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Section Name |
Field Name |
Field and/or Section Description |
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This form contains information prescribed by the New Jersey Insurance Division. It |
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describes coverages available under the New Jersey "basic" and "standard" insurance |
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policies. Use the form with all applications for personal auto insurance, and all |
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TITLE |
New Jersey Auto Supplement - NJ |
applications for private passenger auto insurance for individual owners under a |
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ACORD 61 NJ (2006/10) |
Auto Insurance Buyer's Guide |
commercial policy. |
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IDENTIFICATION SECTION |
Producer |
Producer's name and address. |
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Identification code assigned to the agency or brokerage firm by the insurance company |
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IDENTIFICATION SECTION |
Code |
receiving this form. |
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If the agency or brokerage uses a sub-code identification system with the company, enter |
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IDENTIFICATION SECTION |
Sub Code |
the appropriate code. |
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IDENTIFICATION SECTION |
Applicant/Named Insured |
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). |
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Name of the insurance company (or residual market plan) that will receive the application. |
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Do not use group names, use the actual name of the company within the group in which |
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IDENTIFICATION SECTION |
Company |
you wish to have the policy issued. |
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The number assigned by the insurance company for the policy. In general, policy numbers |
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IDENTIFICATION SECTION |
Policy # |
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 |
Date (MM/DD/YYYY) on which the terms and conditions of the policy will commence. |