|
Form Number |
State |
Description |
Edition Date |
|
1 |
|
Property Loss Notice |
2009/01 |
|
2 |
|
Automobile Loss Notice |
2009/01 |
|
3 |
|
General Liability Notice of Occurrence / Claim |
2009/01 |
|
4 |
|
Workers Compensation - First Report of Injury or Illness |
2009/01 |
|
4 |
WI |
Wisconsin
Employer's First Report of Injury or Disease |
2003/04 |
|
11 |
|
Auto Accident Information Form |
2/95 |
|
12 |
|
Exchange of Information Form |
2/95 |
|
13 |
|
Witness Card |
2/95 |
|
18 |
|
Jewelry Appraisal & Claim Evaluation |
1/98 |
|
22 |
|
Intermodal
Interchange Certificate of Insurance |
2010/03 |
|
22 |
|
Intermodal
Interchange Certificate of Insurance |
2007/02 |
|
23 |
|
Leased Auto Certificate of Insurance |
2010/05 |
|
24 |
|
Certificate of Property |
2009/09 |
|
24 |
|
Certificate of Property |
1/95 |
|
25 |
|
Certificate of Liability Insurance |
2010/05 |
|
25 |
|
Certificate of Liability Insurance |
2009/09 |
|
25 |
|
Certificate of Liability Insurance |
2009/01 |
|
26 |
|
Policy Certification Log |
2002/01 |
|
27 |
|
Evidence of Property |
2009/12 |
|
27 |
|
Evidence of Property |
2006/07 |
|
27 |
|
Evidence of Property |
2004/04 |
|
27 |
|
Evidence of Property |
2003/10 |
|
27 |
|
Evidence of Property |
03/93 |
|
28 |
|
Evidence of Commercial Property |
2009/12 |
|
28 |
|
Evidence of Commercial Property |
2006/07 |
|
28 |
|
Evidence of Commercial Property
(2003) |
2003/10 |
|
30 |
|
Certificate
of
Garage
Insurance |
2010/12 |
|
35 |
|
Cancellation Request |
1/97 |
| 36 |
|
Agent/Broker of Record Change |
2007/01 |
| 37 |
|
Statement of No Loss |
2008/01 |
| 37 |
|
Statement of No Loss |
1/96 |
| 38 |
|
Notice of Information Practices (Privacy) |
2004/11 |
| 38 |
AR |
Arkansas Notice of
Information Practices (Privacy) |
2001/08 |
| 38 |
AZ |
Arizona Notice of
Information Practices (Privacy) |
2003/10 |
| 38 |
CO |
Colorado Notice of
Information Practices (Privacy) |
2001/07 |
| 38 |
MN |
Minnesota
Authorization |
2002/08 |
| 38 |
MT |
Montana Notice of
Information Practices (Privacy) |
2001/01 |
| 38 |
ND |
North Dakota
Personal Insurance Supplement – Notice of
Information Practices |
2004/10 |
| 38 |
NY |
New York Personal Insurance Supplement |
2005/04 |
| 38 |
OR |
Oregon Notice of
Information Practices (Privacy) |
2003/05 |
| 39 |
MD |
Maryland
Application Supplement |
2003/05 |
| 39 |
NY |
New York Insurance supplement |
2011/03 |
| 40 |
|
Residential Property Valuation Survey |
2000/02 |
| 41 |
|
Residential Property Replacement Cost Worksheet |
1/98 |
| 42 |
|
Residential Property Replacement Cost Information Supplement |
2001/05 |
| 45 |
|
Additional Interest |
2003/04 |
| 50 |
|
Insurance ID Card |
1/83 |
| 50 |
AL |
Alabama Insurance ID Card |
2007/10 |
| 50 |
AR |
Arkansas Proof of
Insurance Card |
2007/06 |
| 50 |
AZ |
Arizona Insurance ID Card |
2007/11 |
| 50 |
CA |
California
Insurance ID Card |
2004/07 |
| 50 |
CT |
Connecticut Insurance ID Card - 4 per page |
2009/01 |
| 50 |
FL |
Florida Auto
Insurance ID Card |
3/94 |
| 50 |
FL |
Single and set of 8 |
2008/02 |
| 50 |
GA |
Georgia Insurance
Policy Information Card |
2004/07 |
| 50 |
HI |
Hawaii Motor
Vehicle Insurance ID Card |
2008/01 |
| 50 |
IA |
Iowa Financial
Liability Coverage Card |
2007/08 |
| 50 |
KY |
Commonwealth of
Kentucky Proof of Insurance |
2006/01 |
| 50 |
LA |
Louisiana Auto
Insurance ID Card |
4/96 |
| 50 |
MI |
Michigan
Certificate of No-Fault Insurance |
6/93 |
| 50 |
MO |
Missouri Auto Insurance ID Card (set) |
2007/05 |
| 50 |
MO |
Missouri Auto
Insurance ID Card |
2/98 |
| 50 |
MS |
Mississippi
Insurance ID Card |
2008/01 |
| 50 |
ND |
North Dakota Insurance ID Card |
2007/08 |
| 50 |
NJ |
TEMPORARY State of
New Jersey Insurance ID Card |
2005/05 |
| 50 |
NY |
New York State
Insurance ID Card |
1/98 |
| 50 |
NV |
Nevada Insurance
ID Card |
2002/04 |
| 50 |
OK |
Oklahoma Security
Verification Form |
2008/03 |
| 50 |
PA |
Pennsylvania
Financial Responsibility ID Card |
2002/08 |
| 50 |
PA |
Pennsylvania
Financial Responsibility ID Card |
2002/08 |
| 50 |
RI |
Rhode Island Insurance Identification Card |
2008/01 |
| 50 |
TX |
Texas Liability
Insurance Card |
2003/09 |
| 50 |
WM |
Watermark Auto ID |
2/95 |
| 50 |
WM |
Watermark Auto ID - set (New Jersey only) |
2007/03 |
| 50 |
WM |
Watermark Auto ID (New Jersey only) |
2007/03 |
| 50 |
WV |
West Virginia Auto ID |
3/94 |
| 51 |
CA |
California Evidence
of Liability Insurance |
2004/07 |
| 51 |
FL |
Florida Commercial Auto Insurance ID Card |
2009/07 |
| 51 |
GA |
Georgia Fleet
Policy Information Card |
2004/07 |
| 51 |
NJ |
New Jersey Insurance ID card (set) |
2007/06 |
| 51 |
NJ |
New Jersey Insurance ID card |
2007/06 |
| 51 |
NV |
Nevada Insurance ID card |
2008/11 |
| 51 |
OK |
Oklahoma Operators
Security Verification Form |
2002/07 |
| 54 |
|
Financial Responsibility Form (3part) |
1/97 |
| 57 |
|
Financial Responsibility Form (Notice of Cancellation or Termination)
(3 part) |
1/97 |
| 58 |
|
Notice of Cancellation or Termination of Policy |
2007/11 |
| 60 |
|
Flood Insurance Notice/Rejection |
2002/09 |
| 60 |
HI |
Hawaii Auto
Supplement Uninsured/Underinsured Motorists
Coverage Selection Stacked or Non- Stacked UM and
UIM Coverage |
2004/07 |
| 60 |
LA |
Louisiana Dwelling
Supplement - Loss Settlement (DWG 1) |
4/98 |
| 60 |
MA |
Massachusetts
Property Insurance Underwriting Association -
Application for Homeowners Insurance Inspection
and Placement |
2003/04 |
| 60 |
MN |
Minnesota FAIR Plan Homeowners Application - HO 6 Condo Unit Owners Coverage |
2007/05 |
| 60 |
MT |
Montana Application
Supplement - Refusal to Renew |
2003/09 |
| 60 |
NJ |
New Jersey Personal
Property Insurance Supplement - Flood Exclusion |
2001/10 |
| 60 |
NM |
New Mexico
Confidential Abuse Information Disclosure Notice |
2003/01 |
| 60 |
NY |
New York Homeowners
Supplement |
8/95 |
| 60 |
