ACORD 64CA Instructions

ACORD 64 CA (2004/02) – California Insurance Supplement, Agency Language Form

California Insurance regulations require that each insurer report to the California Department of Insurance, by zip code, the number of agents who identify themselves as conversant in a language other than English. Companies should refer to California Department of Insurance Regulation RH-310.

Agents can use ACORD 64 CA to provide companies with the required information. A separate form should be completed for each officelocation, and the address on the form should be the address of the office location, unless different instructions are provided by insurers.