ACORD Forms Notification Service May 2014 Bulletin

ACORD Forms Notification Service May 2014 Bulletin ACORD P&C and Life/Annuity/Health Form Changes and Additions The following pages include both a List of new and recently revised ACORD forms and an Explanation of the Changes made. Whenever possible, new and revised ACORD forms will be made available one to six months in advance of the form effective date. In these instances, companies will have this additional time to implement the forms into their systems before the current versions are replaced. Both the current versions and the revised future effective date versions will be found on the Forms Download page at www.acord.org. The effective date included on the footer of all forms will match the date the form must be used in all jurisdictions in order to ensure compliance with our filings. ACORD has added an additional file format to the eform library of forms. Added to the eform zip file for the March month end release is an Acroform pdf file. This format is compliant with v1.4 of the Adobe PDF specification and uses the Acroform features of the specification to represent the interactive form. In particular this differs from the other formats ACORD currently provides by not using any XFA (XML Forms Architecture) features. In some areas, an Acroform is not as feature-rich as an XFA based form (such as the calendar), but will probably have improved compatibility with third-party software designed to work with PDF forms. Copies of the forms referenced in this announcement can be downloaded in the formats you need at www.acord.org. To download forms, you will need to sign-in as an ACORD member with your user name and password. Once you are signed in, click on the Forms button, and then click on Download Forms to access the ones you need. If you need assistance, a sample of a form, or are an agent / broker who would like to join the Advantage Program, please call Member Services at (800) 444-3341, Option 2 or email us at memberservices@acord.org. If you do not wish to receive this notification, please send an email to memberservices@acord.org requesting that we unsubscribe you to this Forms Notification Service. ACORD Forms Notification 05-30-2014

Form Number REVISIONS ACORD Forms Release 05-30-2014 Replaces Title For Use on or after: P&C - Countrywide 803 (2014/12) 2011/10 Liquor Liability Section 12/1/2014 807 (2014/12) 2009/12 Directors & Officers Liability Section 12/1/2014 810 (2014/12) 2011/10 Business Income / Extra Expense / Rental 12/1/2014 Value - Supplement to Property Section 811 (2014/12) 2011/10 Value Reporting Information 12/1/2014 Supplement to Property Section 827 (2014/12) 2008/01 Employment Practices Liability Insurance 12/1/2014 Section 828 (2014/12) 2011/09 Fiduciary Liability Coverage Section 12/1/2014 832 (2014/12) 2011/09 Miscellaneous E&O Section 12/1/2014 833 (2014/12) 2011/08 Lawyers Professional Liability Section 12/1/2014 834 (2014/12) 2011/09 Cyber and Privacy Coverage Section 12/1/2014 P&C - State Specific Life Countrywide Life - State Specific Forms highlighted in yellow had e-label changes beyond the scope of the form revision. See highlighted spreadsheets in eform zip file and Toolkit zip files. 1 of 3 ACORD Forms Release 05-30-2014

ACORD Forms Release 05-30-2014 Form Number NEW Replaces Title For Use on or after: P&C Countrywide P&C - State Specific 807 AR (2014/12) 807 MN (2014/12) 807 MT (2014/12) NEW NEW NEW Arkansas Directors & Officers Liability Section Minnesota Directors & Officers Liability Section Montana Directors & Officers Liability Section 12/1/2014 12/1/2014 12/1/2014 827 AR (2014/12) NEW Arkansas Employment Practices Liability 12/1/2014 Insurance Section 827 MN (2014/12) NEW Minnesota Employment Practices Liability 12/1/2014 Insurance Section 827 MT (2014/12) NEW Montana Employment Practices Liability 12/1/2014 Insurance Section 828 AR (2014/12) NEW Arkansas Fiduciary Liability Coverage Section 12/1/2014 828 MN (2014/12) NEW Minnesota Fiduciary Liability Coverage Section 12/1/2014 828 MT (2014/12) NEW Montana Fiduciary Liability Coverage Section 12/1/2014 832 AR (2014/12) NEW Arkansas Miscellaneous E&O Section 12/1/2014 832 MN (2014/12) NEW Minnesota Miscellaneous E&O Section 12/1/2014 832 MT (2014/12) NEW Montana Miscellaneous E&O Section 12/1/2014 833 AR (2014/12) NEW Arkansas Lawyers Professional Liability 12/1/2014 Section 833 MN (2014/12) NEW Minnesota Lawyers Professional Liability 12/1/2014 Section 833 MT (2014/12) NEW Montana Lawyers Professional Liability 12/1/2014 Section 834 AR (2014/12) NEW Arkansas Cyber and Privacy Coverage Section 12/1/2014 834 MN (2014/12) NEW Minnesota Cyber and Privacy Coverage Section 12/1/2014 834 MT (2014/12) NEW Montana Cyber and Privacy Coverage Section 12/1/2014 Life Countrywide Life - State Specific WITHDRAWN 2 of 3 ACORD Forms Release 05-30-2014

