To Print a Form

To view and print a form, you must first download Adobe Acrobat Reader if you do not already have it. To download, just click and follow the instructions to install the software.

To access our policy forms, Click here.

Click to select any of the following forms:

1.	*UA-34 Request For Change*
	*Please note: The form displayed on the screen is a facsimile and may appear incomplete. However, when it is printed the form will be in its detailed format.*
2.	*UA-403 Broker Supply Request*
3.	*ACORD Property Loss Notice*
4.	*UA-483 Monthly Certificate For Vacant Or Unoccupied Buildings*
5.	*UA-484 Application Supplement For Vacant, Or Partially Vacant Buildings And Those Under Repair Or Reconstruction*
6.	*UA-251 Automatic Increase Endorsement*
7.	*Wrap Around Repair or Replacement Cost Application Supplement*
8.	*ACORD 62 NY Application for Dwelling Insurance(UA-1)*
	*You can submit the Dwelling application electronically. Click here for more information and instructions for filing the e-application.*
8.1	*ACORD 67 NY Application for Dwelling Insurance Instruction(UA1)*
9.	*ACORD 177 NY Application for Commercial Insurance(UA-1)*
	*You can submit the Commercial application electronically. Click here for more information and instructions for filing the e-application.*
9.1	*ACORD 70 NY Application for Commercial Insurance Instruction(UA1)*
10.	*UA-542 State of New York Anti-Arson Application*
	Please note: The policy number, property location, and applicant's name must be clearly printed on the application. Incomplete applications will not be accepted, and may result in the cancellation of your policy.


	Windstorm Inspection/Guidelines for Inspections Completed on or After 1/1/2012
11.	*Inspection & Certification Form for Windstorm Coverage Eligibility*
11.1	*Certificate of Compliance NY Property Eligibility Requirements for Windstorm Coverage*
11.2	*Eligibility Requirements for Windstorm Coverage (Guidelines)*


	Windstorm Inspection/Guidelines for Inspections Completed on or Before 12/31/2011
11.	*Inspection & Certification Form for Windstorm Coverage Eligibility*
11.1	*Certificate of Compliance NY Property Eligibility Requirements for Windstorm Coverage*
11.2	*Eligibility Requirements for Windstorm Coverage (Guidelines)*
12.	*Direct Deposit of Commission*
13.	*Cancellation Appeal Forms*

It's as easy as 1, 2, 3,

   1. Print the selected form
   2. Fill in all required information
   3. Mail to:

New York Property Insurance Underwriting Association
100 William Street
New York, New York 10038

Back to home page