Universal wording updates to improve clarity and intent were made to all FIG text for this form on 02/05/2010.
Section Name
Field Name
Field and/or Section Description
TITLE
ACORD 62 OK (2006/05)
Oklahoma Property Supplement
ACORD 62 OK, Oklahoma Property Supplement, complies with
Oklahoma Title 36 O.S.4809 that prohibits insurers or agents from giving certain reduced
insurance rates to any risk in a rural fire protection district in which the district is wholly or
partially funded by dues to any person who fails or refuses to pay the appropriate dues.
Use this supplement with all applications for insurance that provides coverage for the peril
of fire to comply with Oklahoma Title 36 O.S. 4809. Applicants for insurance must be
asked if they have paid the appropriate dues or subscription payments, if their property is
located in a rural fire protection district or in an area protected by a rural fire department.
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 Applicant/Named Insured
Enter text: The named insured(s) as it/they will appear on the policy declarations page.
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.
ACORD 62 OK (2006/05)
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Section Name
Field Name
Field and/or Section Description
NOTICE
Is this property located in a rural
fire protection district or in an area
protected by a rural fire
department? - Yes (checkbox)
Check the box (if applicable): Indicates a Yes response to the question, Is this property
located in a rural fire protection district or in an area protected by a rural fire department?.
NOTICE
Is this property located in a rural
fire protection district or in an area
protected by a rural fire
department? - No (checkbox)
Check the box (if applicable): Indicates a No response to the question, Is this property
located in a rural fire protection district or in an area protected by a rural fire department?.
NOTICE
If the property is located in a rural
fire protection district or in an area
protected by a rural fire
department, have you paid the
appropriate dues or subscription
payments? - Yes (checkbox)
Check the box (if applicable): Indicates a Yes response to the question, If the property
is located in a rural fire protection district or in an area protected by a rural fire department,
have you paid the appropriate dues or subscription payments?.
NOTICE
If the property is located in a rural
fire protection district or in an area
protected by a rural fire
department, have you paid the
appropriate dues or subscription
payments? - No (checkbox)
Check the box (if applicable): Indicates a No response to the question, If the property is
located in a rural fire protection district or in an area protected by a rural fire department,
have you paid the appropriate dues or subscription payments?.
NOTICE
Applicant Signature
Sign here: Accommodates the signature of the applicant or named insured.
NOTICE
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 62 OK (2006/05)
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