OK |
Oklahoma Auto
Supplement, Oklahoma Uninsured Motorists Coverage
Law |
10/94 |
| 60 |
PA |
Pennsylvania Auto
Supplement UM Coverage Selection/Rejection |
2008/01 |
| 60 |
TX |
Texas Auto
Supplement Consumer Bill of Rights for Personal
Automobile Insurance |
2007/05 |
| 60 |
US |
Insurance
Supplement - Notice - Offer of Terrorism Coverage |
2003/01 |
| 60 |
VA |
Virginia Auto
Supplement Rental Reimbursement Coverage |
8/94 |
| 60 |
WV |
West Virginia Auto
Supplement UM/UIM Vehicle Coverages |
12/93 |
| 61 |
AK |
Alaska Auto
Supplement, UM/UIM Cov. Selection Form |
7/97 |
| 61 |
AR |
Arkansas Auto
Supplement, Uninsured/Underinsured Motorists
Coverage Selection; Personal Injury Protection
Selection |
2002/03 |
| 61 |
AZ |
Arizona Auto
Supplement |
2001/02 |
| 61 |
CA |
California Auto
Supplement Mandatory Uninsured Motorists Bodily
Injury Coverage Offer |
2008/03 |
| 61 |
CO |
Colorado Auto
Supplement Summary of Coverages |
2008/01 |
| 61 |
CT |
Connecticut Auto
Supplement UM Coverage |
2004/11 |
| 61 |
DE |
Delaware Auto
Supplement Uninsured Motorists Coverage Selection
Form |
3/97a |
| 61 |
FL |
Florida Auto
Supplement Rejection/Election of UM
Coverage/Personal Injury Protection Disclosures |
2008/03 |
| 61 |
GA |
Georgia Auto
Supplement, UM Cov and Medical |
2002/12 |
| 61 |
IA |
Iowa Auto
Supplement, UM and UIM Selection/Rejection |
2002/02 |
| 61 |
IL |
Illinois Auto
Supplement Uninsured/Underinsured Motorists
Coverage |
2003/03 |
| 61 |
LA |
Louisiana
Homeowners Supplement - Loss Settlement (HO4) |
2001/05 |
| 61 |
MA |
Massachusetts
Property Insurance Underwriting Association
Inspection Notice, Credit Reporting Notice and
Instructions for Completing Homeowners Application
ACORD 60 MA |
2003/04 |
| 61 |
MD |
Maryland Personal
Auto Supplement Summary of Coverages |
2003/09 |
| 61 |
MS |
Mississippi Auto
Supplement - Mississippi Non-Stacking UM Coverage |
2002/09 |
| 61 |
NC |
North Carolina Auto
Supplement Selection/Rejection Form Uninsured
Motorists Coverage Combined Uninsured/Underinsured
Motorists Coverage |
2005/02 |
| 61 |
NJ |
New Jersey Auto
Supplement - Auto Insurance Buyer's Guide |
2006/10 |
| 61 |
NV |
Nevada Auto
Supplement |
2002/12 |
| 61 |
NY |
New York Auto
Supplement Optional Basic Economic Loss (OBEL)
Coverage |
3/94 |
| 61 |
OH |
ACORD Removed this
form 10/15/01 - Ohio Auto Supplement - Uninsured
Motorists Coverage Selection Form |
2001/02 |
| 61 |
OK |
Oklahoma Auto
Supplement Election of Non-Stacked Coverage |
3/94 |
| 61 |
OR |
Oregon Auto
Supplement Uninsured Motorists Coverage Selection
Form |
2004/10 |
| 61 |
PA |
Pennsylvania Auto
Supplement Summary of Coverages |
2007/08 |
| 61 |
RI |
Rhode Island Auto
Supplement Uninsured/Underinsured Motorists Bodily
Injury Coverage Rejection Notice and Warning |
4/95 |
| 61 |
SC |
South Carolina Auto
Supplement Offer of Additional Uninsured Motorists
and Optional Underinsured Motorists Coverage |
2007/08 |
| 61 |
UT |
Utah Auto
Supplement |
2001/02 |
| 61 |
WI |
Wisconsin Auto
Supplement Underinsured Motorists Coverage
Selection Form |
5/96 |
| 61 |
WV |
West Virginia
Uninsured/Underinsured Motorist Coverage - Offer
of Split Limits Liability |
2000/10 |
| 62 |
AK |
Alaska Auto
Supplement |
2/98 |
| 62 |
AL |
Alabama Insurance
Application Supplement |
5/98 |
| 62 |
AZ |
Arizona Auto
Supplement (Spanish Version), Uninsured and
Underinsured Motorists Coverage Selection Form |
2003/05 |
| 62 |
CA |
California Auto
Supplement - Auto Preinspection Law |
2001/05 |
| 62 |
CO |
Colorado Personal
Property Supplement |
2/97 |
| 62 |
DE |
Delaware Auto
Supplement - Personal Injury Protection Deductible
Options |
2004/10 |
| 62 |
GA |
Georgia Auto Supplement |
2008/01 |
| 62 |
IA |
Iowa Auto
Supplement, Notice Regarding UM/UIM Coverage |
2/98 |
| 62 |
IL |
Illinois Property Supplement - Notice of Availability of Earthquake Insurance |
2007/08 |
| 62 |
LA |
Louisiana
Commercial Property Supplement Loss Settlement |
4/98 |
| 62 |
MD |
Maryland Commercial
Auto Supplement |
1/98 |
| 62 |
MI |
Michigan Collision
Insurance Options Notice |
2000/01 |
| 62 |
MO |
Missouri Property Supplement - Notice of Availability of Earthquake Insurance |
2007/08 |
| 62 |
MN |
Minnesota Auto
Supplement |
2000/01 |
| 62 |
NC |
North Carolina
Joint Underwriting Association North Carolina
Insurance Underwriting Association Fair and Beach
Plan Coverage Instructions |
9/97 |
| 62 |
NH |
New Hampshire
Statement of Residency or Exemption |
2004/09 |
| 62 |
NJ |
New Jersey Auto
Supplement Basic Policy Coverage Selection Form |
2006/10 |
| 62 |
NV |
Nevada Umbrella
Supplement |
2001/05 |
| 62 |
NY |
New York
Application for Dwelling Insurance-NYPIUA |
2006/04 |
| 62 |
OK |
Oklahoma
Property Summary |
2006/05 |
| 62 |
OR |
Oregon Personal Lines Supplement |
2006/01 |
| 62 |
PA |
Pennsylvania Auto
Supplement UIM Coverage Selection/Rejection |
2008/01 |
| 62 |
RI |
Rhode Island Property Supplement - Notice of Flood Coverage Exclusion |
2006/01 |
| 62 |
SC |
South Carolina
Commercial Auto Supplement Panel Trucks Pickup
Trucks Vans or Similar Vehicles Affidavit of
Commercial Use |
2/96 |
| 62 |
TX |
Texas Auto
Supplement Consumer Bill of Rights for Personal
Automobile Insurance (Spanish Language Text) |
2007/05 |
| 62 |
VA |
Virginia Property
Supplement |
6/97 |
| 62 |
WA |
Washington Auto
Supplement Mandatory Offer PIP Coverage |
2007/04 |
| 62 |
WV |
West Virginia
Uninsured/Underinsured Motorist Coverage - Offer
of Single Limit Liability |
2000/10 |
| 63 |
|
General Fraud Statement |
2001/10 |
| 63 CO |
CO |
Colorado
Application Supplement Credit Report Disclosure
Information |
1/97 |
| 63 HI |
HI |
Hawaii Application
Supplement |
9/98 |
| 63 OH |
OH |
Ohio Fraud
Statement |
9/93 |
| 63 OK |
OK |
Oklahoma Fraud
Statement |
10/97 |
| 63 UT |
UT |
Utah Fraud
Statement |
9/93 |
| 64 CA |
CA |
California Ins
