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ACORD 60 MT Instructions
 

 
Universal wording updates to improve clarity and intent were made to all FIG text for this form on 06/05/2009.
Section Name Field Name Field and/or Section Description
TITLE ACORD 60 MT (2003/09) Montana Application Supplement -Refusal to Renew The title of the form. ACORD 60 MT, Montana Application Supplement - Refusal to Renew, is used to satisfy a Montana law that requires that if a single loss occurring during the policy period is among an insurance company's criteria for non-renewal of the applicant's policy, then a notice must be given to the applicant informing them of this criteria. This notice must be signed and dated by the applicant.
IDENTIFICATION SECTION Agency Enter text: The full name of the producer/agency.
IDENTIFICATION SECTION Enter text: The mailing address line one of the producer/agency.
IDENTIFICATION SECTION Enter text: The mailing address city name of the producer/agency.
IDENTIFICATION SECTION Enter code: The mailing address state or province code of the producer/agency.
IDENTIFICATION SECTION Enter code: The mailing address postal code of the producer/agency.
IDENTIFICATION SECTION Code Enter code: The identification code assigned to the producer (e.g. agency or brokerage firm) by the insurer.
IDENTIFICATION SECTION Subcode Enter code: The identification code assigned by the insurer to the sub-producer (e.g. person) within a producer's office (e.g. agency or brokerage).
IDENTIFICATION SECTION Name Enter text: The named insured(s) as it/they will appear on the policy declarations page.
IDENTIFICATION SECTION NAIC Code Enter code: The identification code assigned to the insurer by the NAIC.
IDENTIFICATION SECTION Company Enter text: The insurer's full legal company name(s) as found in the file copy of the policy. Use the actual name of the company within the group to which the policy has been issued. This is not the insurer's group name or trade name.
IDENTIFICATION SECTION Policy Enter identifier: The identifier assigned by the insurer to the policy, or submission, being referenced exactly as it appears on the policy, including prefix and suffix symbols. If required for self-insurance, the self-insured license or contract number.
IDENTIFICATION SECTION Effective Date Enter date: The effective date of the policy. The date that the terms and conditions of the policy commence.
APPLIED APPLICATION INFORMATION Homeowners Insurance Check the box (if applicable): Indicates this is a supplement to a homeowners application.
APPLIED APPLICATION INFORMATION Personal Inland Marine Insurance Check the box (if applicable): Indicates this is a supplement to a personal inland marine application.

ACORD 60 MT (2003/09) 1 of 2 ACORD 60 MT (2003/09) 2 of 2

Section Name Field Name Field and/or Section Description
APPLIED APPLICATION INFORMATION Watercraft Insurance Check the box (if applicable): Indicates this is a supplement to a watercraft application.
APPLIED APPLICATION INFORMATION Personal Umbrella Insurance Check the box (if applicable): Indicates this is a supplement to a personal umbrella application.
APPLIED APPLICATION INFORMATION Dwelling Insurance Check the box (if applicable): Indicates this is a supplement to a dwelling fire application.
APPLIED APPLICATION INFORMATION Mobile Home Insurance Check the box (if applicable): Indicates this is a supplement to a mobile home application.
APPLIED APPLICATION INFORMATION Personal Lines Package Insurance Check the box (if applicable): Indicates this is a supplement to a personal lines package application.
APPLIED APPLICATION INFORMATION Personal Auto Insurance Check the box (if applicable): Indicates this is a supplement to a personal auto application.
APPLIED APPLICATION INFORMATION Agriculture Insurance Check the box (if applicable): Indicates this is a supplement to an agriculture application.
APPLIED APPLICATION INFORMATION Commercial Insurance Check the box (if applicable): Indicates this is a supplement to a commercial application.
APPLIED APPLICATION INFORMATION Other Check the box (if applicable): Indicates this is a supplement to an application other than those listed.
APPLIED APPLICATION INFORMATION Other Description Enter text: The type of application this form is a supplement to.
SIGNATURE Signature of Applicant Sign here: Accommodates the signature of the applicant or named insured.
SIGNATURE Date Enter date: The date the form was signed by the named insured.
Edition Date The edition identifier of the form including the form number and edition (the date is typically formatted YYYY/MM).