ACORD 62 MO (2007/08)

Universal wording updates to improve clarity and intent were made to all FIG text for this form on 11/13/2009.
Section Name
Field Name
Field and/or Section Description
TITLE
ACORD 62 MO (2007/08)
Missouri Property Supplement -
Notice of Availability of
Earthquake Insurance
ACORD 62 MO, Missouri Property Supplement - Notice of Availability
of Earthquake Insurance, is required by Missouri law to provide a notice of availability of
earthquake insurance to applicants for homeowners insurance with property located in the
New Madrid Seismic Zone, as defined by the U.S. Geological Survey in Missouri.
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 Applicant / Name Insured
Enter text: The named insured(s) as it/they will appear on the policy declarations page.
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 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.
INFORMATION
Does not cover loss by earthquake-
Check Box
Check the box (if applicable): Indicates the policy has no earthquake coverage.
INFORMATION
Limited coverage for loss by
earthquake-Check Box
Check the box (if applicable): Indicates earthquake coverage applies to the policy.
INFORMATION
Describe Limits-Blank Field
Enter text: The description of the earthquake coverage.
INFORMATION
Describe Limits-Blank Field
Enter text: The description of the earthquake coverage.
INFORMATION
Describe Limits-Blank Field
Enter text: The description of the earthquake coverage.
INFORMATION
Describe Limits-Blank Field
Enter text: The description of the earthquake coverage.
SIGNATURE
Applicant Signature
Sign here: Accommodates the signature of the applicant or named insured.
SIGNATURE
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 62 MO (2007/08)
1 of 1