Supplement, Agency Language Form |
2004/02 |
| 64 DC |
DC |
Application to
District of Columbia Property Insurance Facility
for Basic Property Inspection and Insurance
Program |
2004/11 |
| 64 DE |
DE |
Insurance Placement
Facility of Delaware |
2004/06 |
| 64 IA |
IA |
Iowa Auto
Supplement, UM/UIM Coverage Stacking Coverage
Option Notice |
2/98 |
| 64 LA |
LA |
Louisiana
Homeowners Supplement-Loss Settlement (HO2 & 3) |
2001/05 |
| 64 MA |
MA |
Massachusetts
Residential Property Liability Supplement |
2/97 |
| 64 MD |
MD |
Maryland Property
Insurance Availability Program, |
2004/11 |
| 64 MI |
MI |
Michigan Basic
Property Insurance Association Insurance
Application |
2000/10 |
| 64 MN |
MN |
Minnesota FAIR Plan
Homeowners Application - HO 4 Renters Coverage |
2007/05 |
| 64 NC |
NC |
North Carolina
Property Supplement - Flood Insurance Notice |
2001/02 |
| 64 NJ |
NJ |
New Jersey Auto
Supplement Standard Coverage Selection Form |
2004/01 |
| 64 NY |
NY |
New York Auto
Supplement - Supplementary UM/UIM Insurance
Coverage |
2008/06 |
| 64 NY |
NY |
New York Auto
Supplement - Supplementary UM/UIM Insurance
Coverage |
2003/01 |
| 64 PA |
PA |
Insurance Placement
Facility of Pennsylvania Basic Property Insurance
Application |
2000/01 |
| 64 RI |
RI |
Rhode Island Joint
Reinsurance Association - Application for
Homeowners Insurance Inspection and Placement |
2003/04 |
| 64 TX |
TX |
Texas Windstorm
Insurance Association - Application for Windstorm
and Hail Insurance |
2003/04 |
| 64 US |
US |
Insurance
Supplement - Workers' Compensation Only |
2003/02 |
| 64 VA |
VA |
Virginia Property
Supplement - Notice of Flood Insurance Coverage
Exclusion |
2004/09 |
| 64 WV |
WV |
West Virginia
Essential Property Insurance Association - Basic
Property Insurance Application |
2004/06 |
| 65 CA |
CA |
California
Insurance Supplement, Race, National Origin and
Gender Form |
2004/07 |
| 65 DC |
DC |
Application to
District of Columbia Property Insurance Facility
for Basic Property Inspection and Insurance
Program |
2001/06 |
| 65 IA |
IA |
Iowa Auto
Supplement - Notice - Payment for Aftermarket
Crash Parts |
2000/07 |
| 65 LA |
LA |
Louisiana
Homeowners Supplement-Loss Settlement (HO6) |
2001/02 |
| 65 MA |
MA |
Massachusetts
Property Insurance Underwriting Association -
Application for Dwelling Fire Insurance Inspection
and Placement |
2003/04 |
| 65 MD |
MD |
Maryland Property
Insurance Availability Program Essential
Homeowners Insurance Inspection and Placement |
2001/06 |
| 65 MN |
MN |
Minnesota Guaranty
Association Notice |
2005/06 |
| 65 NJ |
NJ |
New Jersey Property
Insurance Supplement - Earthquake Notice |
2003/02 |
| 65 NY |
NY |
New York Auto
Supplement - Supplemental Spousal Liability
Coverage |
2003/01 |
| 65 PA/ DE/WV |
PA/ DE/WV |
Fair Plan
Supplementary Questionnaire |
2000/01 |
| 65 RI |
RI |
Rhode Island Joint
Reinsurance Association - Inspection Notice,
Credit Reporting Notice and Instructions for
Completing Homeowners Application ACORD 64 RI |
2003/04 |
| 65 WV |
WV |
West Virginia
Personal and Commercial Umbrella Liability
Supplement Uninsured/Underinsured Motor Vehicle
Coverage Important Notice |
2001/08 |
| 66 |
CA |
California Offer of
Earthquake Coverage |
2/98 |
| 66 |
CT |
Connecticut FAIR
Plan Application for Basic Property & Liability
Insurance |
2006/06 |
| 66 |
DC |
District of
Columbia Property Insurance Facility - Essential
Homeowners Insurance Inspection and Placement
Application p.1 |
2005/12 |
| 66 |
FL |
Florida Insurance
Supplement, Credit Report Disclosure Information |
2001/08 |
| 66 |
IA |
Iowa Personal Insurance Supplement - Disclosure
Use of Claims History |
2006/07 |
| 66 |
LA |
Louisiana Dwelling
Supplement-Loss Settlement (DWG2 & 3) |
4/98 |
| 66 |
MA |
Massachusetts
Property Insurance Underwriting Association -
Inspection Notice, Credit Reporting Notice and
Instructions for Completing Homeowners Application
|
2005/01 |
| 66 |
MD |
Maryland Property
Insurance Availability Program Essential
Homeowners Insurance Inspection and Placement |
2005/12 |
| 66 |
MN |
Minnesota Fair Plan
Homeowners HO 8 Application |
2007/05 |
| 66 |
NC |
North Carolina
Insurance Supplement |
8/97 |
| 66 |
RI |
Rhode Island Joint
Reinsurance Association - Application for Dwelling
Fire Insurance Inspection and Placement |
2003/04 |
| 66 |
US |
Insurance
Supplement - Commercial Auto Only - AK, CT, HI,
KS, KY, NJ, NY, OR |
2003/02 |
| 66 UT |
UT |
Utah Arbitration
Provisions |
6/94 |
| 66 VT |
VT |
Vermont Insurance
Supplement Fair Credit Reporting Act |
2003/06 |
| 66 WV |
WV |
West Virginia
Personal and Commercial Umbrella Liability
Supplement Uninsured/Underinsured Motor Vehicle
Coverage Offer of Split Limits Liability |
2001/08 |
| 67 |
|
Illinois, Indiana, Kentucky, West Virginia Mine Subsidence Home &
Dwelling Fire Supplement |
2001/07 |
| 67 AR |
AR |
Arkansas Property
Supplement |
2000/02 |
| 67 CA |
CA |
California
Residential Property Disclosure |
2005/01 |
| 67 DC |
DC |
District of
Columbia Property Insurance Facility - Essential
Homeowners Insurance Inspection and Placement
Application p. 2 |
2004/07 |
| 67 FL |
FL |
Florida Homeowners
Supplement |
7/94 |
| 67 LA |
LA |
Louisiana
Certification of Mobile Home Tie Downs |
5/98 |
| 67 MA |
MA |
Massachusetts
Property Insurance Underwriting Association -
Application for Commercial Fire Insurance
Inspection and Placement |
2003/04 |
| 67 MD |
MD |
Maryland Personal
Auto Supplement - Notice Concerning Waiver of PIP
Coverage |
2005/01 |
| 67 MN |
MN |
Minnesota Fair Plan
Dwelling Fire Application |
2007/05 |
| 67 MO |
MO |
Missouri FAIR Plan
Insurance Application |
2003/11 |
| 67 NJ |
NJ |
New Jersey
Insurance Underwriting Insurance Association
Dwelling Fire Application |
2002/07 |
| 67 NY |
NY |
New York Property
Insurance Underwriting Association Instructions
