ACORD 38 ND Instructions

 

Section Name	Field Name	Field and/or Section Description
TITLE ACORD 38 ND (2005/08)	North Dakota Personal Insurance Supplement - Notice of Information Practices	Use ACORD 38 ND with all applications for personal insurance, to comply with North Dakota law requiring that written authorization from the insured (or in electronic form if the insured agrees) be obtained by the insurer, prior to the disclosure of non-public personal and privileged information to non-affiliated third parties. This supplement also informs the insured that claims history will be considered in determining whether to decline, cancel, non-renew or surcharge a policy. The form also states that claims incurred by the applicant will be reported to an insurance support organzation.
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).
NOTICE OF INFORMATION		Indicate the toll-free telephone number in which applicant may contact the insurer
PRACTICES	Toll-Free Telephone Number	regarding disclosure authorization.

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