Field and/or Section Description
ACORD 65 NC (2010/02)
North Carolina Auto Supplement,
Notice of Right to Purchase Higher
Limits of Uninsured Motorist (UM)
and Underinsured Motorist (UIM)
ACORD 65 NC, North Carolina Auto Supplement, Notice of Right to
Purchase Higher Limits of Uninsured Motorist (UM) and Underinsured Motorist (UIM)
Coverage, is used to comply with the statutory requirement that current policyholders and
new applicants must be notified that they have the right to purchase Uninsured Motorist
Bodily Injury coverage with limits up to one million dollars ($1,000,000) per person and
one million dollars ($1,000,000) per accident. This requirement does not apply to (1) fleet
policies, or (2) policies issued on commercial vehicles as defined by NC General Statute
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 Policy Number
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
IDENTIFICATION SECTION Named Insured(s)
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.
The edition identifier of the form including the form number and edition (the date is
typically formatted YYYY/MM).
ACORD 65 NC (2010/02) rev. 11-25-2009
1 of 1