Instructions ACORD 64US Insurance Supplement for Workers Compensation

Instructions ACORD 64US Insurance Supplement for Workers Compensation

The ACORD 64 US is the Workers Compensation supplement for the Federal Terrorism Risk Insurance Act. It should be used in all states with any workers compensation insurance application.


BASIC INFORMATION

Instructions ACORD 64 US Terrorism Coverage Supplement

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.

APPLICANT / NAMED INSURED

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

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.

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 HOLDER DISCLOSURE - NOTICE OF TERRORISM INSURANCE COVERAGE

Policy Holder Disclosure Terrorism Insurance Coverage

This section contains the actual coverage details. It references the Terrorism Risk Insurance ACT.

Here is a selection of very good, informative links about this act...

http://www.naic.org/cipr_topics/topic_tria.htm

http://www.treasury.gov/resource-center/fin-mkts/Pages/program.aspx

http://en.wikipedia.org/wiki/Terrorism_Risk_Insurance_Act

https://www.ncci.com/nccimain/industryinformation/terrorismwc/pages/tria-faq.aspx


PREMIUM

Enter the portion of this policy premium which is attributable to this coverage. If you do not know ask you underwriter.



ACKNOWLEDGEMENT and SIGNATURES

Instructions ACORD 64 US

Policyholder/Applicant's Signature - have the authorized representative or representatives sign.

Print Name - have the person who signed print their name.

Date - enter the date the person signed. It is best to have the signee enter the date.

Effective Date - enter the effective date of this coverage - it will normally be the same as the policy effective date.

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