for Completing Application for Dwelling Insurance |
2000/08 |
| 67 OH |
OH |
Ohio Mine
Subsidence Homeowners and Dwelling Supplement |
1/94a |
| 67 RI |
RI |
Rhode Island Joint
Reinsurance Association - Inspection Notice,
Credit Reporting Notice and Instructions for
Completing Dwelling Fire Application |
2003/04 |
| 67 TX |
TX |
Texas Homeowners
and Personal Property Supplement |
2007/05 |
| 67 UT |
UT |
Utah Auto Insurance
Supplement Personal Injury Protection Coverage
Waiver of Loss of Income Benefits |
10/94 |
| 67 VA |
VA |
Virginia Property
Insurance Association Application For Insurance |
2000/11 |
| 68 CA |
CA |
California
Scheduled Personal Property - Loss Computation
Disclosure |
2001/03 |
| 68 FL |
FL |
Citizens Property
Insurance Corporation, Residential - Dwelling Wind
Only |
2004/09 |
| 68 IL |
IL |
Illinois FAIR Plan
Association (Part 2 of 2 Parts) Supplemental
Application for (1-4 Family) Homeowners & Dwelling
Property Insurance |
2004/03 |
| 68 LA |
LA |
Louisiana Plan
Services Application for Insurance |
4/98 |
| 68 MA |
MA |
Massachusetts
Property Insurance Underwriting Association -
Inspection Notice, Credit Reporting Notice and
Instructions for Completing Commercial Fire
Application |
2003/04 |
| 68 MN |
MN |
Minnesota Fair Plan
Commercial Fire Application |
2004/07 |
| 68 ND |
ND |
North Dakota
Supplement to Property Insurance Applications |
10/93a |
| 68 NJ |
NJ |
New Jersey
Insurance Underwriting Association - Commercial
Fire Application |
2003/07 |
| 68 NY |
NY |
New York Liability
Supplement - Claims-Made Policy Important
Information |
2002/01 |
| 68 OH |
OH |
Ohio Offer of Mine
Subsidence Ins. HO & Dwelling Supplement |
7/99 |
| 68 RI |
RI |
Rhode Island Joint
Reinsurance Association - Application for
Commercial Fire Insurance Inspection and Placement |
2003/04 |
| 68 TX |
TX |
Texas Homeowners
and Personal Property Supplement (Spanish Language
Text) |
2002/12 |
| 68 WV |
WV |
West Virginia
Personal and Commercial Umbrella Liability
Supplement Uninsured/Underinsured Motor Vehicle
Coverage Offer of Single Limit Liability |
2001/08 |
| 69 FL |
FL |
Citizens Property
Insurance Corporation, Wind Only Supplemental
Residential Application Schedule |
2004/09 |
| 69 IL |
IL |
Illinois FAIR Plan
Association (Part 1 of 2 Parts) Application for
(1-4 Family) Homeowners & Dwelling Property
Insurance |
2004/03 |
| 69 LA |
LA |
Louisiana Auto
Supplement - UM/UIM BI Coverage - UM Property
Damage Coverage |
2002/06 |
| 69 MN |
MN |
Minnesota Fair Plan Farm Fire Application |
2007/05 |
| 69 RI |
RI |
Rhode Island Joint
Reinsurance Association - Inspection Notice,
Credit Reporting Notice and Instructions for
Completing Commercial Fire Application |
2003/04 |
| 69 TX |
TX |
Texas Special
Mobile Home Windstorm & Hail Application - Texas
Windstorm Insurance Association |
2000/08 |
| 70 |
|
Personal Policy Change Request (Except Auto) |
2004/05 |
| 70 |
NY |
Instructions for
Completing Application for Commercial Insurance -
NYPIUA |
2000/09 |
| 71 |
|
Personal Auto Policy Change Request |
2003/09 |
| 71 |
SC |
SC Associated Auto
Insurers Plan - Private Passenger Policy Change
Request |
2003/03 |
| 72 |
|
Certification of Mobile Home Tie Downs - Supplement to Mobile Home
Application |
2002/12 |
| 73 |
|
Solid Fuel Questionnaire Personal Property Supplement |
2000/08 |
| 74 |
|
Residence Based Business Supplement to Personal Property Applications |
2001/05 |
| 75 |
|
Insurance Binder |
2004/09 |
| 76 |
|
Binder Log |
9/93 |
| 77 |
|
No longer on ACORD's Website - Jewelry Evaluation Form Diamonds and
Mounting Information |
2000/08 |
| 78 |
|
Jewelry Insurance Appraisal-Single Item |
2003/04 |
| 79 |
|
Jewelry Insurance Appraisal |
2003/04 |
| 80 |
|
Homeowner Application |
2010/05 |
| 80 |
|
Homeowner Application |
2006/08 |
| 81 |
|
Personal Inland Marine Application |
2005/08 |
| 82 |
|
Watercraft Application |
2009/09 |
| 82 |
|
Watercraft Application |
2007/06 |
| 83 |
|
Personal Umbrella Application |
2011/01 |
| 83 |
|
Personal Umbrella Application |
2009/10 |
| 83 |
|
Personal Umbrella Application |
2008/11 |
| 84 |
|
Dwelling Fire Application |
2004/02 |
| 85 |
|
Mobile Home Application |
2004/09 |
| 86 |
|
Personal Lines Package Application |
2004/09 |
| 87 |
|
Personal Lines Package Application Watercraft/Inland Marine Supplement |
2003/06 |
| 88 |
|
Personal Insurance Application |
2007-11 |
| 89 |
|
Residential Section |
2007-11 |
| 90 AK |
AK |
Alaska Personal
Auto Application |
2001/02 |
| 90 AL |
AL |
Alabama Personal
Auto Application |
2004/04 |
| 90 AR |
AR |
Arkansas Personal
Auto Application |
2000/10 |
| 90 AZ |
AZ |
Arizona Personal
Auto Application |
2003/10 |
| 90 CA |
CA |
California Personal
Auto Application |
2000/01 |
| 90 CO |
CO |
Colorado Personal
Auto Application |
2009/01 |
| 90 CT |
CT |
Connecticut
Personal Auto Application |
2003/06 |
| 90 DC |
DC |
District of
Columbia Personal Auto Application |
2002/01 |
| 90 DE |
DE |
Delaware Personal
Auto Application |
2003/09 |
| 90 FL |
FL |
Florida Personal
Auto Application |
2003/10 |
| 90 GA |
GA |
Georgia Auto
Application |
2009/01 |
| 90 HI |
HI |
Hawaii Personal
Auto Application |
2004/05 |
| 90 IA |
IA |
Iowa Personal Auto
Application |
2002/10 |
| 90 ID |
ID |
Idaho Personal Auto
Application |
2001/03 |
| 90 IL |
IL |
Illinois Personal
Auto Application |
2003/10 |
| 90 IN |
IN |
Indiana Personal
Auto Application |
2003/12 |
| 90 KS |
KS |
Kansas Personal
Auto Application |
2004/01 |
| 90 KY |
KY |
Kentucky Personal
Auto Application |
2002/07 |
| 90 LA |
LA |
Louisiana Personal
Auto Application |
2004/04 |
| 90 MA |
MA |
Application for
Massachusetts Motor Vehicle Ins. |
2007/08 |
| 90 MD |
MD |
Maryland Personal
Auto Application |
2003/05 |
| 90 ME |
ME |
Maine Personal Auto
Application |
2003/11 |
| 90 MI |
MI |
Michigan Personal
Auto Application |
