Section Name
Field Name
Field and/or Section Description
TITLE
ACORD 862 WV (2005/07)
West Virginia Property Supplement
- Notice of Flood Coverage
Exclusion
Use this supplement to comply with West Virginia law which requires that the
applicant/named insured be informed that their insurance policy does not cover damage
from flood.
IDENTIFICATION SECTION Agency
Producers name and address.
IDENTIFICATION SECTION Code
Identification code assigned to your agency or brokerage firm by the insurance company
receiving this form.
IDENTIFICATION SECTION Subcode
If your agency uses a subcode identification system with the company, enter the
appropriate code.
IDENTIFICATION SECTION Applicant/Named Insured
Indicate applicant name. If named insured, name exactly as it appears on the policy.
IDENTIFICATION SECTION Company
Issuing company's name.
IDENTIFICATION SECTION Policy #
Number exactly as it appears on the policy, including prefix and suffix symbols.
IDENTIFICATION SECTION Effective Date
Date on which the terms and conditions of the policy commenced.
SIGNATURE
Applicant/Named Insured's
Signature
Applicant/Named Insured must sign the supplement.
SIGNATURE
Date
Indicate the date the supplement was signed in MM/DD/YYYY format.
ACORD 862 WV (2005/07)
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