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ACORD Form 140 Property Section Instructions

 

 
ACORD 140 (2007/09) 1 of 24
Universal wording updates to improve clarity and intent were made to all FIG text for this form on 10/07/2008.
Section Name Field Name Field and/or Section Description
TITLE ACORD 140 (2007/09) Property Section The title of the form. The ACORD 140 Property Section has been designed to handle the basic underwriting and rating needs for commercial property exposures. The Property Section accommodates two locations, with coverage and rating information recorded separately for each location. This form was designed to be used in conjunction with the Commercial Insurance Application - Applicant Information Section (ACORD 125). Much of the information for the Identification Section should match the data found within the Applicant Information Section of ACORD 125. Nevertheless, it is still important to complete it. Many companies separate the applications by line of business for rating purposes. Not completing this portion of the application makes it difficult to keep track of the full account.
IDENTIFICATION SECTION Agency Customer ID Enter identifier: The customer's identification number assigned by the producer (e.g. agency or brokerage).
IDENTIFICATION SECTION Date Enter date: The month/day/year on which the form is completed. (MM/DD/YYYY)
IDENTIFICATION SECTION Agency Enter text: The producer's full name.
IDENTIFICATION SECTION Applicant (First Named Insured) Enter text: The named insured’s full name as it appears on the policy declarations page.
IDENTIFICATION SECTION Policy Number Enter identifier: The identifier assigned by the insurer to the policy, or submission, being referenced. If required for self-insurance, the self-insured license or contract number.
IDENTIFICATION SECTION Carrier Enter text: The insurer's full legal company name(s) as found in the file copy of the policy. This is not the insurer's group name or trade name.
IDENTIFICATION SECTION NAIC Code Enter code: The identification code assigned to the insurer by the NAIC.
IDENTIFICATION SECTION Effective Date Enter date: The effective date of the policy.
IDENTIFICATION SECTION Expiration Date Enter date: The date on which the terms and conditions of the policy will expire.
IDENTIFICATION SECTION Direct Bill Check the box (if applicable): Indicates if the policy is to be direct billed.

ACORD 140 (2007/09) 2 of 24

Section Name Field Name Field and/or Section Description
IDENTIFICATION SECTION Agency Bill Check the box (if applicable): Indicates if the policy is to be producer/agency billed.
IDENTIFICATION SECTION Payment Plan Enter code: The payment plan for the policy.
IDENTIFICATION SECTION Audit Enter code: The audit term for policies that are subject to periodic audit. If the audit period is known, enter the code; A - annual, S - semi-annual, Q - Quarterly, M - Monthly, O -Other.
IDENTIFICATION SECTION For Company Use Only Enter text: This area is to be completed by the insurer.
PREMISES INFORMATION Premises # Enter number: The location number for the premises.
PREMISES INFORMATION Street Address Enter text: The first address line of the commercial structure.
PREMISES INFORMATION Building # Enter number: The building number for the premises. Used when more than one building exists at an individual location.
PREMISES INFORMATION Building Description Enter text: This describes the particular sublocation in a manner sufficient to distinguish it from other sublocations at a given location. An example might be "3 story blue structure on the left of the main building".
PREMISES INFORMATION Subject of Insurance Enter code: Enter all units at risk/coverages that are to be insured at this particular location number/building number combination. Examples: * Building * Personal Property * Extra Expense * Business Income
PREMISES INFORMATION Amount Enter limit: The maximum amount of coverage provided for this subject of insurance or premium-bearing option.
PREMISES INFORMATION Coins % Enter percentage: The Coinsurance Percentage is the percentage of the total value of the subject of insurance being insured. If the amount of insurance falls below this percentage, the insured must share in the amount of the loss. This field should be completed even when writing agreed amount coverage.
PREMISES INFORMATION Valuation Enter code: Indicate the method which will be used to determine the amount paid on a claim. Valuation methods are: ACV . . . . . . . . . . . . . . . . . . . . . . . . . Actual Cash Value RC. . . . . . . . . . . . . . . . . . . . . . . . . . .Replacement Cost AA . . . . . . . . . . . . . . . . . . . . . . . . . . Agreed Amount MV . . . . . . . . . . . . . . . . . . . . . . . . . . Market Value