2003/04 |
| 90 MN |
MN |
Minnesota Personal
Auto Application |
2004/01 |
| 90 MO |
MO |
Missouri Personal
Auto Application |
2002/09 |
| 90 MS |
MS |
Mississippi
Personal Auto Application |
2004/09 |
| 90 MT |
MT |
Montana Personal
Auto Application |
2003/09 |
| 90 NC |
NC |
North Carolina
Personal Auto Application |
2007/06 |
| 90 ND |
ND |
North Dakota
Personal Auto Application |
2003/12 |
| 90 NE |
NE |
Nebraska Personal
Auto Application |
2003/12 |
| 90 NH |
NH |
New Hampshire
Personal Auto Application |
2004/10 |
| 90 NJ |
NJ |
New Jersey Personal
Auto Application |
2000/09 |
| 90 NM |
NM |
New Mexico Personal
Auto Application |
2001/03 |
| 90 NV |
NV |
Nevada Personal
Auto Application |
2001/03 |
| 90 NY |
NY |
New York Personal
Auto Application |
2003/11 |
| 90 OH |
OH |
Ohio Personal Auto
Application |
2003/09 |
| 90 OK |
OK |
Oklahoma Personal
Auto Application |
2003/12 |
| 90 OR |
OR |
Oregon Personal
Auto Application |
2003/05 |
| 90 PA |
PA |
Pennsylvania
Personal Auto Application |
2000/09 |
| 90 PR |
PR |
Puerto Rico
Personal Auto Application |
2004/04 |
| 90 RI |
RI |
Rhode Island
Personal Auto Application |
2003/05 |
| 90 SC |
SC |
South Carolina
Personal Auto Application |
2002/10 |
| 90 SD |
SD |
South Dakota
Personal Auto Application |
9/98 |
| 90 TN |
TN |
Tennessee Personal
Auto Application |
2005/01 |
| 90 TX |
TX |
Texas Personal Auto
Application |
2001/03 |
| 90 UT |
UT |
Utah Personal Auto
Application |
2001/01 |
| 90 VA |
VA |
Virginia Personal
Auto Application |
2005/01 |
| 90 VI |
VI |
Virgin Islands
Personal Auto Application |
2001/03 |
| 90 VT |
VT |
Vermont Personal
Auto Application |
2003/06 |
| 90 WA |
WA |
Washington Personal
Auto Application |
2000/08 |
| 90 WI |
WI |
Wisconsin Personal
Auto Application |
2001/03 |
| 90 WV |
WV |
West Virginia
Personal Auto Application |
2003/10 |
| 90 WY |
WY |
Wyoming Personal
Auto Application |
2004/04 |
| 91 |
|
Good Student/Driver Training |
3/93a |
| 92 |
|
Medical Statement |
2/95 |
| 93 |
|
Young Driver Questionnaire |
2004/10 |
| 94 HI |
HI |
Hawaii Vehicle
Inspection Report Supplement |
2001/03 |
| 94 NJ |
NJ |
Insurance
Inspection Report |
3/94 |
| 95 MA |
MA |
Massachusetts
Renewal Application (Statement of Facts) |
4/98 |
| 97 SC |
SC |
Private Passenger
Auto Application |
2003/03 |
| 97 WI |
WI |
Wisconsin
Automobile Plan |
2003/10 |
| 101 |
|
Additional Remarks Schedule |
2008/01 |
| 102 |
|
No longer on ACORD's Website - Jewelry Evaluation Form Colored Stone
Information |
2000/08 |
| 125 |
|
Commercial Insurance Application - Applicant Information |
2009/05 |
| 125 |
|
Commercial Insurance Application - Applicant Information |
2007/10 |
| 126 |
|
Commercial General Liability Section |
20010/05 |
| 126 |
|
Commercial General Liability Section |
2007/05 |
| 127 |
|
Business Auto Section |
2009/01 |
| 127 |
|
Business Auto Section |
2003/08 |
| 128 |
|
Garage and Dealers Section |
2004/03 |
| 129 |
|
Vehicle Schedule |
2003/08 |
| 129 SC |
SC |
Vehicle Schedule |
2003/03 |
| 130 |
|
Workers Compensation |
2010/05 |
| 130 |
|
Workers Compensation |
2009/09 |
| 130 |
|
Workers Compensation |
2007/11 |
| 130 FL |
FL |
Florida Workers
Compensation Application |
2002/07 |
| 131 |
|
Umbrella Section |
2009/10 |
| 131 |
|
Umbrella Section |
2009/02 |
| 131 |
|
Umbrella Section |
2007/09 |
| 132 |
|
Truckers/Motor Carriers Section |
2008/09 |
| 132 |
|
Truckers/Motor Carriers Section |
2004/03 |
| 132 NJ |
NJ |
New Jersey Workers
Compensation Insurance Plan Instructions and Rules |
2000/04 |
| 133 |
|
Workers Compensation Insurance Plan Assigned Risk Section |
2007/11 |
| 133 FL |
FL |
Florida Workers
Compensation Joint Underwriting Association Inc.
Addendum to 130 FL |
2003/07 |
| 133 MI |
MI |
Michigan
Application for Workers' Compensation Insurance |
2003/02 |
| 133 MT |
MT |
Montana State
Compensation Insurance Fund |
8/98 |
| 133 NC |
NC |
North Carolina
Workers Compensation Insurance Plan |
10/96 |
| 133 NJ |
NJ |
New Jersey Workers
Compensation Insurance Plan |
2004/01 |
| 133 PA |
PA |
3/20/03 Withdrawn
by ACORD - Pennsylvania State Workers' Insurance
Fund, Application for Workers' Compensation
Insurance |
5/98 |
| 133 TN |
TN |
Tennessee Workers
Compensation Insurance Plan Assigned Risk
Supplement |
2004/09 |
| 133 WI |
WI |
Wisconsin Workers
Compensation Insurance Pool |
2002/01 |
| 134 |
|
Workers Compensation Application Supplement - Multi State Rating Sheet |
2004/03 |
| 134 FL |
FL |
Florida Workers
Compensation Joint Underwriting Association Inc. |
2003/07 |
| 134 NC |
NC |
North Carolina
Workers Compensation Insurance Plan |
10/96 |
| 134 NJ |
NJ |
New Jersey Workers
Comp. Insurance Plan Notice of Election -
Proprietors and Partners |
2001/07 |
| 134 WI |
WI |
Wisconsin
Supplementary Non-Election Form |
8/99 |
| 135 NC |
NC |
North Carolina Workers Comp Insurance Plan App for Designation of an Insurance Co |
2007/10 |
| 135 NJ |
NJ |
New Jersey Workers
Compensation Insurance Plan - Supplemental
Employee Leasing Application |
2000/04 |
| 135 WI |
WI |
Wisconsin
Supplementary Election of Coverage Form |
8/99 |
| 136 NC |
NC |
North Carolina Workers Comp Insurance Plan Instructions for Completing ACORD 135 NC App |
2007/10 |
| 136 NJ |
NJ |
New Jersey Workers
Compensation Insurance Plan - Truckers
Supplemental Application |
2000/04 |
| 136 WI |
WI |
Wisconsin
Supplementary Limited Other States Coverage
Request |
7/96 |
| 137 AK |
AK |
Alaska Commercial
Auto |
2001/06 |
| 137 AL |
AL |
Alabama Commercial
Auto |
2004/04 |
| 137 AR |
AR |
Arkansas Commercial
Auto |
2004/05 |
| 137 AZ |
AZ |
Arizona Commercial
Auto |
2003/10 |
| 137 CA |
CA |
California
Commercial Auto |
2001/06 |
| 137 CO |
CO |
Colorado Commercial
Auto |
2003/07 |
| 137 CT |
CT |
Connecticut
Commercial Auto |
2003/05 |
| 137 DC |
DC |
District of
Columbia Commercial Auto |
