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ACORD 61 FL Instructions
 

 
Section Name Field Name Field and/or Section Description
ACORD 61 FL, Florida Auto Supplement - Rejection / Election of Uninsured Motorist Coverage, complies with Florida law, which requires that every applicant for auto insurance:
* Must receive an explanation of Uninsured Motorists (UM) coverage
* Must be offered Uninsured Motorist (UM) coverage equal to the bodily Injury limits in the policy
* Must be allowed to select lower limits or reject UM coverage entirely
* If accepting UM coverage, can elect non-stacked coverage
TITLE ACORD 61 FL (2008/06) Florida Auto Supplement -Rejection / Election of Uninsured Motorist Coverage This form must be signed by the applicant if Uninsured Motorist coverage less than the policy's Bodily Injury Liability limit(s) is selected or UM is rejected entirely; or if, non-stacked coverage is selected. If UM coverage less than the policy's Bodily Injury Liability limit(s) is selected or UM is rejected entirely, or if, non-stacked coverage is selected, the applicant must initial.
Use with ACORD 90 FL, and any commercial auto application where the named insured is designated as an individual in the Declaration of the auto policy.
In addition, Florida requires that Uninsured Motorist coverage must be offered in umbrella policies when auto liability coverage is included. Use ACORD 61 FL with personal umbrella applications and with commercial umbrella applications where the named insured is designated as an individual in the Declaration of the policy.
IDENTIFICATION SECTION Agency Customer ID Customer's identification number assigned by the agency or brokerage.
IDENTIFICATION SECTION Agency Producer's name.
The number assigned by the insurance company for the policy. In general, policy numbers
IDENTIFICATION SECTION Policy Number will not appear on new business applications since they are not known at that point in time.
Name of the insurance company (or residual market plan) that will receive the application.
Do not use group names, use the actual name of the company within the group in which
IDENTIFICATION SECTION Carrier you wish to have the policy issued.

ACORD 61 FL (2008/06) 1 of 2 ACORD 61 FL (2008/06) 2 of 2

Section Name Field Name Field and/or Section Description
IDENTIFICATION SECTION NAIC Code The identification code assigned to the company by the NAIC.
IDENTIFICATION SECTION Named Insured(s) Full name of the applicant as it should appear on the policy. The First Named Insured is given certain rights and responsibilities by the policy contract language. If more than one insured is named, be sure the one intended to receive these rights and responsibilities is named first and any additional insureds identified as such. If joint ownership, the name used may include both names (e.g., John and Mary Smith).
I reject Uninsured Motorist
REJECTION / SELECTION coverage entirely Applicant/Named Insured must initial his/her rejection of Uninsured Motorist coverage.
I select the following Uninsured
Motorist coverage limits which are
REJECTION / SELECTION lower than my bodily injury liability limits Applicant/Named Insured must initial his/her selection of Uninsured Motorist coverage limits which are lower than his/her bodily injury liability limits.
REJECTION / SELECTION $ each person Indicate the desired limit if applicable.
REJECTION / SELECTION $ each accident Indicate the desired limit.
SIGNATURE Applicant's Signature Applicant/Named Insured must sign the application.
SIGNATURE Date Date the application was completed. (MM/DD/YYYY)
SIGNATURE Effective Date Enter the effective date of the Uninsured Motorist coverage selection/rejection.
IDENTIFICATION SECTION Agency Customer ID Customer's identification number assigned by the agency or brokerage.
ELECTION OF NON I elect the non-stacked form of Applicant/Named Insured must initial his/her selection of the non-stacked Uninsured
STACKED COVERAGE Uninsured Motorist coverage Motorist coverage.
SIGNATURE Applicant's Signature Applicant/Named Insured must sign the application.
SIGNATURE Date Date the application was completed. (MM/DD/YYYY)
Enter the effective date of the Uninsured Motorist coverage selection/rejection.
SIGNATURE Effective Date (MM/DD/YYYY)