ACORD 140 (2007/09) 3 of 24

Section Name Field Name Field and/or Section Description
PREMISES INFORMATION Causes of Loss Enter code: The causes of loss the subject of insurance is to be covered for. Examples: * Basic * Broad * Special excluding theft * Earthquake
PREMISES INFORMATION Inflation Guard % Enter percentage: The inflation guard percentage gives an automatic increase in the amount of coverage based on a percentage over time. List both the percentage amount and the period of time during which it applies (e.g., 4% per year).
PREMISES INFORMATION Deductible(s) Enter deductible: The deductible amount that is to apply to this subject of insurance.
PREMISES INFORMATION Blkt # Enter number: The identifying number for the blanket under which this subject of insurance is rated. Leave blank if the subject of insurance is not included under a blanket.
PREMISES INFORMATION Forms and Conditions to Apply Enter text: The form numbers and special conditions that apply to this subject of insurance. Also indicate here if coverage is blanket or average rated.
PREMISES INFORMATION Subject of Insurance Enter code: Enter all units at risk/coverages that are to be insured at this particular location number/building number combination. Examples: * Building * Personal Property * Extra Expense * Business Income
PREMISES INFORMATION Amount Enter limit: The maximum amount of coverage provided for this subject of insurance or premium-bearing option.
PREMISES INFORMATION Coins % Enter percentage: The Coinsurance Percentage is the percentage of the total value of the subject of insurance being insured. If the amount of insurance falls below this percentage, the insured must share in the amount of the loss. This field should be completed even when writing agreed amount coverage.
PREMISES INFORMATION Valuation Enter code: Indicate the method which will be used to determine the amount paid on a claim. Valuation methods are: ACV . . . . . . . . . . . . . . . . . . . . . . . . . Actual Cash Value RC. . . . . . . . . . . . . . . . . . . . . . . . . . .Replacement Cost AA . . . . . . . . . . . . . . . . . . . . . . . . . . Agreed Amount MV . . . . . . . . . . . . . . . . . . . . . . . . . . Market Value

ACORD 140 (2007/09) 4 of 24

Section Name Field Name Field and/or Section Description
PREMISES INFORMATION Causes of Loss Enter code: The causes of loss the subject of insurance is to be covered for. Examples: * Basic * Broad * Special excluding theft * Earthquake
PREMISES INFORMATION Inflation Guard % Enter percentage: The inflation guard percentage gives an automatic increase in the amount of coverage based on a percentage over time. List both the percentage amount and the period of time during which it applies (e.g., 4% per year).
PREMISES INFORMATION Deductible(s) Enter deductible: The deductible amount that is to apply to this subject of insurance.
PREMISES INFORMATION Blkt # Enter number: The identifying number for the blanket under which this subject of insurance is rated. Leave blank if the subject of insurance is not included under a blanket.
PREMISES INFORMATION Forms and Conditions to Apply Enter text: The form numbers and special conditions that apply to this subject of insurance. Also indicate here if coverage is blanket or average rated.
PREMISES INFORMATION Subject of Insurance Enter code: Enter all units at risk/coverages that are to be insured at this particular location number/building number combination. Examples: * Building * Personal Property * Extra Expense * Business Income
PREMISES INFORMATION Amount Enter limit: The maximum amount of coverage provided for this subject of insurance or premium-bearing option.
PREMISES INFORMATION Coins % Enter percentage: The Coinsurance Percentage is the percentage of the total value of the subject of insurance being insured. If the amount of insurance falls below this percentage, the insured must share in the amount of the loss. This field should be completed even when writing agreed amount coverage.
PREMISES INFORMATION Valuation Enter code: Indicate the method which will be used to determine the amount paid on a claim. Valuation methods are: ACV . . . . . . . . . . . . . . . . . . . . . . . . . Actual Cash Value RC. . . . . . . . . . . . . . . . . . . . . . . . . . .Replacement Cost AA . . . . . . . . . . . . . . . . . . . . . . . . . . Agreed Amount MV . . . . . . . . . . . . . . . . . . . . . . . . . . Market Value

