ACORD 60 OK (2009/11)

Section Name
Field Name
Field and/or Section Description
TITLE
ACORD 60 OK (2009/11)
Oklahoma Auto Supplement
Oklahoma Uninsured Motorists
Coverage Law
ACORD 60 OK, Oklahoma Auto Supplement, Oklahoma Uninsured
Motorists Coverage Law, is used to satisfy an Oklahoma law that requires every applicant
for auto insurance must:
* Be given a copy of the text in ACORD 60 OK-1 that explains Uninsured Motorists
coverage
* Make option choices, including coverage rejection, by selecting among the options
included in 60 OK-1
* Page 2 of the form (60 OK-2) is applicable for Single Limit Liability
* Every named insured in the policy must sign this form
Use 60 OK-1 or 60 OK-2 with ACORD 90 OK, and all commercial auto applications.
IDENTIFICATION SECTION Agency Customer ID
Enter identifier: The customer's identification number assigned by the producer (e.g.
agency or brokerage).
IDENTIFICATION SECTION Agency
Enter text: The full name of the producer/agency.
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.
IDENTIFICATION SECTION Named Insured(s)
Enter text: The named insured(s) as it/they will appear on the policy declarations page.
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.
IDENTIFICATION SECTION NAIC Code
Enter code: The identification code assigned to the insurer by the NAIC.
UNINSURED MOTORIST
COVERAGE
I want the same amount of
Uninsured Motorist coverage as
my bodily injury liability coverage
Initial here: The named insured's initials. As used here, indicates the proposed insured
has selected uninsured motorists split limits equal to their bodily injury coverage.
ACORD 60 OK (2009/11) rev. 08-31-2009
1 of 3
Section Name
Field Name
Field and/or Section Description
UNINSURED MOTORIST
COVERAGE
I want minimum Uninsured
Motorist Coverage
Initial here: The named insured's initials. As used here, indicates the proposed insured
has selected uninsured motorists split limits of $25,000 per accident / $50,000 per
occurrence.
UNINSURED MOTORIST
COVERAGE
I want Uninsured Motorist
Coverage in the following amount:
Initial here: The named insured's initials. As used here, indicates the proposed insured
has selected uninsured motorists split limits listed below.
UNINSURED MOTORIST
COVERAGE
Uninsured Motorist Per Person ($)
Enter limit: The uninsured motorists bodily injury per person limit. The use of this limit
varies by state. (in some states this may contain the combined single limit per accident
limit amount.)
UNINSURED MOTORIST
COVERAGE
Uninsured Motorist Per
Occurrence ($)
Enter limit: The uninsured motorists bodily injury per accident limit (in some states this
may contain the uninsured motorists combined single limit per accident limit). The use of
this limit varies by state.
UNINSURED MOTORIST
COVERAGE
Reject Uninsured Motorist
Coverage
Initial here: The named insured's initials. As used here, indicates the proposed insured
has rejected uninsured motorists coverage.
UNINSURED MOTORIST
COVERAGE
Proposed Insured
Sign here: Accommodates the signature of the applicant or named insured.
UNINSURED MOTORIST
COVERAGE
Proposed Insured
Sign here: Accommodates the signature of the applicant or named insured.
UNINSURED MOTORIST
COVERAGE
Date
Enter date: The date the form was signed by the named insured.
IDENTIFICATION SECTION Agency Customer ID
Enter identifier: The customer's identification number assigned by the producer (e.g.
agency or brokerage).
UNINSURED MOTORIST
COVERAGE SINGLE LIMIT
Agency
Enter text: The full name of the producer/agency.
UNINSURED MOTORIST
COVERAGE SINGLE LIMIT
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.
UNINSURED MOTORIST
COVERAGE SINGLE LIMIT
Effective Date
Enter date: The effective date of the policy. The date that the terms and conditions of the
policy commence.
UNINSURED MOTORIST
COVERAGE SINGLE LIMIT
Named Insured(s)
Enter text: The named insured(s) as it/they will appear on the policy declarations page.
UNINSURED MOTORIST
COVERAGE SINGLE LIMIT
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.
UNINSURED MOTORIST
COVERAGE SINGLE LIMIT
NAIC Code
Enter code: The identification code assigned to the insurer by the NAIC.
ACORD 60 OK (2009/11) rev. 08-31-2009
2 of 3
Section Name
Field Name
Field and/or Section Description
UNINSURED MOTORIST
COVERAGE SINGLE LIMIT
I want the same amount of
Uninsured Motorist coverage as
my bodily injury liability coverage
Initial here: The named insured's initials. As used here, indicates the proposed insured
has selected uninsured motorists combined single limit equal to their bodily injury
coverage.
UNINSURED MOTORIST
COVERAGE SINGLE LIMIT
I want minimum Uninsured
Motorist Coverage
Initial here: The named insured's initials. As used here, indicates the proposed insured
has selected minimum uninsured motorists combined single limit coverage of $50,000 per
accident.
UNINSURED MOTORIST
COVERAGE SINGLE LIMIT
Uninsured Coverage in the
following amount
Initial here: The named insured's initials. As used here, indicates the proposed insured
has selected uninsured motorists combined single limit other than those listed.
UNINSURED MOTORIST
COVERAGE SINGLE LIMIT
Uninsured Motorist Per Accident
($)
Enter limit: The uninsured motorists combined single limit per accident limit amount.
UNINSURED MOTORIST
COVERAGE SINGLE LIMIT
Reject Uninsured Motorist
Coverage
Initial here: The named insured's initials. As used here, indicates the proposed insured
has rejected uninsured motorists coverage.
SIGNATURE
Proposed Insured
Sign here: Accommodates the signature of the applicant or named insured.
SIGNATURE
Proposed Insured
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 OK (2009/11) rev. 08-31-2009
3 of 3