ACORD 61 NJ, New Jersey Auto Supplement - New Jersey Auto
Insurance Buyer's Guide, contains information prescribed by the New Jersey Insurance
Division. It describes coverages available under the New Jersey basic and standard
insurance policies. Use the form with all applications for personal auto insurance. For all
applications for individually owned private passenger automobiles written under a for individually owned private passenger automobiles written under a
TITLE
ACORD 61 NJ (2011/07)
New
Buyer's Guide
applications
commercial policy, see ACORD 66 NJ.
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.
Enter identifier: The identifier assigned by the insurer to the policy or submission being identifier: The identifier assigned by the insurer to the policy, or submission, being
IDENTIFICATION SECTION
Policy #
Enter
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
NNamed Insured(s)
d I
d( )
E t
t
t Th
d i
d( )
it/th
ill
th
li
d
l
ti
IDENTIFICATION SECTION
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.
g
y
IDENTIFICATION SECTION
Agency Customer ID
Enter identifier: The customer's identification number assigned by the producer (e.g.
agency or brokerage).
IDENTIFICATION SECTION
Agency Customer ID
Enter identifier: The customer's identification number assigned by the producer (e.g.
agency or brokerage).
IDENTIFICATION SECTION SECTION
Agency Customer ID Customer ID
Enter identifier: The customer's identification number assigned by the producer (e.g.
agency or brokerage) or brokerage).
IDENTIFICATION
Agency
agency
IDENTIFICATION SECTION
Agency Customer ID
Enter identifier: The customer's identification number assigned by the producer (e.g.
agency or brokerage).
IDENTIFICATION SECTION
Agency Customer ID
Enter identifier: The customer's identification number assigned by the producer (e.g.
agency or brokerage).
IDENTIFICATION SECTION SECTION
Agency Customer IDgency Customer ID
Enter identifier: The customer's identification number assigned by the producer (e.g.
agency or brokerage)brokerage).
IDENTIFICATION
A
agency or
IDENTIFICATION SECTION
Agency Customer ID
Enter identifier: The customer's identification number assigned by the producer (e.g.
agency or brokerage).
ACORD 61 NJ (2011/07) rev. 07-29-2011
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Section Name
Field Name
Field and/or Section Description
Edition
Date
The edition identifier of the form including the form number and edition (the date is typically