ACORD 60 Instructions


Section Name Field Name Field and/or Section Description
TITLE ACORD 60 (2008/11) Flood InsuranceSelection / Rejection Use ACORD 60, Flood Insurance Selection / Rejection, to explain to applicants for property insurance the value of purchasing flood insurance coverage, and to record the signature of the applicant if flood insurance coverage is selected or rejected. This form contains advisory text provided by the Federal Emergency ManagementAgency (FEMA).
IDENTIFICATION SECTION Agency Customer ID Customer’s identification number assigned by the agency or brokerage.
IDENTIFICATION SECTION Date (MM/DD/YYYY) Month/day/year (MM/DD/YYYY) on which the form is completed.
IDENTIFICATION SECTION Agency Producer’s name.
IDENTIFICATION SECTION Policy # The number assigned by theinsurance company for the policy. In general, policy numbers will not appear on new business applications since they are not known at that point in time.
IDENTIFICATION SECTION Effective Date Date (MM/DD/YYYY) on which the terms and conditions of the policy will commence.
IDENTIFICATION SECTION Applicant / Named Insured(s) Full name of the applicant as it should appear on the policy. The First Named Insured is given certain rights and responsibilities by the policy contract language. If more than one insured is named, be sure the one intended to receive these rights and responsibilities is named first and any additional insureds identified as such. If joint ownership, the name used may include both names (e.g., John and Mary Smith).
IDENTIFICATION SECTION Carrier Name of the insurance company (or residual market plan) that will receive the application. Do not use group names, use the actual name of the company within the group in which you wish to have the policy issued.
IDENTIFICATION SECTION NAIC Code Enter the identification code assigned to the company by the NAIC.
SELECTION / REJECTION OF FLOOD INSURANCE COVERAGE NFIP Building Coverage – Accept Check this box if you accept NFIP Building Coverage.
SELECTION / REJECTION OF FLOOD INSURANCE COVERAGE NFIP Building Coverage – Reject Check this box if you reject NFIP Building Coverage.
SELECTION / REJECTION OF FLOOD INSURANCE COVERAGE NFIP Contents / Personal Property Accept Check this box if you accept NFIP Contents / Personal Property Coverage.
SELECTION / REJECTION OF FLOOD INSURANCE COVERAGE NFIP Contents / Personal Property Reject Check this box if you reject NFIP Contents / Personal Property Coverage.
SELECTION / REJECTION OF FLOOD INSURANCE COVERAGE Excess Building Coverage -Accept Check this box if you accept Excess Building Coverage.
SELECTION / REJECTION OF FLOOD INSURANCE COVERAGE Excess Building Coverage – Reject Check this box if you reject Excess Building Coverage.
SELECTION / REJECTION OF FLOOD INSURANCE COVERAGE Excess Contents / Personal Property – Accept Check this box if you accept Excess Contents / Personal Property Coverage.
SELECTION / REJECTION OF FLOOD INSURANCE COVERAGE Excess Contents / Personal Property – Reject Check this box if you reject Excess Contents / Personal Property Coverage.
SELECTION / REJECTION OF FLOOD INSURANCE COVERAGE Excess Loss of Income or AdditionalLiving Expenses -Accept Check this box if you accept Excess Loss of Income or Additional Living Expenses Coverage.
SELECTION / REJECTION OF FLOOD INSURANCE COVERAGE Excess Loss of Income or Additional Living Expenses -Reject Check this box if you reject Excess Loss of Income or Additional Living Expenses Coverage.
SELECTION / REJECTION OF FLOOD INSURANCE COVERAGE Applicant’s Signature The applicant should read and understand this important notice and any other disclosure information on the form before personally signing the application. By signing this application, the applicant/named insured is electing not to purchase flood insurance.
SELECTION / REJECTION OF FLOOD INSURANCE COVERAGE Date Date the form was signed.
SELECTION / REJECTION OF FLOOD INSURANCE COVERAGE Address of Property Indicate the physical address of the property for which flood insurance coverage is available but has been rejected by the applicant/first named insured.
SELECTION / REJECTION OF FLOOD INSURANCE COVERAGE Producer The producer should sign the application. This is required in most states.
SELECTION / REJECTION OF FLOOD INSURANCE COVERAGE Date Date the form was signed.