Instructions ACORD 63 Fraud Statements

Instructions ACORD 63 Fraud Statements

BASIC INFORMATION

Instructions ACORD 63 Fraud Statements

AGENCY CUSTOMER ID

As with all ACORD forms with more than one page enter your agency customer ID so this page will be able to find the rest of this application if somewhere, somehow in that thing we call the business cycle they get separated from each other.

AGENCY

Enter your agency's name here.

CARRIER

The insurance company underwriting this policy. This is the company listed on the DEC page of the policy.

NAIC NUMBER

NAIC stands for the National Association of Insurance Commissioners.

Here is their website home page...

http://www.naic.org/index.htm


They assign each insurance company a five digit code. You can search for any insurance company by name on their website at this page...

https://eapps.naic.org/cis/


POLICY NUMBER

Enter the policy number if one exists. If no policy number has been assigned yet enter TBD for to be determined. If you have a binder number enter that here.

EFFECTIVE DATE

This is the effective date of the policy to which this form is attached.


APPLICANT / NAMED INSURED

Enter the same as the Name on the preceding documents in this application.


FRAUD WARNINGS

Instructions ACORD 63

Familiarize yourself with each of these warnings - including the ones for states other than your home state.

If you have an insured with locations in more than one state the applicable law may be the law for that state.

You do not use this form with Loss Notices or with Workers Compensation applications.


SIGN AND DATE

How to complete the ACORD 63 Fraud Statements

APPLICANT'S SIGNATURE

Have you applicant or their legally authorized representative sign here.

DATE ( MM/DD/YYYY)

Enter the date this form is signed. Use the format month month / day day / year year year year - which looks like this for Oct first two thousand fourteen...

10/01/2014

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