Universal wording updates to improve clarity and intent were made to all FIG text for this form on 05/08/2009.
Section Name
Field Name
Field and/or Section Description
TITLE
ACORD 61 ID (2009/01)
Idaho Auto Supplement, Idaho
Uninsured Motorist and
Underinsured Motorist Disclosure
Statement
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.
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 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.
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 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.
ACORD 61 ID (2009/01)
1 of 2
Section Name
Field Name
Field and/or Section Description
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.
UNINSURED AND
UNDERINSURED
MOTORIST COVERAGE
WAIVER
I hereby reject Uninsured Motorist
Bodily Injury Coverage
Check the box (if applicable): Indicates uninsured motorists coverage has been rejected
by the named insured.
UNINSURED AND
UNDERINSURED
MOTORIST COVERAGE
WAIVER
I hereby reject Underinsured
Motorist Bodily Injury Coverage
Check the box (if applicable): Indicates underinsured motorists coverage has been
rejected by the named insured.
UNINSURED AND
UNDERINSURED
MOTORIST COVERAGE
WAIVER
Named Insured
Sign here: Accommodates the signature of the applicant or named insured.
UNINSURED AND
UNDERINSURED
MOTORIST COVERAGE
WAIVER
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 61 ID (2009/01)
2 of 2