ACORD 65CA Instructions

ACORD 65 CA (2004/07) – California Insurance Supplement, Race, National Origin and Gender Form

California insurance regulations as amended in 2003 require that certain applicants for certain insurance coverages be asked to provide information about their race or national origin and gender. The applicantis not required to provide this information.

This information cannot be used for underwriting or rating purposes.

The regulation applies only to individuals, spouses, domestic partners, or business partners named on the policy..

The regulations also require that each insurer report information gathered from applicants for insurance, to the Department of Insurance. Companies should refer to California Department of Insurance Regulation RH-310.

Use ACORD 65 CA with applications for policies that include any of the following coverages:

    • Personal Auto
    • Commercial Fire
    • Homeowners
    • Dwelling Fire
    • Commercial Multi Peril