ACORD 140 (2007/09) 5 of 24

Section Name Field Name Field and/or Section Description
PREMISES INFORMATION Causes of Loss Enter code: The causes of loss the subject of insurance is to be covered for. Examples: * Basic * Broad * Special excluding theft * Earthquake
PREMISES INFORMATION Inflation Guard % Enter percentage: The inflation guard percentage gives an automatic increase in the amount of coverage based on a percentage over time. List both the percentage amount and the period of time during which it applies (e.g., 4% per year).
PREMISES INFORMATION Deductible(s) Enter deductible: The deductible amount that is to apply to this subject of insurance.
PREMISES INFORMATION Blkt # Enter number: The identifying number for the blanket under which this subject of insurance is rated. Leave blank if the subject of insurance is not included under a blanket.
PREMISES INFORMATION Forms and Conditions to Apply Enter text: The form numbers and special conditions that apply to this subject of insurance. Also indicate here if coverage is blanket or average rated.
PREMISES INFORMATION Subject of Insurance Enter code: Enter all units at risk/coverages that are to be insured at this particular location number/building number combination. Examples: * Building * Personal Property * Extra Expense * Business Income
PREMISES INFORMATION Amount Enter limit: The maximum amount of coverage provided for this subject of insurance or premium-bearing option.
PREMISES INFORMATION Coins % Enter percentage: The Coinsurance Percentage is the percentage of the total value of the subject of insurance being insured. If the amount of insurance falls below this percentage, the insured must share in the amount of the loss. This field should be completed even when writing agreed amount coverage.
PREMISES INFORMATION Valuation Enter code: Indicate the method which will be used to determine the amount paid on a claim. Valuation methods are: ACV . . . . . . . . . . . . . . . . . . . . . . . . . Actual Cash Value RC. . . . . . . . . . . . . . . . . . . . . . . . . . .Replacement Cost AA . . . . . . . . . . . . . . . . . . . . . . . . . . Agreed Amount MV . . . . . . . . . . . . . . . . . . . . . . . . . . Market Value

ACORD 140 (2007/09) 6 of 24

Section Name Field Name Field and/or Section Description
PREMISES INFORMATION Causes of Loss Enter code: The causes of loss the subject of insurance is to be covered for. Examples: * Basic * Broad * Special excluding theft * Earthquake
PREMISES INFORMATION Inflation Guard % Enter percentage: The inflation guard percentage gives an automatic increase in the amount of coverage based on a percentage over time. List both the percentage amount and the period of time during which it applies (e.g., 4% per year).
PREMISES INFORMATION Deductible(s) Enter deductible: The deductible amount that is to apply to this subject of insurance.
PREMISES INFORMATION Blkt # Enter number: The identifying number for the blanket under which this subject of insurance is rated. Leave blank if the subject of insurance is not included under a blanket.
PREMISES INFORMATION Forms and Conditions to Apply Enter text: The form numbers and special conditions that apply to this subject of insurance. Also indicate here if coverage is blanket or average rated.
PREMISES INFORMATION Subject of Insurance Enter code: Enter all units at risk/coverages that are to be insured at this particular location number/building number combination. Examples: * Building * Personal Property * Extra Expense * Business Income
PREMISES INFORMATION Amount Enter limit: The maximum amount of coverage provided for this subject of insurance or premium-bearing option.
PREMISES INFORMATION Coins % Enter percentage: The Coinsurance Percentage is the percentage of the total value of the subject of insurance being insured. If the amount of insurance falls below this percentage, the insured must share in the amount of the loss. This field should be completed even when writing agreed amount coverage.
PREMISES INFORMATION Valuation Enter code: Indicate the method which will be used to determine the amount paid on a claim. Valuation methods are: ACV . . . . . . . . . . . . . . . . . . . . . . . . . Actual Cash Value RC. . . . . . . . . . . . . . . . . . . . . . . . . . .Replacement Cost AA . . . . . . . . . . . . . . . . . . . . . . . . . . Agreed Amount MV . . . . . . . . . . . . . . . . . . . . . . . . . . Market Value

