ACORD 81 - Instructions for Binders, Information Practices, Fraud Warnings & Signatures

Instructions for Binders, Information Practices, Fraud Warnings & Signatures in the ACORD 81

BINDER & NOTICE OF INFORMATION PRACTICES

ACORD 81 INSTRUCTIONS Binder and Notice of Information Practices

The second half - bottom half - of the third page of the ACORD 81 form contains the wording for the Binder and the wording for the Notice of Information Practices.

INSURANCE BINDER

If you are not binding coverage you should not put any information in the binder box.

If you are binding this policy enter correct information into the following....

EFFECTIVE DATE

EXPIRATION DATE

TIME - If the binder will take effect after the time and date you are completing this form then check the box for either 12:01 AM or Noon,

If the binder will take effect immediately, enter the actual time you complete the form.


NOTICE OF INFORMATION PRACTICES

Your customer must initial the space in the bottom right hand corner of this document to acknowledge she has read the Information Practices statement.

If, at the time of this writing, your customer is in...

Arizona
California
Delaware
Kansas
Massachusetts
Minnesota
North Dakota
Oregon
Virginia
West Virginia

Then you need to use the state specific Notice of Information Practices ACORD document instead of this portion of this form.

Your producer must also check the check box stating a copy of this notice has been given to this customer.

FRAUD STATEMENTS / SIGNATURES -  Page 4

ACORD 81 Instructions for Agency ID

In the top right hand corner of teh page enter your agency's or agency management system's customer ID number.

FRAUD STATEMENT

ACORD 81 Fraud Statement Instructions

If you are selling this policy for a customer in any of the states listed in the Fraud Warning section you need to review that state's Fraud Warning statement with your customer. People can and have gone to jail over this issue. If you do not advise them of this fact, you will also be exposed.


SIGNATURES

ACORD 81 Signatures Instructions

PRODUCER'S SIGNATURE - The producer / agent should sign by hand or digitally.

PRODUCER"S NAME (Please Print) - Print the name of the producer / agent whose signature is on the space to the left.

STATE PRODUCER LICENSE NO (Required in Florida) - Enter you state producer number.

APPLICANT'S SIGNATURE - the authorized representative of the insured should sign by hand or digitally.

DATE - the date of the signature by the customer

NATIONAL PRODUCER NUMBER - enter 'em if you got 'em.



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