ACORD 171 OH (2004/03) – Ohio FAIR Plan Underwriting Association – Application for Insurance – Basic Property Application
Use this form to submit an application for Basic Property insurance through the Ohio FAIR Plan Underwriting Association. Certain types of applications require an additional supplement in order to qualify as a “properly completed application”. See ACORD 170 OH for instructions on the proper completion of applications submitted to the Ohio FAIR Plan.
The Ohio FAIR Plan document number for this form was OFB-BPA.
For additional information, contact the Ohio FAIR Plan Underwriting Association at (614) 839-6446 or (800) 282-1772.