ACORD Forms Release 05-30-2014 e-label Corrections P&C Countrywide P&C - State Specific 137 LA (2014/12) Louisiana Commercial Auto 290 NY (2014/12) New York Personal Auto Application Section FIG Corrections Only 90 KS (2014/12) Kansas Personal Auto Application 90 KY (2014/12) Kentucky Personal Auto Application 90 LA (2014/12) Louisiana Personal Auto Application 90 MI (2014/12) Michigan Personal Auto Application 90 NY (2014/12) New York Personal Auto Application 90 TX (2014/12) Texas Personal Auto Application 137 IA (2014/12) Iowa Commercial Auto 137 KY (2014/12) Kentucky Commercial Auto 137 MI (2014/12) Michigan Commercial Auto 137 NY (2014/12) New York Commercial Auto 138 KY (2014/12) Kentucky Garage and Dealers 138 MI (2014/12) Michigan Garage and Dealers 138 NY (2014/12) New York Garage and Dealers See rows highlighted in yellow in the excel Mapping List (Highlighted) spreadsheet posted on the ACORD website in the eform zip file. See also the FIG excel (highlighted) spreadsheet in the Toolkit zip file. 3 of 3 ACORD Forms Release 05-30-2014

ADDITIONAL FILE FORMAT ADDED TO THE EFORM LIBRARY OF FORMS. ACORD has added an additional file format to the eform library of forms. Added to the eform zip file for the May month end release is an Acroform pdf file. This format is compliant with v1.4 of the Adobe PDF specification and uses the Acroform features of the specification to represent the interactive form. In particular this differs from the other formats ACORD currently provides by not using any XFA (XML Forms Architecture) features. In some areas, an Acroform is not as feature-rich as an XFA based form (such as the calendar), but will probably have improved compatibility with third-party software designed to work with PDF forms. Countrywide Revised P&C FORMS 803 (2014/12) Liquor Liability Section 1. Revise copyright dates to 2011, 2014 2. Add Attach to ACORD 125 immediately below page numbers in footer Page 3 3. Move ATTACHMENTS checkboxes from the REMARKS / ATTACHMENTS section form the top of page 4 to the REMARKS section on this page and rename section REMARKS / ATTACHMENTS Page 4 (new page) 4. Delete REMARKS / ATTACHMENTS section. ATTACHMENTS checkboxes are now on page 3 5. SIGNATURE section, revise all Fraud Notices 6. Add Applicant s Statement above signature fields 7. Add Producer Authorization and fields for Producer information 1 of 12 ACORD Explanation of Changes 05-30-2014

807 (2014/12) Directors & Officers Liability Section 1. Reduce title font to 14 point bold 2. IDENTIFICATION section, move CARRIER and NAIC fields to the top right of the section 3. Add Claims Made statement immediately below IDENTIFICATION section 4. Reformat SHARED LIMITS section 5. Move PRIVATE section to top of page 2 6. Revise copyright dates to 2008-2014 7. Revise ATTACH TO 825 etc. to Attach to ACORD 825 and move up 8. Move down The ACORD name and logo, etc. Page 2 9. GENERAL INFORMATION section, move Question 6 to top of page 3 Page 3 10. Combine REMARKS and ATTACHMENTS sections into one section labeled REMARKS / ATTACHMENTS 11. Reduce height of REMARKS / ATTACHMENTS SECTION 12. Expand SIGNATURE section and add fraud warnings 13. SIGNATURE section, add field to the right of APPLICANT S TITLE, labeled STATE PRODUCER LICENSE NO (Required in FL and NE) 810 (2014/12) Business Income / Extra Expense / Rental Value Supplement to Property Section Please note: This form is now three pages 1. PREMISES INFORMATION, Tuition Fees, revise field label to: Other Ed Serv / Inc 2. Revise page numbers to of 3 3. Revise copyright dates to 2005-2014 Page 3 4. ADDITIONAL PREMISES INFORMATION, Tuition Fees, revise field label to: Other Ed Serv / Inc 5. Delete Fraud Warnings 6. Revise page numbers to Page 2 of 3 Page 3 (new page) 7. Add a field for AGENCY CUSTOMER ID: in upper right hand corner of page 8. Add Fraud Notices 9. Add Authorized Representative statement above signature fields 10. Add Signature fields 11. Add Page 3 of 3 to footer 2 of 12 ACORD Explanation of Changes 05-30-2014

