ACORD 38 KS Instructions

 

Section Name	Field Name	Field and/or Section Description
TITLE ACORD 38 KS (2005/03)	Kansas Personal Insurance Supplement - Notice of Information Practices	Use ACORD 38 KS with all applications for personal insurance, to comply with a law requiring that all applicants for insurance must be told that credit reports or other investigative reports may be requested in connection with the application, and that credit scoring information may be used to determine eligibility or the premium charged. Applicant is also advised that they have the right to correct any information that may be wrong and that there is a specific appeal process.
IDENTIFICATION SECTION	Date	Month/day/year (MM/DD/YYYY) on which the form is completed.
IDENTIFICATION SECTION	Agency	Producer’s name and address.
		Identification code assigned to your agency or brokerage firm by the insurance company
IDENTIFICATION SECTION	Code	receiving this form.
		If your agency uses a subcode identification system with the company, enter the
IDENTIFICATION SECTION	Subcode	appropriate code.
IDENTIFICATION SECTION	Agency Customer ID	Customer’s identification number assigned by the agency.
	Applicant's Name and Mailing
IDENTIFICATION SECTION	Address	Applicant's name and mailing address.
IDENTIFICATION SECTION	Telephone Number	Applicant's telephone number.
IDENTIFICATION SECTION	Company Name	Issuing company’s name.
		If applicable, account number to be used for billing purposes. This is the Billing Number
		assigned by the billing entity. If agency bill, the agency assigns; if direct bill the company
IDENTIFICATION SECTION	Account Number	assigns.
		Number exactly as it appears on the policy, including prefix and suffix symbols. Check if a
IDENTIFICATION SECTION	Policy Number	new policy or a renewal.
IDENTIFICATION SECTION	Effective Date	Date on which the terms and conditions of the policy commenced.
IDENTIFICATION SECTION	Expiration Date	Date on which the terms and conditions of the policy will or have expire(d).
APPLICANT/NAMED	Applicant/Named Insured's
INSURED'S SIGNATURE	Signature	All applicants/named insureds must sign this form.

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