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. 39, September 25, 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NYS APD Form B and NYS APD Form C as set forth in section 67.12 are REPEALED and new forms are added as follows: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)
