ACORD 64NC Instructions


Section Name Field Name Field and/or Section Description
TITLE ACORD 64 NC (2008/04) North Carolina Property Supplement – Property InsuranceDisclosure Notice Use ACORD 64 NC, North Carolina Property Supplement, to comply with North Carolina regulation that requires advice to all property insurance applicants that: – their property insurance policy does not protect them against losses from floods – their property insurance policy does not protect them against losses from earthquakes, mudslides, mudflows or landslides
IDENTIFICATION SECTION Agency Customer ID Customer’s identification number assigned by the agency or brokerage.
IDENTIFICATION SECTION Agency Producer’s name.
IDENTIFICATION SECTION Policy Number The number assigned bythe insurance 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 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 The identification code assigned to the company by the NAIC.
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).
DISCLOSURE Check Box 1 – Warning: This property insurance policy does not protect you against losses from floods Check if applicable.
DISCLOSURE Check Box 2 -Warning: This property insurance policy does not protect you against losses from earthquakes, mudslides, mudflows or landslides Check if applicable.
DISCLOSURE Telephone Number of Agent Enter the telephone number of the agent, include area code and extension (if applicable)
DISCLOSURE Telephone Number of Company / Association Enter the telephone number of the company or association, include area code and extension (if applicable)
DISCLOSURE Applicant / Named Insured Signature Applicant / Named Insured must sign the application.
DISCLOSURE Date Date the application was completed. (MM/DD/YYYY)