ACORD 68 LA (4/98) – Louisiana Plan Services Application for Insurance

This form may be used to apply to the Louisiana Joint Reinsurance Plan or the Louisiana Insurance Underwriting Plan for any of the coverages offered.

Note that the following supplements are also required:

ACORD 60 LA, if applying for Dwelling coverage

ACORD 61 LA, if applying for HO4 or HO8 coverage

ACORD 62 LA, if applying for commercial coverage

ACORD 64 LA, if applying for HO2 or HO3 coverage

ACORD 65 LA, if applying for HO6 coverage

ACORD 66LA, if applying for DWG 2 or 3 coverage

ACORD 67 LA, if applying for Mobile Home coverage