|
Section Name |
Field Name |
Field and/or Section Description |
|
TITLE ACORD 65 NC (2009/01) |
North Carolina Auto Supplement, Notice of Right to Purchase Higher Limits of Uninsured Motorist (UM) and Underinsured Motorist (UIM) Coverage |
Use ACORD 65 NC, North Carolina Auto Supplement, Notice of Right to Purchase Higher Limits of Uninsured Motorist (UM) and Underinsured Motorist (UIM) Coverage, to comply with the statutory requirement that current policyholders and new applicants must be notified that they have the right to purchase Uninsured Motorist Bodily Injury coverage with limits up to one million dollars ($1,000,000) per person and one million dollars ($1,000,000) per accident. This requirement does not apply to (1) fleet policies, or (2) policies issued on commercial vehicles as defined by NC General Statute 20-4.01(d). |
|
IDENTIFICATION SECTION |
Agency Customer ID |
Customer's identification number assigned by the agency or brokerage. |
|
IDENTIFICATION SECTION |
Agency |
Producer's name. |
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|
The number assigned by the insurance company for the policy. In general, policy numbers |
|
IDENTIFICATION SECTION |
Policy Number |
will not appear on new business applications since they are not known at that point in time. |
|
|
Enter the effective date of the Uninsured / Underinsured Motorists coverage rejection. |
|
IDENTIFICATION SECTION |
Effective Date |
(MM/DD/YYYY) |
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|
The named insured(s) as it/they appear, or if a policy has not yet been issued, will appear |
|
IDENTIFICATION SECTION |
Named Insured(s) |
on the policy declarations page. |
|
|
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 |
The identification code assigned to the company by the NAIC. |