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ACORD Forms Release 12-27-2010

Form Number REVISIONS P&C - Countrywide 825 (2010/12) Replaces Title

2008/01

Professional / Specialty Insurance Application (For Use in Management, Executive & Professional Lines ­ Applicant Section)

P&C-State Specific 61 NM (2010/12) 64 KY (2011/01) 65 KY (2011/01) 66 KY (2011/01) 68 KY (2011/01) 90 CA (2010/12) 137 CA (2010/12) 138 CA (2010/12)

2005/04 2009/01 2009/01 2009/01 2009/01 2007/04 2007/01 2007/01

New Mexico Auto Supplement (effective 01-01-2011) (Resulting from a NM Supreme Court decision) Kentucky FAIR Plan Homeowners Application (effective 01-01-2011) Kentucky FAIR Plan Dwelling Fire Application (effective 01-01-2011) Kentucky FAIR Plan Farm Fire Application (effective 01-01-2011) Kentucky FAIR Plan Commercial Fire Application (effective 01-01-2011) California Personal Auto Application California Commercial Auto Coverages / Limits Section California Garage and Dealers Coverages / Limits Section

Life/Annuity/Health 655 VA (2010/12) NEW P&C - Countrywide 29 (2010/12) 831 (2010/12)

2009/06

Virginia Group Health Insurance Medical History Form

NEW NEW

Evidence of Flood Insurance Professional / Specialty Insurance Notice of Incident / Claim

P&C ­ State Specific 290 CA (2010/12) NEW California Personal Auto Application Section

Life/Annuity/Health WITHDRAWN 69 KY (2009/01)

NONE

Kentucky FAIR Plan Woodstove Questionnaire

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ACORD Forms Release 12-27-2010

ACORD Forms Release 12-27-2010

E-FORMS / FIG REVISIONS / ENHANCEMENTS ONLY 137 CT 810 137 MI 823 137 MO 137 MS 137 VT

Note: These are not new forms editions. The forms have not changed, nor have any fields been added or removed. The fields have been assigned unique e-labels. These forms are now available in both IBM and Adobe fillable formats.

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ACORD Forms Release 12-27-2010

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Microsoft Word - Forms Release 2010 _12-27_.doc