811 (2014/12) Value Reporting Information Supplement to Property Section Please note: This form is now two pages 1. VALUE REPORTING INFORMATION, add 8 additional blank rows of data 2. Delete fraud warnings 3. Add of 2 to footer 4. Revise copyright dates to 2005-2014 Page 2 (new page) 5. Add a field for AGENCY CUSTOMER ID: in upper right hand corner of page 6. Add new SIGNATURE section and add Fraud Notices 7. Add Authorized Representative statement above signature fields 8. Add Signature fields 9. Add Page 2 of 2 to footer 3 of 12 ACORD Explanation of Changes 05-30-2014

827 (2014/12) Employment Practices Liability Insurance Section Please note: This form is now four pages 1. Move down ACORD logo 2. IDENTIFICATION section, move CARRIER and NAIC fields to the top right of the section 3. Revise Claims Made statement immediately below IDENTIFICATION section 4. For all instances of Y / N, add extra space around the slash (/) 5. For all instances, delete border around Y / N fields 6. Reformat SHARED LIMITS section 7. Renumber page to of 4 8. Revise copyright dates to 2008, 2014 9. Revise ATTACH TO 825 etc. to Attach to ACORD 825 and move up 10. Move down The ACORD name and logo, etc. Page 2 11. For all instances of Y / N, add extra space around the slash (/) 12. For all instances, delete border around Y / N fields 13. Renumber page to Page 2 of 4 Page 3 14. For all instances of Y / N, add extra space around the slash (/) 15. For all instances, delete border around Y / N fields 16. Renumber page to Page 3 of 4 Page 4 (new page) 17. Add SIGNATURE section with fraud warnings 18. SIGNATURE section, add authorized representative statement with fields for Signatures, etc. 19. Add Page 4 of 4 to footer 4 of 12 ACORD Explanation of Changes 05-30-2014

828 (2014/12) Fiduciary Liability Coverage Section 1. IDENTIFICATION section, move CARRIER and NAIC fields to the top right of the section 2. Add Claims Made statement immediately below IDENTIFICATION section 3. Reformat SHARED LIMITS section 4. ENDORSEMENTS section, add three additional blank rows 5. PLAN INFORMATION section, revise text in parentheses 6. Reduce REMARKS and add text in parentheses 7. Revise copyright dates to 2008-2014 8. Add Attach to ACORD 825 immediately below page number 9. Move down The ACORD name and logo, etc. Page 2 10. REMARKS section, add text in parentheses Page 3 11. REMARKS section, add text in parentheses Page 4 12. Reduce REMARKS and add text in parentheses 13. Delete checkbox and Notice of Insurance Information Practices (contained in ACORD 825 to which this form must be attached) 14. Add SIGNATURE section with revised fraud warnings 15. SIGNATURE section, reformat signature fields and add fields for Applicant s Name and State Producer License No 832 (2014/12) Miscellaneous E&O Section 1. Revise copyright dates to 2011, 2014 Page 3 2. CLAIMS INFORMATION (continued), reduce height of Q. 5 and revise text in parentheses 3. Delete REMARKS 4. Add SIGNATURE section with revised fraud warnings 5. SIGNATURE section, reformat signature fields and field for Applicant s Name and State Producer License No 833 (2014/12) Lawyers Professional Liability Section 1. Revise copyright date to 2011, 2014 Page 5 2. Reduce height of REMARKS 3. SIGNATURE section, revised all fraud warnings 5 of 12 ACORD Explanation of Changes 05-30-2014

834 (2014/12) Cyber and Privacy Coverage Section 1. Revise copyright date to 2011, 2014 Page 3 2. Delete REMARKS 3. SIGNATURE section, revised all fraud warnings 4. Reformat Producer SIGNATURE fields and add a field for State Producer License No 6 of 12 ACORD Explanation of Changes 05-30-2014

State Specific Revised Countrywide New State Specific New 807 AR (2014/12) Arkansas Directors & Officers Liability Section ACORD 807 AR, Arkansas Directors & Officers Liability Section, is used to apply for Directors and Officers liability coverage in Arkansas. 807 MN (2014/12) Minnesota Directors & Officers Liability Section ACORD 807 MN, Minnesota Directors & Officers Liability Section, is used to apply for Directors and Officers liability coverage in Minnesota. 807 MT (2014/12) Montana Directors & Officers Liability Section ACORD 807 MT, Montana Directors & Officers Liability Section, is used to apply for Directors and Officers liability coverage in Montana. 7 of 12 ACORD Explanation of Changes 05-30-2014

