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ACORD 38 WV Instructions

 

 
Section Name Field Name Field and/or Section Description
TITLE ACORD 38 WV (2006/04) West Virginia Personal Insurance Supplement - Notice of Information Practices Use ACORD 38 WV with all personal lines applications except Personal Auto, to comply with West Virginia Insurance Department Infomational Letter 142A. Applicants for insurance must be advised that credit scoring may be used in connection with an application for personal insurance, and that if the credit score increases their premium, an insured may request a recalculation of the credit score once in a twelve (12) month period. ACORD 90 WV, West Virginia Personal Auto Application, includes the disclosure in the application.
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).

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Section Name Field Name Field and/or Section Description
APPLICANT/NAMED Applicant/Named Insured's
INSURED'S SIGNATURE Signature All applicants/named insureds must sign this form.
APPLICANT/NAMED
INSURED'S SIGNATURE Date Enter the date the form was signed by the applicant/named insureds.