underinsured Motorists Coverage; Mandatory Physical Damage Deductibles
61 UT Utah Auto Supplement
61 WI Wisconsin Auto Supplement Underinsured Motorists Coverage Selection Form
61 WV West Virginia/Underinsured Motorist Coverage - Offer of Split Limits Liability
62 AL Alabama Auto Supplement
62 AK Alaska Auto Supplement
62 AZ Arizona Commercial Auto Supplement
62 CA California Auto Supplement
62 CO Colorado Personal Property Supplement
62 IA Iowa Auto Supplement, Notice Regarding UM/UIM Coverage
62 LA Louisiana Commercial Property Supplement Loss Settlement
62 MD Maryland Commercial Auto Supplement
62 MI Michigan Collision Insurance Options Notice
62 MN Minnesota Auto Supplement
62 NV Nevada Umbrella Supplement
62 NH New Hampshire Statement of Residency or Exemption
62 NC North Carolina Joint Underwriting Association North Carolina Insurance Underwriting Association Fair and Beach Plan Coverage Instructions
62 NJ New Jersey Auto Supplement Basic Policy Coverage Selection Form
62 PA Pennsylvania Auto Supplement UIM Coverage Selection/Rejection
62 SC South Carolina Commercial Auto Supplement Panel Trucks Pickup Trucks Vans or Similar Vehicles Affidavit of Commercial Use
62 TX Texas Auto Supplement Consumer Bill of Rights for Personal Automobile Insurance (Spanish Language Text)
62 VA Virginia Property Supplement
62 WA Washington Auto Supplement Mandatory Offer of PIP Coverage
62 WV West Virginia Uninsured/Underinsured Motorist Coverage Offer of Single Limit Liability
63 CO Colorado Application Supplement Credit Report Disclosure Information
63
General Fraud Statement
63 HI Hawaii Application Supplement
63 OH Ohio Fraud Statement
63 OK Oklahoma Fraud Statement
63 UT Utah Fraud Statement
64 CA California Insurance Supplement - Agency Language Form
64 IA Iowa Auto Supplement, UM/UIM Coverage Stacking Coverage Option Notice
64 PA Insurance Placement Facility of Pennsylvania - Basic Property Insurance Application
64 LA Louisiana Homeowners Supplement-Loss Settlement
64 MD Maryland Property Insurance Availability Program
64 MA Mass. Residential Property Liability Supplement
64 NJ New Jersey Auto Supplement Standard Coverage Selection Form
64 NY New York Auto Supplement
64 TX Texas Windstorm Insurance Association
64 WV West Virginia Essential Property Insurance Association - Basic Property Insurance Application
65 CA California Insurance Supplement - Race- National Origin & Gender Form
65 LA Louisiana Homeowners Supplement-Loss Settlement
65 MN Minnesota Guaranty Association Notice
66 AR Arkansas Insurance Supplement
66 CA California Offer of Earthquake Coverage
66 FL Florida Insurance Supplement Credit Report Disclosure Information
66 LA Lousiana Dwelling Supplement-Loss Settlement
66 NC North Carolina Insurance Supplement
66 UT Utah Arbitration Provisions
66 VT Vermont Insurance Supplement Fair Credit Reporting Act
67 CA California Residential Property Disclosure
67 FL Florida Homeowners Supplement
67
IL- IN- KY- WV Mine Subsidence Homeowners and Dwelling Supplement
67 OH Ohio Mine Subsidence Homeowners and Dwelling Supplement (Required Counties)
67 TX Texas Homeowners and Personal Property Supplement
67 UT Utah Auto Insurance Supplement Personal Injury Protection Coverage Waiver of Loss of Income Benefits
67 VA Virginia Property Insurance Association Application For Insurance
68 FL Florida Windstorm Underwriting Association
68 LA Louisiana Plan Services Application for Insurance
68 ND North Dakota Supplement to Property Insurance Applications
68 OH Ohio Offer of Mine Subsidence Ins. HO & Dwelling (Optional Counties)
68 TX Texas Homeowners and Personal Property Supplement (Spanish Language Text)
69 LA Louisiana Auto Supplement-UM/UIM BI Coverage Form
69 TX Texas Special Mobile Home Windstorm & Hail Application - Texas Windstorm Insurance Association
70 NY Instructions for Completing Application for Commercial Insurance - NYPIUA
70
Personal Policy Change Request (Except Auto)

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