|
Section Name |
Field Name |
Field and/or Section Description |
|
West Virginia Property Supplement |
Use this supplement to comply with West Virginia law which requires that the |
|
TITLE |
- Notice of Flood Coverage |
applicant/named insured be informed that their insurance policy does not cover damage |
|
ACORD 862 WV (2005/07) |
Exclusion |
from flood. |
|
IDENTIFICATION SECTION |
Agency |
Producer’s name and address. |
|
|
Identification code assigned to your agency or brokerage firm by the insurance company |
|
IDENTIFICATION SECTION |
Code |
receiving this form. |
|
|
If your agency uses a subcode identification system with the company, enter the |
|
IDENTIFICATION SECTION |
Subcode |
appropriate code. |
|
IDENTIFICATION SECTION |
Applicant/Named Insured |
Indicate applicant name. If named insured, name exactly as it appears on the policy. |
|
IDENTIFICATION SECTION |
Company |
Issuing company's name. |
|
IDENTIFICATION SECTION |
Policy # |
Number exactly as it appears on the policy, including prefix and suffix symbols. |
|
IDENTIFICATION SECTION |
Effective Date |
Date on which the terms and conditions of the policy commenced. |
|
Applicant/Named Insured's |
|
|
SIGNATURE |
Signature |
Applicant/Named Insured must sign the supplement. |
|
SIGNATURE |
Date |
Indicate the date the supplement was signed in MM/DD/YYYY format. |