827 AR (2014/12) Arkansas Employment Practices Liability Insurance Section ACORD 827 AR, Arkansas Employment Practices Liability Insurance Section, is used to apply for employment practices liability insurance coverage in Arkansas. 827 MN (2014/12) Minnesota Employment Practices Liability Insurance Section ACORD 827 MN, Minnesota Employment Practices Liability Insurance Section, is used to apply for employment practices liability insurance coverage in Minnesota. 827 MT (2014/12) Montana Employment Practices Liability Insurance Section ACORD 827 MT, Montana Employment Practices Liability Insurance Section, is used to apply for employment practices liability insurance coverage in Montana. 828 AR (2014/12) Arkansas Fiduciary Liability Coverage Section ACORD 828 AR, Arkansas Fiduciary Liability Coverage Section, is used to apply for fiduciary liability coverage in Arkansas. 8 of 12 ACORD Explanation of Changes 05-30-2014

828 MN (2014/12) Minnesota Fiduciary Liability Coverage Section ACORD 828 MN, Minnesota Fiduciary Liability Coverage Section, is used to apply for fiduciary liability coverage in Minnesota. 828 MT (2014/12) Montana Fiduciary Liability Coverage Section ACORD 828 MT, Montana Fiduciary Liability Coverage Section, is used to apply for fiduciary liability coverage in Montana. 832 AR (2014/12) Arkansas Miscellaneous E&O Section ACORD 832 AR, Arkansas Miscellaneous E&O Section, is used to apply for miscellaneous errors and omissions coverage in Arkansas. 832 MN (2014/12) Minnesota Miscellaneous E&O Section ACORD 832 MN, Minnesota Miscellaneous E&O Section, is used to apply for miscellaneous errors and omissions coverage in Minnesota. 9 of 12 ACORD Explanation of Changes 05-30-2014

832 MT (2014/12) Montana Miscellaneous E&O Section ACORD 832 MT, Montana Miscellaneous E&O Section, is used to apply for miscellaneous errors and omissions coverage in Montana. 833 AR (2014/12) Arkansas Lawyers Professional Liability Section ACORD 833 AR, Arkansas Lawyers Professional Liability Section, is used to apply for lawyers professional liability coverage in Arkansas. 833 MN (2014/12) Minnesota Lawyers Professional Liability Section ACORD 833 MN, Minnesota Lawyers Professional Liability Section, is used to apply for lawyers professional liability coverage in Minnesota. 833 MT (2014/12) Montana Lawyers Professional Liability Section ACORD 833 MT, Montana Lawyers Professional Liability Section, is used to apply for lawyers professional liability coverage in Montana. 10 of 12 ACORD Explanation of Changes 05-30-2014

834 AR (2014/12) Arkansas Cyber and Privacy Coverage Section ACORD 834 AR, Arkansas Cyber and Privacy Coverage Section, is used to apply for cyber and privacy coverage in Arkansas. 834 MN (2014/12) Minnesota Cyber and Privacy Coverage Section ACORD 834 MN, Minnesota Cyber and Privacy Coverage Section, is used to apply for cyber and privacy coverage in Minnesota. 834 MT (2014/12) Montana Cyber and Privacy Coverage Section ACORD 834 MT, Montana Cyber and Privacy Coverage Section, is used to apply for cyber and privacy coverage in Montana. WITHDRAWN FORMS 11 of 12 ACORD Explanation of Changes 05-30-2014

FIG CHANGES 90 KS (2014/12) 90 KY (2014/12) 90 LA (2014/12) 90 MI (2014/12) 90 NY (2014/12) 90 TX (2014/12) 137 IA (2014/12) 137 KY (2014/12) 137 MI (2014/12) 137 NY (2014/12) 138 KY (2014/12) 138 MI (2014/12) 138 NY (2014/12) See rows highlighted in yellow in the excel Mapping List (Highlighted) spreadsheet posted on the ACORD website in the eform zip file. See also the FIG excel (highlighted) spreadsheet in the Toolkit zip file. LIFE / ANNUITY / HEALTH FORMS Countrywide Revised State Specific - Revised Countrywide New State Specific New WITHDRAWN FORMS 12 of 12 ACORD Explanation of Changes 05-30-2014