2000/09 |
| 137 DE |
DE |
Delaware Commercial
Auto |
2001/06 |
| 137 FL |
FL |
Florida Commercial
Auto |
2003/10 |
| 137 GA |
GA |
Georgia Commercial
Auto |
2001/02 |
| 137 HI |
HI |
Hawaii Commercial
Auto |
2001/02 |
| 137 IA |
IA |
Iowa Commercial
Auto |
2002/10 |
| 137 ID |
ID |
Idaho Commercial
Auto |
2002/09 |
| 137 IL |
IL |
Illinois Commercial
Auto |
2004/12 |
| 137 IN |
IN |
Indiana Commercial
Auto |
2004/07 |
| 137 KS |
KS |
Kansas Commercial
Auto |
2002/07 |
| 137 KY |
KY |
Kentucky Commercial
Auto |
2002/09 |
| 137 LA |
LA |
Louisiana
Commercial Auto |
2001/10 |
| 137 MA |
MA |
Massachusetts
Commercial Auto |
2000/09 |
| 137 MD |
MD |
Maryland Commercial
Auto |
2004/03 |
| 137 ME |
ME |
Maine Commercial
Auto |
2000/09 |
| 137 MI |
MI |
Michigan Commercial
Auto |
2000/09 |
| 137 MN |
MN |
Minnesota
Commercial Auto |
2001/10 |
| 137 MO |
MO |
Missouri Commercial
Auto |
2001/10 |
| 137 MS |
MS |
Mississippi
Commercial Auto |
2004/09 |
| 137 MT |
MT |
Montana Commercial
Auto |
2003/09 |
| 137 NC |
NC |
North Carolina
Commercial Auto |
2007/06 |
| 137 ND |
ND |
North Dakota
Commercial Auto |
2002/02 |
| 137 NE |
NE |
Nebraska Commercial
Auto |
2001/10 |
| 137 NH |
NH |
New Hampshire
Commercial Auto |
2001/11 |
| 137 NJ |
NJ |
New Jersey
Commercial Auto |
2004/11 |
| 137 NM |
NM |
New Mexico
Commercial Auto |
2001/11 |
| 137 NV |
NV |
Nevada Commercial
Auto |
2001/11 |
| 137 NY |
NY |
New York Commercial
Auto |
2003/11 |
| 137 OH |
OH |
Ohio Commercial
Auto |
2002/11 |
| 137 OK |
OK |
Oklahoma Commercial
Auto |
2001/11 |
| 137 OR |
OR |
Oregon Commercial
Auto |
2002/02 |
| 137 PA |
PA |
Pennsylvania
Commercial Auto |
2002/11 |
| 137 RI |
RI |
Rhode Island
Commercial Auto |
2003/05 |
| 137 SC |
SC |
South Carolina
Commercial Auto |
2003/02 |
| 137 SD |
SD |
South Dakota
Commercial Auto |
2002/02 |
| 137 TN |
TN |
Tennessee
Commercial Auto |
2002/01 |
| 137 TX |
TX |
Texas Commercial
Auto |
2007/08 |
| 137 TX |
TX |
Texas Commercial
Auto |
2000/08 |
| 137 UT |
UT |
Utah Commercial
Auto |
2001/01 |
| 137 VA |
VA |
Virginia Commercial
Auto |
2007/05 |
| 137 VT |
VT |
Vermont Commercial
Auto |
2003/06 |
| 137 WA |
WA |
Washington
Commercial Auto Coverages/Limits Section |
2009/01 |
| 137 WA |
WA |
Washington
Commercial Auto Coverages/Limits Section |
2002/08 |
| 137 WI |
WI |
Wisconsin
Commercial Auto |
2002/02 |
| 137 WV |
WV |
West Virginia
Commercial Auto |
2002/02 |
| 137 WY |
WY |
Wyoming Commercial
Auto - Coverages Limits Section |
2002/02 |
| 138 AK |
AK |
Alaska Garage and
Dealers |
4/97 |
| 138 AL |
AL |
Alabama Garage and
Dealers |
2004/04 |
| 138 AR |
AR |
Arkansas Garage and
Dealers |
2000/10 |
| 138 AZ |
AZ |
Arizona Garage and
Dealers |
2003/10 |
| 138 CA |
CA |
California Garage
and Dealers |
3/96 |
| 138 CO |
CO |
Colorado Garage and
Dealers |
2003/07 |
| 138 CT |
CT |
Connecticut Garage
and Dealers |
2003/05 |
| 138 DC |
DC |
District of
Columbia Garage and Dealers |
2003/09 |
| 138 DE |
DE |
Delaware Garage and
Dealers |
3/96 |
| 138 FL |
FL |
Florida Garage and
Dealers |
2003/10 |
| 138 GA |
GA |
Georgia Garage and
Dealers |
2001/02 |
| 138 HI |
HI |
Hawaii Garage and
Dealers |
2004/05 |
| 138 IA |
IA |
Iowa Garage and
Dealers |
2002/10 |
| 138 ID |
ID |
Idaho Garage and
Dealers |
3/96 |
| 138 IL |
IL |
Illinois Garage and
Dealers |
2003/03 |
| 138 IN |
IN |
Indiana Garage and
Dealers |
2004/07 |
| 138 KS |
KS |
Kansas Garage and
Dealers |
2002/07 |
| 138 KY |
KY |
Kentucky Garage and
Dealers |
2000/09 |
| 138 LA |
LA |
Louisiana Garage
and Dealers |
6/98 |
| 138 MA |
MA |
Massachusetts
Garage and Dealers |
2000/09 |
| 138 MD |
MD |
Maryland Garage and
Dealers |
2004/03 |
| 138 ME |
ME |
Maine Garage and
Dealers |
2000/09 |
| 138 MI |
MI |
Michigan Garage and
Dealers |
4/96 |
| 138 MN |
MN |
Minnesota Garage
and Dealers |
2001/10 |
| 138 MO |
MO |
Missouri Garage and
Dealers |
3/96 |
| 138 MS |
MS |
Mississippi Garage
and Dealers |
2004/09 |
| 138 MT |
MT |
Montana Garage and
Dealers |
2003/09 |
| 138 NC |
NC |
North Carolina
Garage and Dealers |
2007/06 |
| 138 ND |
ND |
North Dakota Garage
and Dealers |
2000/07 |
| 138 NE |
NE |
Nebraska Garage and
Dealers |
8/97 |
| 138 NH |
NH |
New Hampshire
Garage and Dealers |
3/96 |
| 138 NJ |
NJ |
New Jersey Garage
and Dealers |
2004/11 |
| 138 NM |
NM |
New Mexico Garage
and Dealers |
3/96 |
| 138 NV |
NV |
Nevada Garage and
Dealers |
3/96 |
| 138 NY |
NY |
New York Garage and
Dealers |
2003/11 |
| 138 OH |
OH |
Ohio Garage and
Dealers |
2002/11 |
| 138 OK |
OK |
Oklahoma Garage and
Dealers |
3/96 |
| 138 OR |
OR |
Oregon Garage and
Dealers |
2000/07 |
| 138 |
PA |
Pennsylvania Garage
and Dealers |
2002/07 |
| 138 |
RI |
Rhode Island Garage
and Dealers |
2003/05 |
| 138 |
SC |
South Carolina
Garage and Dealers |
2003/02 |
| 138 |
SD |
South Dakota Garage
and Dealers |
2/97 |
| 138 |
TN |
Tennessee Garage
and Dealers Coverages/Limits Section |
2002/01 |
| 138 |
TX |
Texas Garage and
Dealers |
2000/08 |
| 138 |
UT |
Utah Garage and
Dealers |
2001/01 |
| 138 |
VA |
Virginia Garage and
Dealers |
2002/12 |
| 138 |
VT |
Vermont Garage and
Dealers |
2003/06 |
| 138 |
WA |
Washington Garage
and Dealers |
2002/08 |
| 138 |
WI |
Wisconsin Garage
and Dealers |
4/96 |
| 138 |
WV |
West Virginia
Garage and Dealers |
3/96 |
| 138 |
WY |
Wyoming Garage and
Dealers - Coverages/Limits Section |
3/96 |
| 139 |
|
Statement of Values |
2004/03 |
| 139 |
MI |
Michigan Automobile
Insurance Placement Facility Supplement to ACORD
Application. Application for Commercial, Public
Automobiles and Corporately Owned Vehicles |
2004/07 |
| 139 |
MS |
Mississippi
Statement/Schedule Of Values |
2/99 |
| 140 |
|
Property Section |
2010/12 |
| 140 |
|
Property Section |
2007/05 |
| 141 |
|
Crime Section |
2009/12 |
| 141 |
|
Crime Section |
2003/07 |
| 141 C |
|
Crime Section 2000 |
