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Universal wording updates to improve clarity and intent were made to all FIG text for this form on 05/08/2009. |
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Section Name |
Field Name |
Field and/or Section Description |
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TITLE ACORD 61 ID (2009/01) |
Idaho Auto Supplement, Idaho Uninsured Motorist and Underinsured Motorist Disclosure Statement |
The title of the form. ACORD 61 ID, Idaho Auto Supplement, Idaho Uninsured Motorist and Underinsured Motorist Disclosure Statement, complies with Idaho law and regulations, which require that the insured: * Must be offered Uninsured Motorist Bodily Injury coverage and Underinsured Motorist Bodily Injury coverage; * Can reject Uninsured Motorist Bodily Injury coverage completely; * Can reject Underinsured Motorist Bodily Injury coverage completely. Any of these rejection options must be agreed to in writing by the insured. Use this form with ACORD 90 ID, and all commercial auto applications. |
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IDENTIFICATION SECTION |
Agency Customer ID |
Enter identifier: The customer's identification number assigned by the producer (e.g. agency or brokerage). |
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IDENTIFICATION SECTION |
Agency |
Enter text: The full name of the producer/agency. |
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IDENTIFICATION SECTION |
Policy Number |
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. As used here, in general, policy numbers will not appear on new business applications since they are not known at that point in time. |
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IDENTIFICATION SECTION |
Effective Date |
Enter date: The effective date of the policy. The date that the terms and conditions of the policy commence. |
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IDENTIFICATION SECTION |
Named Insured(s) |
Enter text: The named insured(s) as it/they will appear on the policy declarations page. |
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IDENTIFICATION SECTION |
Carrier |
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. |
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IDENTIFICATION SECTION |
NAIC Code |
Enter code: The identification code assigned to the insurer by the NAIC. |
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UNINSURED AND UNDERINSURED MOTORIST COVERAGE WAIVER |
Insurer |
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. As used here, the placement of these fields is required by the Idaho Department of Insurance. |
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Section Name |
Field Name |
Field and/or Section Description |
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UNINSURED AND UNDERINSURED MOTORIST COVERAGE WAIVER |
Policy Number |
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. As used here, in general, policy numbers will not appear on new business applications since they are not known at that point in time. The placement of these fields is required by the Idaho Department of Insurance. |
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UNINSURED AND |
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UNDERINSURED |
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MOTORIST COVERAGE |
I hereby reject Uninsured Motorist |
Check the box (if applicable): Indicates uninsured motorists coverage has been rejected |
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WAIVER |
Bodily Injury Coverage |
by the named insured. |
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UNINSURED AND |
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UNDERINSURED |
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MOTORIST COVERAGE |
I hereby reject Underinsured |
Check the box (if applicable): Indicates underinsured motorists coverage has been |
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WAIVER |
Motorist Bodily Injury Coverage |
rejected by the named insured. |
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UNINSURED AND |
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UNDERINSURED |
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MOTORIST COVERAGE |
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WAIVER |
Named Insured |
Sign here: Accommodates the signature of the applicant or named insured. |
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UNINSURED AND |
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UNDERINSURED |
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MOTORIST COVERAGE |
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WAIVER |
Date |
Enter date: The date the form was signed by the named insured. |
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The edition identifier of the form including the form number and edition (the date is |
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Edition |
Date |
typically formatted YYYY/MM). |