Universal wording updates to improve clarity and intent were made to all FIG text for this form on 10/22/2008.
Section Name
Field Name
Field and/or Section Description
TITLE
ACORD 64 OK (2007/10)
Oklahoma Liability Supplement
Use ACORD 64 OK, Oklahoma Liability Supplement, with any
application for a claims-made policy in Oklahoma. Oklahoma regulations require that all
applicants be informed that the policy is a claims-made policy, and that the applicant
should read all provisions of the policy carefully.
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 Applicant/Named Insured
Enter text: The named insureds full name as it appears on the policy declarations page.
IDENTIFICATION SECTION Policy #
Enter identifier: The identifier assigned by the insurer to the policy, or submission, being
referenced. If required for self-insurance, the self-insured license or contract number.
IDENTIFICATION SECTION Carrier
Enter text: The insurer's full legal company name(s) as found in the file copy of the policy.
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.
SIGNATURE
Applicant / Insured Signature
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.
SIGNATURE
Applicant / Insured Signature
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 64 OK (2007/10)
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