ACORD Form 64 NJ New Jersey Auto
Supp Standard Policy Coverage Instructions

 

Section Name	Field Name	Field and/or Section Description
		New Jersey laws and regulations require that every applicant for auto insurance be given a
		copy of this supplement, which explains various coverage choices available under the
		"Standard" insurance policy. Specific premium and rate information, as well as differences
		in premium between various coverage's, must be filled in and provided to the applicant.
		The applicant must make coverage choices on this form, and must sign it. This form also
		refers to ACORD 61NJ, the Auto Insurance Buyers Guide, prescribed by the New Jersey
		Insurance Division.
TITLE	New Jersey Auto Supplement,
ACORD 64 NJ (2006/10)	Standard Coverage Selection Form	Use with all applications for personal auto insurance.
IDENTIFICATION SECTION	Producer	Producer's name and address.
		Identification code assigned to the agency or brokerage firm by the insurance company
IDENTIFICATION SECTION	Code	receiving this form.
		If the agency or brokerage uses a sub-code identification system with the company, enter
IDENTIFICATION SECTION	Sub Code	the appropriate code.
IDENTIFICATION SECTION	Applicant/Named Insured	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	Company	you wish to have the policy issued.
		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.

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