ACORD 65PA Instructions


65 PA/DE/WV (2000/01) – Fair Plan Supplementary Questionnaire


Use this form as a supplement to the Insurance Placement Facility of Pennsylvania’s Basic Property Insurance Application, ACORD 64 PA, when the instructions for 64 PA indicate that this form must be attached. Please note that, when this supplement is required, applications submittedWITHOUT 65 PA/DE/WV attached may be returned.

Use this form as a supplement to the Insurance Placement Facility of Delaware’s Basic Property Insurance Application, ACORD 64 DE, when the instructions for 64 DE indicate that this form must be attached. Please note that, when this supplement is required, applications submittedWITHOUT 65 PA/DE/WV attached may be returned.

Use this form as a supplement to the West Virginia Essential PropertyInsurance Association’s Basic Property Insurance Application, ACORD 64 WV, when the instructions for 64 WV indicate that this form must be attached. Please note that, when this supplement is required, applications submitted WITHOUT 65 PA/DE/WV attached may be returned.