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ACORD Form 60 Flood Insurance
Selection/Rejection Instructions
 

 
Section Name Field Name Field and/or Section Description
Use ACORD 60, Flood Insurance Selection / Rejection, to explain to applicants for property insurance the value of purchasing flood insurance coverage, and to record the signature of the applicant if flood insurance coverage is selected or rejected.
TITLE ACORD 60 (2008/11) Flood Insurance Selection / Rejection This form contains advisory text provided by the Federal Emergency Management Agency (FEMA).
IDENTIFICATION SECTION Agency Customer ID Customer's identification number assigned by the agency or brokerage.
IDENTIFICATION SECTION Date (MM/DD/YYYY) Month/day/year (MM/DD/YYYY) on which the form is completed.
IDENTIFICATION SECTION Agency Producer's name.
The number assigned by the insurance company for the policy. In general, policy numbers
IDENTIFICATION SECTION Policy # will not appear on new business applications since they are not known at that point in time.
IDENTIFICATION SECTION Effective Date Date (MM/DD/YYYY) on which the terms and conditions of the policy will commence.
IDENTIFICATION SECTION Applicant / Named Insured(s) Full name of the applicant as it should appear on the policy. The First Named Insured is given certain rights and responsibilities by the policy contract language. If more than one insured is named, be sure the one intended to receive these rights and responsibilities is named first and any additional insureds identified as such. If joint ownership, the name used may include both names (e.g., John and Mary Smith).
Name of the insurance company (or residual market plan) that will receive the application.
Do not use group names, use the actual name of the company within the group in which
IDENTIFICATION SECTION Carrier you wish to have the policy issued.
IDENTIFICATION SECTION NAIC Code Enter the identification code assigned to the company by the NAIC.
SELECTION / REJECTION
OF FLOOD INSURANCE
COVERAGE NFIP Building Coverage - Accept Check this box if you accept NFIP Building Coverage.
SELECTION / REJECTION
OF FLOOD INSURANCE
COVERAGE NFIP Building Coverage - Reject Check this box if you reject NFIP Building Coverage.

ACORD 60 (2008/11) 1 of 3 ACORD 60 (2008/11) 2 of 3 ACORD 60 (2008/11) 3 of 3

Section Name Field Name Field and/or Section Description
SELECTION / REJECTION
OF FLOOD INSURANCE NFIP Contents / Personal Property
COVERAGE Accept Check this box if you accept NFIP Contents / Personal Property Coverage.
SELECTION / REJECTION
OF FLOOD INSURANCE NFIP Contents / Personal Property
COVERAGE Reject Check this box if you reject NFIP Contents / Personal Property Coverage.
SELECTION / REJECTION
OF FLOOD INSURANCE Excess Building Coverage -
COVERAGE Accept Check this box if you accept Excess Building Coverage.
SELECTION / REJECTION
OF FLOOD INSURANCE
COVERAGE Excess Building Coverage - Reject Check this box if you reject Excess Building Coverage.
SELECTION / REJECTION
OF FLOOD INSURANCE Excess Contents / Personal
COVERAGE Property - Accept Check this box if you accept Excess Contents / Personal Property Coverage.
SELECTION / REJECTION
OF FLOOD INSURANCE Excess Contents / Personal
COVERAGE Property - Reject Check this box if you reject Excess Contents / Personal Property Coverage.
SELECTION / REJECTION Excess Loss of Income or
OF FLOOD INSURANCE Additional Living Expenses - Check this box if you accept Excess Loss of Income or Additional Living Expenses
COVERAGE Accept Coverage.
SELECTION / REJECTION Excess Loss of Income or
OF FLOOD INSURANCE Additional Living Expenses - Check this box if you reject Excess Loss of Income or Additional Living Expenses
COVERAGE Reject Coverage.
SELECTION / REJECTION The applicant should read and understand this important notice and any other disclosure
OF FLOOD INSURANCE information on the form before personally signing the application. By signing this
COVERAGE Applicant's Signature application, the applicant/named insured is electing not to purchase flood insurance.
SELECTION / REJECTION
OF FLOOD INSURANCE
COVERAGE Date Date the form was signed.
SELECTION / REJECTION
OF FLOOD INSURANCE Indicate the physical address of the property for which flood insurance coverage is
COVERAGE Address of Property available but has been rejected by the applicant/first named insured.
Section Name Field Name Field and/or Section Description
SELECTION / REJECTION
OF FLOOD INSURANCE
COVERAGE Producer The producer should sign the application. This is required in most states.
SELECTION / REJECTION
OF FLOOD INSURANCE
COVERAGE Date Date the form was signed.