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ACORD 60 OK Instructions
 

 
ACORD 60 OK (2005/04) 1 of 4
Universal wording updates to improve clarity and intent were made to all FIG text for this form on 07/10/2009.
Section Name Field Name Field and/or Section Description
TITLE ACORD 60 OK (2005/04) Oklahoma Auto Supplement Oklahoma Uninsured Motorists Coverage Law The title of the form. ACORD 60 OK, Oklahoma Auto Supplement, Oklahoma Uninsured Motorists Coverage Law, is used to satisfy an Oklahoma law that requires every applicant for auto insurance must: * Be given a copy of the text in ACORD 60 OK-1 that explains Uninsured Motorists coverage * Make option choices, including coverage rejection, by selecting among the options included in 60 OK-1 * Page 2 of the form (60 OK-2) is applicable for Single Limit Liability * Every named insured in the policy must sign this form Use 60 OK-1 or 60 OK-2 with ACORD 90 OK, and all commercial auto applications.
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 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.

ACORD 60 OK (2005/04) 2 of 4

Section Name Field Name Field and/or Section Description
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
IDENTIFICATION SECTION Policy # required for self-insurance, the self-insured license or contract number.
Enter date: The effective date of the policy. The date that the terms and conditions of the
IDENTIFICATION SECTION Effective Date policy commence.
UNINSURED MOTORIST Uninsured Motorist Coverage Enter amount: The uninsured motorists bodily injury or combined single limit premium
COVERAGE equal to Bodily Injury Premium amount.
Uninsured Motorist Coverage
UNINSURED MOTORIST equal to Bodily Injury Coverage
COVERAGE Months Enter number: The number of months of coverage.
UNINSURED MOTORIST Uninsured Motorist Coverage Enter amount: The uninsured motorists bodily injury or combined single limit premium
COVERAGE Premium amount.
UNINSURED MOTORIST Uninsured Motorist Coverage
COVERAGE Months Enter number: The number of months of coverage.
I want the same amount of
UNINSURED MOTORIST Uninsured Motorist coverage as Initial here: The named insured's initials. As used here, indicates the proposed insured
COVERAGE my bodily injury liability coverage has selected uninsured motorists split limits equal to their bodily injury coverage.
Initial here: The named insured's initials. As used here, indicates the proposed insured
UNINSURED MOTORIST I want minimum Uninsured has selected uninsured motorists split limits of $25,000 per accident / $50,000 per
COVERAGE Motorist Coverage occurrence.
UNINSURED MOTORIST I want Uninsured Coverage in the Initial here: The named insured's initials. As used here, indicates the proposed insured
COVERAGE following amount: has selected uninsured motorists split limits other than those listed.
Enter limit: The uninsured motorists bodily injury per person limit. The use of this limit
UNINSURED MOTORIST varies by state. (in some states this may contain the combined single limit per accident
COVERAGE Uninsured Motorist Per Person ($) limit amount.)
Enter limit: The uninsured motorists bodily injury per accident limit (in some states this
UNINSURED MOTORIST Uninsured Motorist Per Occurance may contain the uninsured motorists combined single limit per accident limit). The use of
COVERAGE ($) this limit varies by state.
UNINSURED MOTORIST Reject Uninsured Motorist Initial here: The named insured's initials. As used here, indicates the proposed insured
COVERAGE Coverage has rejected uninsured motorists coverage.
UNINSURED MOTORIST
COVERAGE Proposed Insured Sign here: Accommodates the signature of the applicant or named insured.
UNINSURED MOTORIST
COVERAGE Proposed Insured Sign here: Accommodates the signature of the applicant or named insured.

