New York Codes, Rules and Regulations › Title 11 - INSURANCE › Chapter III - Policy and Certificate Provisions › Subchapter B - Property and Casualty Insurance › Part 67 - Underwriting Inspection Requirement for Private Passenger Automoblies › Section 67.12 - Forms

Current through Register Vol. 46, No. 28, July 10, 2024
NYS APD Form B and NYS APD Form C as set forth in
					 section 67.12  are REPEALED and new forms
					 are added as follows:
(company letterhead)
CONFIRMATION OF PHYSICAL DAMAGE
					 COVERAGE
NOTICE OF PHOTO INSPECTION REQUIREMENT
Policyholder's Name:
					 ___________________________________________________________
Address:
					 _____________________________________________________________________
Date of Mailing: ________________
Coverage Effective Date: ______________
Inspection Must Be Completed By: ________________
Policy Number: __________________
Please Check One: [] Initial Inspection [] Renewal
					 Inspection
Dear Policyholder,
This will confirm that your vehicle(s) are insured as
					 follows:
1) __________, __________,
				  __________, __________[] Comprehensive [] Collision [] Fire and Theft
2) __________, __________, __________,
				  __________[] Comprehensive [] Collision [] Fire and Theft
3) __________, __________, __________,
				  __________[] Comprehensive [] Collision [] Fire and Theft
Year Make Model VIN
Please disregard this notice if your vehicle(s) already had
					 their photo inspections.
You are reminded that the above-described vehicle(s) must
					 be inspected by the date indicated above, or physical damage coverage will be
					 suspended effective 12:01 A.M. on ____________.
If you have your vehicle(s) inspected after the date
					 indicated above, then your coverage will be restored effective at the date and
					 time of inspection. However, you will have no coverage for any loss that occurs
					 during the suspension period.
For further information, please contact:
					 _________________________________________________________
Name of and Contact Information for Insurer's Authorized
					 Representative
cc: Producer of Record
NYS APD Form B (2024)
(company letterhead)
CONFIRMATION OF SUSPENSION OF PHYSICAL DAMAGE
					 COVERAGE
Date: ____________
Policyholder's Name:
					 ____________________________________________________
Address:
					 _______________________________________________________________
Policy Number: __________________
Dear Policyholder,
The vehicle(s) listed below are no longer insured as
					 follows:
1) __________,
				  __________, __________, __________ [] Comprehensive [] Collision [] Fire and
				  Theft
2) __________, __________,
				  __________, __________ [] Comprehensive [] Collision [] Fire and
				  Theft
3) __________, __________,
				  __________, __________ [] Comprehensive [] Collision [] Fire and Theft
Year Make Model VIN
Date coverage was requested: __________
Date coverage was suspended: __________
The physical damage coverage(s) indicated above have been
					 suspended on the vehicle(s) described, effective 12:01 A.M. on the suspension
					 date. We suspended your coverage(s) due to your failure to comply with the
					 photo inspection requirement.
Your premium adjustment for the suspended
					 coverage(s).*
You will not have physical damage coverage on the
					 vehicle(s) during the suspension period. We will restore the coverage(s) if you
					 have your vehicle(s) inspected.
For further information, please contact:
					 _________________________________________________________
Name of and Contact Information for Insurer's Authorized
					 Representative
cc: Producer of Record
Lienholder
* Companies may substitute "is enclosed" if the premium
					 adjustment accompanies this letter.
NYS APD Form C (2024)