2007/06 |
| 143 |
|
Transportation Section |
2004/01 |
| 144 |
|
Glass and Sign Supplement |
11/94 |
| 145 |
|
Accounts Receivable/Valuable Papers |
2004/03 |
| 146 |
|
Equipment Floater Section |
2003/09 |
| 147 |
|
Installation/Builders Risk Section |
2001/02 |
| 148 |
|
Electronic Data Processing Section |
2000/02 |
| 149 |
|
Dealers Section |
2004/04 |
| 151 |
|
Miscellaneous Crime Coverage Section |
2001/07 |
| 154 |
|
Jewelers Inventory Record |
1/98 |
| 155 |
|
Boiler & Machinery Section |
2000/11 |
| 155 BM |
|
Boiler & Machinery
Section 2002 |
2004/03 |
| 159 |
|
Schedule of Insurance |
2004/03 |
| 160 |
|
Business Owners Application |
2009/05 |
| 160 |
|
Business Owners Application |
2004/03 |
| 161 |
|
Withdrawn By ACORD - Business Owners Supplemental App |
11/98 |
| 163 |
|
Commercial Auto Driver Information Schedule |
2000/11 |
| 170 |
OH |
Ohio FAIR Plan
Underwriting Association - Instructions for
Completion of Insurance Applications |
2002/09 |
| 171 |
AK |
Alaska Petition for
Executive Officer Waiver |
6/98 |
| 171 |
CO |
Colorado Rejection
of Coverage by Corporate Officers |
2002/12 |
| 171 |
CT |
Workers'
Compensation Commission of Connecticut |
4/96 |
| 171 |
DE |
Delaware Workers
Compensation Election |
7/96 |
| 171 |
FL |
Florida Notice of
Election of Coverage Under Workers Compensation
Law |
2004/04 |
| 171 |
GA |
Georgia State Board
of Workers Compensation Notice of Election or
Rejection of Workers' Compensation Coverage |
2001/03 |
| 171 |
IL |
Illinois FAIR Plan
Application for Commercial Property Insurance |
2002/10 |
| 171 |
KS |
Kansas Election of
Individual Partner or Self-Employed Individual |
2003/11 |
| 171 |
MI |
Michigan Notice of
Election |
4/96 |
| 171 |
NJ |
New Jersey Workers
Compensation Insurance Plan - New Jersey Workers
Compensation and Employers Liability Manual, Part
3, Section 14 |
2003/07 |
| 171 |
NM |
New Mexico
Executive Employee Exemption |
2004/10 |
| 171 |
NY |
New York Notice of
Election of a Corporation |
10/96 |
| 171 |
OH |
Ohio FAIR Plan
Underwriting Association - Application for
Insurance - Basic Property Application |
2004/03 |
| 171 |
PA |
Pennsylvania
Application for Executive Officer Exception From
the Provisions of the Pennsylvania Workers'
Compensation Act: Section 104 |
2002/02 |
| 171 |
TN |
Notice of Corporate
Officer to Employer of Not to Accept Provisions of
the "Compensation Act" of Tennessee |
2003/09 |
| 171 |
VA |
Virginia Rejection
of Coverage Under The Virginia Workers'
Compensation Act |
2003/02 |
| 172 |
CT |
Workers'
Compensation Commission of Connecticut |
4/96 |
| 172 |
FL |
Florida Revocation
of Election to be Exempt |
2004/04 |
| 172 |
KS |
Kansas Cancellation
of Election of Individual |
2003/11 |
| 172 |
MI |
Michigan
Application for Exclusion of Partner(s) |
4/96 |
| 172 |
NM |
New Mexico Election
to Accept |
2004/10 |
| 172 |
NY |
New York Notice of
Election of a Partnership or Sole Proprietorship
to Bring Partners or Self-Employed Persons Under
the Coverage of the New York Workers Compensation
Law |
7/96 |
| 172 |
OH |
Ohio FAIR Plan
Underwriting Association - Homeowners Supplement |
2002/09 |
| 172 |
PA |
Pennsylvania
Executive Officers Declaration |
2002/02 |
| 172 |
TN |
Notice of Corporate
Officer's Revocation of Exemption |
2003/09 |
| 172 |
VA |
Virginia Notice
Terminating Prior Rejection of Coverage |
2003/02 |
| 173 |
CT |
Workers'
Compensation Commission of Connecticut |
4/96 |
| 173 |
FL |
Notice of Election
to be Exempt |
2004/04 |
| 173 |
KS |
Kansas Cancellation
of Election Not to Accept Coverage |
2001/05 |
| 173 |
MI |
Michigan Workers
Compensation Placement Facility Specific Person
Exclusion Form |
2000/09 |
| 173 |
NM |
New Mexico
Revocation |
2004/10 |
| 173 |
NY |
New York Notice of
Election of an Incorporated Religious |
7/96 |
| 173 |
OH |
Ohio FAIR Plan
Underwriting Association - Dwelling Fire
Supplement |
2002/09 |
| 173 |
TN |
Election of Sole
Proprietor or Partner to Come Within the
Provisions of the Tennessee Workers' Compensation
Law |
2003/09 |
| 174 |
FL |
Florida Revocation
of Election of Coverage |
2004/04 |
| 174 |
KS |
Kansas Election Not
to Accept Coverage |
2001/05 |
| 174 |
NM |
New Mexico Limited
Liability Company Member Affirmative Election Form |
2004/10 |
| 174 |
NY |
New York Revocation
of an Incorporated Religious |
7/96 |
| 174 |
OH |
Ohio FAIR Plan
Underwriting Association - Commercial Supplement |
2002/09 |
| 174 |
TN |
Notice of
Withdrawal of Sole Proprietor or Partner Election |
2003/09 |
| 175 |
|
Commercial Policy Change Request |
2009/01 |
| 175 |
FL |
Florida Workers
Compensation Monthly Change Sheet |
2000/11 |
| 175 |
OH |
Ohio FAIR Plan
Underwriting Association - Farm Supplement |
2002/09 |
| 175 |
SC |
Associated Auto
Insurers Plan of South Carolina - Commercial Auto
Policy Change Request |
2003/03 |
| 176 |
KS |
Kansas Election of
Employer to Cover Employees |
2001/05 |
| 176 |
OH |
Ohio FAIR Plan
Underwriting Association - Rehabilitation
Supplement |
2002/09 |
| 177 |
CA |
California Auto
Supplement - Auto Body Repair Consumer Bill of
Rights |
2001/03 |
| 177 |
KS |
Kansas Election of
Coverage for Volunteer Workers |
2003/11 |
| 177 |
NY |
Application for
Commercial Insurance - NYPIUA |
2000/09 |
| 177 |
OH |
Ohio FAIR Plan
Underwriting Association - Bowling Alley
Supplement |
2002/09 |
| 177 |
SC |
Associated Auto
Insurers Plan of South Carolina - Commercial
Application |
2004/06 |
| 177 |
WI |
Wisconsin
Automobile Insurance Plan - Business Auto
Application |
2003/10 |
| 178 |
KS |
Kansas Cancellation
of Election of Employer To Cover Employees |
2003/11 |
| 178 |
SC |
Removed from ACORD
- Business Auto Section |
2/99 |
| 178 |
WI |
Wisconsin
Automobile Insurance Plan - Truckers Application |
2003/10 |
| 179 |
KS |
Kansas Cancellation
of Election of Coverage for Volunteer Workers |
