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 OR (2006/01)
Oregon Personal Lines
Supplement Notice of Use of Loss
History Report Home Insurance
ACORD 62 OR, Oregon Personal Lines Supplement Notice of Use of
Loss History Report Home Insurance, complies with Oregon law which requires that the
applicant/named insured be informed that the insurance company to whom they are
applying for insurance or their agent will request a loss history report relating to the
applicant/named insured or the property to be insured.
IDENTIFICATION SECTION Agency
Enter text: The full name 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.
NOTICE OF USE OF LOSS
HISTORY REPORT
Other Exceptions:
Enter text: The remarks associated with loss history information
NOTICE OF USE OF LOSS
HISTORY REPORT
Other Exceptions:
Enter text: The remarks associated with loss history information
NOTICE OF USE OF LOSS
HISTORY REPORT
Other Exceptions:
Enter text: The remarks associated with loss history information
EDITION
Date
The edition identifier of the form including the form number and edition (the date is
typically formatted YYYY/MM).
ACORD 62 OR (2006/01)
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