ACORD 61 NM (2010/12)

Section Name
Field Name
Field and/or Section Description
TITLE
ACORD 61 NM (2010/12)
New Mexico Auto Supplement
ACORD 61 NM, New Mexico Auto Supplement, complies with New
Mexico law, and must be used with applications for auto insurance under the following
circumstances:
UM Coverage Selection
1. When an applicant for either personal or commercial auto insurance:
- Selects Uninsured Motorists (UM) coverage less than the liability limits of the policy,
or
- Rejects Uninsured Motorists (UM) coverage entirely
Rejection of Stacked UM Coverage
2. When an applicant for a multi-vehicle personal auto policy, or a multi-vehicle
commercial auto policy if the applicant is an individual, decides to reject intra-policy
Stacked Uninsured Motorists (UM) coverage.
IDENTIFICATION SECTION Agency Customer ID
Enter identifier: The customer's identification number assigned by the producer (e.g.
agency or brokerage).
IDENTIFICATION SECTION Agency
Enter text: The full name of the producer/agency.
IDENTIFICATION SECTION Policy Number
Enter identifier: The identifier assigned by the insurer to the policy, or submission, being
referenced exactly as it appears on the policy, including prefix and suffix symbols. If
required for self-insurance, the self-insured license or contract number.
IDENTIFICATION SECTION Effective Date
Enter date: The effective date of the policy. The date that the terms and conditions of the
policy commence.
IDENTIFICATION SECTION Named Insured(s)
Enter text: The named insured(s) as it/they will appear on the policy declarations page.
IDENTIFICATION SECTION Carrier
Enter text: The insurer's full legal company name(s) as found in the file copy of the policy.
Use the actual name of the company within the group to which the policy has been issued.
This is not the insurer's group name or trade name.
IDENTIFICATION SECTION NAIC Code
Enter code: The identification code assigned to the insurer by the NAIC.
COVERAGES
Option 1 - Combined Single Limit
ea accident
Enter limit: The uninsured motorists combined single limit per accident limit amount.
ACORD 61 NM (2010/12) rev. 12-27-2010
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Section Name
Field Name
Field and/or Section Description
COVERAGES
Option 1 - Bodily Injury ea
accident
Enter limit: The uninsured motorists bodily injury per accident limit (in some states this
may contain the uninsured motorists combined single limit per accident limit). The use of
this limit varies by state.
COVERAGES
Option 1 - Bodily Injury ea person
Enter limit: The uninsured motorists bodily injury per person limit. The use of this limit
varies by state. (in some states this may contain the combined single limit per accident
limit amount.)
COVERAGES
Option 1 - Premium CSL / BI
Enter amount: The uninsured motorist combined single limit premium amount.
COVERAGES
Option 1 - Property Damage ea
accident
Enter limit: The uninsured motorists property damage per accident amount. The use of
this limit varies by state.
COVERAGES
Option 1 - Property Damage
Deductible
Enter deductible: The uninsured motorists property damage deductible amount.
COVERAGES
Option 1 - Premium PD
Enter amount: The uninsured motorists property damage premium amount.
COVERAGES
Option 2 - Combined Single Limit
ea accident
Enter limit: The uninsured motorists combined single limit per accident limit amount.
COVERAGES
Option 2 - Bodily Injury ea
accident
Enter limit: The uninsured motorists bodily injury per accident limit (in some states this
may contain the uninsured motorists combined single limit per accident limit). The use of
this limit varies by state.
COVERAGES
Option 2 - Bodily Injury ea person
Enter limit: The uninsured motorists bodily injury per person limit. The use of this limit
varies by state. (in some states this may contain the combined single limit per accident
limit amount.)
COVERAGES
Option 2 - Premium CSL / BI
Enter amount: The uninsured motorist combined single limit premium amount.
COVERAGES
Option 2 - Property Damage ea
accident
Enter limit: The uninsured motorists property damage per accident amount. The use of
this limit varies by state.
COVERAGES
Option 2 - Property Damage
Deductible
Enter deductible: The uninsured motorists property damage deductible amount.
COVERAGES
Option 2 - Premium PD
Enter amount: The uninsured motorists property damage premium amount.
COVERAGES
Option 3 - Combined Single Limit
ea accident
Enter limit: The uninsured motorists combined single limit per accident limit amount.
COVERAGES
Option 3 - Bodily Injury ea
accident
Enter limit: The uninsured motorists bodily injury per accident limit (in some states this
may contain the uninsured motorists combined single limit per accident limit). The use of
this limit varies by state.
COVERAGES
Option 3 - Bodily Injury ea person
Enter limit: The uninsured motorists bodily injury per person limit. The use of this limit
varies by state. (in some states this may contain the combined single limit per accident
limit amount.)
COVERAGES
Option 3 - Premium CSL / BI
Enter amount: The uninsured motorist combined single limit premium amount.
ACORD 61 NM (2010/12) rev. 12-27-2010
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Section Name
Field Name
Field and/or Section Description
COVERAGES
Option 3 - Property Damage ea
accident
Enter limit: The uninsured motorists property damage per accident amount. The use of
this limit varies by state.
COVERAGES
Option 3 - Property Damage
Deductible
Enter limit: The uninsured motorists bodily injury per person limit. The use of this limit
varies by state. (in some states this may contain the combined single limit per accident
limit amount.)
COVERAGES
Option 3 - Premium PD
Enter amount: The uninsured motorists property damage premium amount.
UNINSURED MOTORISTS
COVERAGE SELECTION
I Select UM Applicant's Signature
Sign here: Accommodates the signature of the applicant or named insured. As used here,
indicates the named insured selects uninsured motorists limits indicated in the application.
UNINSURED MOTORISTS
COVERAGE SELECTION
Date
Enter date: The date the form was signed by the named insured.
UNINSURED MOTORISTS
COVERAGE SELECTION
I Reject UM Applicant's Signature
Sign here: Accommodates the signature of the applicant or named insured. As used here,
indicates the named insured rejects uninsured motorists limits indicated in its entirety.
UNINSURED MOTORISTS
COVERAGE SELECTION
Date
Enter date: The date the form was signed by the named insured.
IDENTIFICATION SECTION Agency Customer ID
Enter identifier: The customer's identification number assigned by the producer (e.g.
agency or brokerage).
REJECTION OF STACKED
UNINSURED MOTORISTS
COVERAGE
I Reject intra policy Stacked UM
Applicant's Signature
Sign here: Accommodates the signature of the applicant or named insured. As used here,
indicates the named insured rejects intra-policy stacked uninsured motorists coverage and
selects non-stacked uninsured motorists coverage.
REJECTION OF STACKED
UNINSURED MOTORISTS
COVERAGE
Date
Enter date: The date the form was signed by the named insured.
Edition
Date
The edition identifier of the form including the form number and edition (the date is
typically formatted YYYY/MM).
ACORD 61 NM (2010/12) rev. 12-27-2010
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