2003/11 |
| 179 |
SC |
Associated Auto
Insurers Plan of South Carolina - Garage
Application |
2004/06 |
| 180 |
|
Errors and Omissions Section |
1/97 |
| 180 |
KS |
Kansas Election of
Coverage for Persons Performing Public Service |
2001/05 |
| 180 |
SC |
Removed from ACORD
- Named Non-owner Application |
2/99 |
| 181 |
KS |
Kansas Cancellation
of Election of Coverage for Persons Performing
Public Service |
2001/08 |
| 181 |
SC |
Associated Auto
Insurers Plan of South Carolina - Company
Performance Complaint Form |
2003/03 |
| 182 |
KS |
Kansas Election of
a Noncompensated Volunteer To Be Covered |
2001/05 |
| 182 |
SC |
Associated Auto
Insurers Plan of South Carolina - Producer
Performance Complaint Form |
2003/03 |
| 183 |
KS |
Kansas Cancellation
of Election of a Noncompensated Volunteer To Be
Covered |
2001/05 |
| 183 |
SC |
Associated Auto
Insurers Plan of South Carolina - Automobile Loss
Notice |
2003/03 |
| 184 |
SC |
Associated Auto
Insurers Plan of South Carolina - Garage
Supplemental Form |
2004/06 |
| 185 |
|
Restaurant/Tavern Supplement |
2007/05 |
| 185 |
SC |
Associated Auto
Insurers Plan of South Carolina - Uninsured &
Underinsured Auto Insurance Coverages Form for
Private Passenger Risks |
2004/02 |
| 186 |
|
Contractors Supplement |
2001/09 |
| 186 |
SC |
Associated Auto
Insurers Plan of South Carolina - Uninsured &
Underinsured Auto Insurance Coverages Form for
Commercial Risks |
2004/06 |
| 187 |
|
Professional Liability Supplement |
3/98 |
| 187 |
SC |
Associated Auto
Insurers Plan of South Carolina - Name and/or
Ownership Change |
2003/03 |
| 188 |
|
Employment Related Practices Liability Section |
2003/02 |
| 188 |
SC |
Associated Auto
Insurers Plan of South Carolina - Endorsement
Voiding Automobile Insurance while Named Person is
Operating Car |
2003/03 |
| 190 |
|
Supplemental Property Application |
2007/05 |
| 192 |
|
Equine Application |
7/98 |
| 193 |
|
Open Cargo Section |
2001/02 |
| 194 |
|
Truckers/Motor Carrier Supplement, Request for State/Federal Filing
Action |
2001/05 |
| 195 |
|
Design Professional’s Individual Property Survey |
10/96 |
| 196 |
|
Medical Professional Liability Insurance |
2000/08 |
| 199 |
|
Application Supplement - Undertaking |
1/99 |
| 200 |
|
Producer Account |
3/93 |
| 201 |
|
Producer Account Discrepancy Notice |
3/93 |
| 210 |
|
Yacht Section |
2001/05 |
| 220 |
FL |
Citizens Property
Insurance Corporation, Commercial and Commercial -
Residential Wind Only Application |
2003/08 |
| 221 |
FL |
Citizens Property
Insurance Corporation, Wind Only Supplemental
Commercial and Commercial - Residential
Application Schedule |
2002/07 |
| 225 |
|
Policyholder’s Report |
1/98 |
| 226 |
|
Statement of Premium Adjustment |
3/93 |
| 290 |
NJ |
Personal Auto Application Section |
2011/06 |
| 301 |
|
Flood Insurance Application |
2005/04 |
| 302 |
|
Flood Insurance
General Change Endorsement |
3/97 |
| 303 |
|
Flood Insurance Preferred Risk Policy Application |
2003/07 |
| 304 |
|
Flood Insurance Cancellation/Nullification Form |
3/97 |
| 325 |
|
Aviation Insurance Application |
2006/06 |
| 351 |
|
NAIC Uniform Application for Individual Non-Resident License |
2000/02 |
| 352 |
|
NAIC Uniform Application for Business Entity Non-Resident
License/Registration |
2000/02 |
| 401 |
|
Agriculture Application |
2001/10 |
| 402 |
|
Agriculture Property Section |
2001/10 |
| 403 |
|
Agriculture Property Section |
2000/05 |
| 404 |
|
Agriculture Liability Section |
2000/05 |
| 405 |
|
Agriculture Premises Diagram |
2007/09 |
| 406 |
|
Agriculture Supplement |
2007/09 |
| 407 |
|
Livestock Mortality Section |
2007/09 |
| 408 |
|
Equine Liability Supplement |
2007/09 |
| 410 |
|
Small Farm/Ranch Application |
2004/04 |
| 501 |
|
Surety Report of Execution |
2004/07 |
| 610 |
|
Premium Payment Supplement |
2000/05 |
| 752 |
|
Illustration Certification and Acknowledgement |
2004/01 |
| 758 |
|
Producer Appointment Data Sheet |
2004/06 |
| 764 |
|
Fair Credit Reporting Act Disclosure |
2004/03 |
| 765 |
|
Agent's Report |
2004/01 |
| 801 |
|
Railroad Protective Liability Supplement |
2002/01 |
| 802 |
|
Hotel/Motel Supplement |
2002/01 |
| 805 |
|
Jewelry Sales Receipt for Insurance Purposes |
2002/12 |
| 807 |
|
Directors and Officers Liability Section |
2009/12 |
| 815 |
|
International Liability Exposure Supplement |
2009-02 |
| 816 |
|
International Property Exposure Supplement |
2005-06 |
| 823 |
|
Commercial Insurance Application Supplement - Additional Premises Information Section |
2007-07 |
| 825 |
|
Professional / Specialty Insurance Application
(For Use in Management, Executive & Professional Lines - Applicant Section) |
2008/01 |
| 827 |
|
Employment Practices Liability Insurance Section |
2008/01 |
| 829 |
|
Forms and Endorsements Schedule |
2007/05 |
| 830 |
|
Property Insurance Card |
2008/11 |
| 831 |
|
Professional / Specialty Insurance - Notice of Incident / Claim |
2010/12 |
| 834 |
|
Cyber and Privacy Coverage Section |
2011/09 |
| 851 |
SC |
Associated Auto
Insurers Plan of South Carolina - Electronic
Application Submission Interface Retraction
Request Form |
2003/03 |
| 851 |
MN |
Minnesota Fair Plan Interest Change Request |
2007/05 |
| 851 |
TX |
Texas Personal
Lines Supplement - Use of Credit Information
Disclosure |
2004/02 |
| 852 |
MN |
Minnesota Fair Plan Cancellation Request / Policy Release |
2007/05 |
| 852 |
TX |
Texas Personal
Lines Supplement (Spanish Version) - Use of Credit
Information Disclosure |
2004/02 |
| 855 |
CA |
California FAIR
Plan Property Insurance - Application for Property
Insurance |
2004/04 |
| 856 |
CA |
California FAIR
Plan Property Insurance - Business Owners
Application |
2004/07 |
| 857 |
CA |
California
Earthquake Authority - Application for Earthquake
Insurance |
2004/04 |
| 951 |
|
1035 Exchange / Rollover / Transfer Form |
2004/05 |