ACORD 60 OK (2005/04) 3 of 4

Section Name Field Name Field and/or Section Description
UNINSURED MOTORIST
COVERAGE Date Enter date: The date the form was signed by the named insured.
UNINSURED MOTORIST Sign here: Accommodates the signature of the authorized representative (e.g. producer,
COVERAGE Producer agent, broker, etc.). by all companies to issue Certificates. This is required in most states.
UNINSURED MOTORIST
COVERAGE SINGLE LIMIT Agency Enter text: The full name of the producer/agency.
UNINSURED MOTORIST
COVERAGE SINGLE LIMIT Enter text: The mailing address line one of the producer/agency.
UNINSURED MOTORIST
COVERAGE SINGLE LIMIT Enter text: The mailing address city name of the producer/agency.
UNINSURED MOTORIST
COVERAGE SINGLE LIMIT Enter code: The mailing address state or province code of the producer/agency.
UNINSURED MOTORIST
COVERAGE SINGLE LIMIT Enter code: The mailing address postal code of the producer/agency.
UNINSURED MOTORIST Enter code: The identification code assigned to the producer (e.g. agency or brokerage
COVERAGE SINGLE LIMIT Code firm) by the insurer.
UNINSURED MOTORIST Enter code: The identification code assigned by the insurer to the sub-producer (e.g.
COVERAGE SINGLE LIMIT Subcode person) within a producer's office (e.g. agency or brokerage).
UNINSURED MOTORIST
COVERAGE SINGLE LIMIT Name Enter text: The named insured(s) as it/they will appear on the policy declarations page.
Enter text: The insurer's full legal company name(s) as found in the file copy of the policy.
UNINSURED MOTORIST Use the actual name of the company within the group to which the policy has been issued.
COVERAGE SINGLE LIMIT Company This is not the insurer's group name or trade name.
Enter identifier: The identifier assigned by the insurer to the policy, or submission, being
UNINSURED MOTORIST referenced exactly as it appears on the policy, including prefix and suffix symbols. If
COVERAGE SINGLE LIMIT Policy # required for self-insurance, the self-insured license or contract number.
UNINSURED MOTORIST Enter date: The effective date of the policy. The date that the terms and conditions of the
COVERAGE SINGLE LIMIT Effective Date policy commence.
Uninsured Motorist Coverage
UNINSURED MOTORIST equal to Bodily Injury Coverage Enter amount: The uninsured motorists bodily injury or combined single limit premium
COVERAGE SINGLE LIMIT Premium amount.
Uninsured Motorist Coverage
UNINSURED MOTORIST equal to Bodily Injury Coverage
COVERAGE SINGLE LIMIT Number of Months Enter number: The number of months of coverage.
Section Name Field Name Field and/or Section Description
UNINSURED MOTORIST Uninsured Motorist Coverage Enter amount: The uninsured motorists bodily injury or combined single limit premium
COVERAGE SINGLE LIMIT $50,000 per accident premium amount.
Uninsured Motorist Coverage
UNINSURED MOTORIST $50,000 Per Accident Number of
COVERAGE SINGLE LIMIT Months Enter number: The number of months of coverage.
UNINSURED MOTORIST COVERAGE SINGLE LIMIT I want the same amount of Uninsured Motorist coverage as my bodily injury liability coverage Initial here: The named insured's initials. As used here, indicates the proposed insured has selected uninsured motorists combined single limit equal to their bodily injury coverage.
Initial here: The named insured's initials. As used here, indicates the proposed insured
UNINSURED MOTORIST I want minimum Uninsured has selected minimum uninsured motorists combined single limit coverage of $50,000 per
COVERAGE SINGLE LIMIT Motorist Coverage accident.
UNINSURED MOTORIST Uninsured Coverage in the Initial here: The named insured's initials. As used here, indicates the proposed insured
COVERAGE SINGLE LIMIT following amount has selected uninsured motorists combined single limit other than those listed.
UNINSURED MOTORIST Uninsured Motorist Per Accident
COVERAGE SINGLE LIMIT ($) Enter limit: The uninsured motorists combined single limit per accident limit amount.
UNINSURED MOTORIST Reject Uninsured Motorist Initial here: The named insured's initials. As used here, indicates the proposed insured
COVERAGE SINGLE LIMIT Coverage has rejected uninsured motorists coverage.
SIGNATURE Proposed Insured Sign here: Accommodates the signature of the applicant or named insured.
SIGNATURE Proposed Insured 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.
Sign here: Accommodates the signature of the authorized representative (e.g. producer,
SIGNATURE Producer agent, broker, etc.). by all companies to issue Certificates. This is required in most states.
The edition identifier of the form including the form number and edition (the date is
Edition Date typically formatted YYYY/MM).

ACORD 60 OK (2005/04) 4 of 4