Universal wording updates to improve clarity and intent were made to all FIG text for this form on 06/05/2009.
Section Name
Field Name
Field and/or Section Description
TITLE
ACORD 60 MT (2003/09)
Montana Application Supplement -
Refusal to Renew
ACORD 60 MT, Montana Application Supplement - Refusal to
Renew, is used to satisfy a Montana law that requires that if a single loss occurring during
the policy period is among an insurance company's criteria for non-renewal of the
applicant's policy, then a notice must be given to the applicant informing them of this
criteria. This notice must be signed and dated by the applicant.
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 NAIC Code
Enter code: The identification code assigned to the insurer by the NAIC.
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.
IDENTIFICATION SECTION Policy
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.
IDENTIFICATION SECTION Effective Date
Enter date: The effective date of the policy. The date that the terms and conditions of the
policy commence.
APPLIED APPLICATION
INFORMATION
Homeowners Insurance
Check the box (if applicable): Indicates this is a supplement to a homeowners application.
APPLIED APPLICATION
INFORMATION
Personal Inland Marine Insurance
Check the box (if applicable): Indicates this is a supplement to a personal inland marine
application.
ACORD 60 MT (2003/09)
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Section Name
Field Name
Field and/or Section Description
APPLIED APPLICATION
INFORMATION
Watercraft Insurance
Check the box (if applicable): Indicates this is a supplement to a watercraft application.
APPLIED APPLICATION
INFORMATION
Personal Umbrella Insurance
Check the box (if applicable): Indicates this is a supplement to a personal umbrella
application.
APPLIED APPLICATION
INFORMATION
Dwelling Insurance
Check the box (if applicable): Indicates this is a supplement to a dwelling fire application.
APPLIED APPLICATION
INFORMATION
Mobile Home Insurance
Check the box (if applicable): Indicates this is a supplement to a mobile home application.
APPLIED APPLICATION
INFORMATION
Personal Lines Package Insurance
Check the box (if applicable): Indicates this is a supplement to a personal lines package
application.
APPLIED APPLICATION
INFORMATION
Personal Auto Insurance
Check the box (if applicable): Indicates this is a supplement to a personal auto application.
APPLIED APPLICATION
INFORMATION
Agriculture Insurance
Check the box (if applicable): Indicates this is a supplement to an agriculture application.
APPLIED APPLICATION
INFORMATION
Commercial Insurance
Check the box (if applicable): Indicates this is a supplement to a commercial application.
APPLIED APPLICATION
INFORMATION
Other
Check the box (if applicable): Indicates this is a supplement to an application other than
those listed.
APPLIED APPLICATION
INFORMATION
Other Description
Enter text: The type of application this form is a supplement to.
SIGNATURE
Signature of Applicant
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.
Edition
Date
The edition identifier of the form including the form number and edition (the date is
typically formatted YYYY/MM).
ACORD 60 MT (2003/09)
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