Home

 

ACORD 61 SC Instructions
 

 
Section Name Field Name Field and/or Section Description
Use ACORD 61 SC, South Carolina Auto Supplement, to comply with South Carolina requirements that UM and optional UIM coverages must be explained to every applicant for auto insurance.
TITLE
ACORD 61 SC (2007/08) South Carolina Auto Supplement The text of this form is prescribed by the Insurance Commissioner.
IDENTIFICATION SECTION Agency Customer ID: Customer's identification number assigned by the agency or brokerage.
IDENTIFICATION SECTION Agency Producer's name.
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).
The number assigned by the insurance company for the policy. In general, policy numbers
IDENTIFICATION SECTION Policy # 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.
IDENTIFICATION SECTION NAIC Code The identification code assigned to the company by the NAIC.
OFFER OF ADDITIONAL
UNINSURED MOTORIST
COVERAGE Split Limits Enter the premium per auto for these limits.
OFFER OF ADDITIONAL
UNINSURED MOTORIST
COVERAGE Single Limits Enter the premium per auto for these limits.
OFFER OF ADDITIONAL Do you wish to purchase
UNINSURED MOTORIST additional uninsured motorist
COVERAGE coverage? Check the applicable box. If "NO", applicant must sign in the designated space.
OFFER OF ADDITIONAL
UNINSURED MOTORIST
COVERAGE I select split limits Check this box if split limits are desired. Applicant must select the limits desired.

ACORD 61 SC (2007/08) 1 of 2 ACORD 61 SC (2007/08) 2 of 2

Section Name Field Name Field and/or Section Description
OFFER OF ADDITIONAL UNINSURED MOTORIST COVERAGE I select single limits Check this box if a single limit is desired. Applicant must select the limit desired.
OFFER OF OPTIONAL UNDERINSURED MOTORIST COVERAGE Split Limits Enter the premium per auto for these limits.
OFFER OF OPTIONAL UNDERINSURED MOTORIST COVERAGE Single Limits Enter the premium per auto for these limits.
OFFER OF OPTIONAL UNDERINSURED MOTORIST COVERAGE Do you wish to purchase optional uninsured motorist coverage? Check the applicable box. If "NO", applicant must sign in the designated space.
OFFER OF OPTIONAL UNDERINSURED MOTORIST COVERAGE I select split limits Check this box if split limits are desired. Applicant must select the limits desired.
OFFER OF OPTIONAL UNDERINSURED MOTORIST COVERAGE I select single limits Check this box if a single limit is desired. Applicant must select the limit desired.
APPLICANT'S ACKNOWLEDGEMENT Type or print your name Type or print applicant's name.
APPLICANT'S ACKNOWLEDGEMENT Your Signature Applicant must sign the acknowledgement.
APPLICANT'S ACKNOWLEDGEMENT Your address Enter applicant's complete address.
APPLICANT'S ACKNOWLEDGEMENT Zip Code Enter the applicant's zip code
APPLICANT'S ACKNOWLEDGEMENT Today's date Date the acknowledgement was signed.
APPLICANT'S ACKNOWLEDGEMENT Effective Date Enter the effective date for the coverages selected.