ACORD 140 (2007/09) 7 of 24

Section Name Field Name Field and/or Section Description
PREMISES INFORMATION Causes of Loss Enter code: The causes of loss the subject of insurance is to be covered for. Examples: * Basic * Broad * Special excluding theft * Earthquake
PREMISES INFORMATION Inflation Guard % Enter percentage: The inflation guard percentage gives an automatic increase in the amount of coverage based on a percentage over time. List both the percentage amount and the period of time during which it applies (e.g., 4% per year).
PREMISES INFORMATION Deductible(s) Enter deductible: The deductible amount that is to apply to this subject of insurance.
PREMISES INFORMATION Blkt # Enter number: The identifying number for the blanket under which this subject of insurance is rated. Leave blank if the subject of insurance is not included under a blanket.
PREMISES INFORMATION Forms and Conditions to Apply Enter text: The form numbers and special conditions that apply to this subject of insurance. Also indicate here if coverage is blanket or average rated.
PREMISES INFORMATION Subject of Insurance Enter code: Enter all units at risk/coverages that are to be insured at this particular location number/building number combination. Examples: * Building * Personal Property * Extra Expense * Business Income
PREMISES INFORMATION Amount Enter limit: The maximum amount of coverage provided for this subject of insurance or premium-bearing option.
PREMISES INFORMATION Coins % Enter percentage: The Coinsurance Percentage is the percentage of the total value of the subject of insurance being insured. If the amount of insurance falls below this percentage, the insured must share in the amount of the loss. This field should be completed even when writing agreed amount coverage.
PREMISES INFORMATION Valuation Enter code: Indicate the method which will be used to determine the amount paid on a claim. Valuation methods are: ACV . . . . . . . . . . . . . . . . . . . . . . . . . Actual Cash Value RC. . . . . . . . . . . . . . . . . . . . . . . . . . .Replacement Cost AA . . . . . . . . . . . . . . . . . . . . . . . . . . Agreed Amount MV . . . . . . . . . . . . . . . . . . . . . . . . . . Market Value
Section Name Field Name Field and/or Section Description
PREMISES INFORMATION Causes of Loss Enter code: The causes of loss the subject of insurance is to be covered for. Examples: * Basic * Broad * Special excluding theft * Earthquake
PREMISES INFORMATION Inflation Guard % Enter percentage: The inflation guard percentage gives an automatic increase in the amount of coverage based on a percentage over time. List both the percentage amount and the period of time during which it applies (e.g., 4% per year).
PREMISES INFORMATION Deductible(s) Enter deductible: The deductible amount that is to apply to this subject of insurance.
PREMISES INFORMATION Blkt # Enter number: The identifying number for the blanket under which this subject of insurance is rated. Leave blank if the subject of insurance is not included under a blanket.
PREMISES INFORMATION Forms and Conditions to Apply Enter text: The form numbers and special conditions that apply to this subject of insurance. Also indicate here if coverage is blanket or average rated.
PREMISES INFORMATION Additional Information - Business Income/Extra Expense Check the box (if applicable): Indicates the ACORD 810 Business Income/Extra Expense supplement is attached for this location.
PREMISES INFORMATION Additional Information -Value Reporting Information Check the box (if applicable): Indicates the ACORD 811 Value Reporting Information form is attached for this location.
PREMISES INFORMATION Spoilage Coverage Yes Enter Y for a “Yes” response. Input N for “No” response. Indicates if spoilage coverage applies.
PREMISES INFORMATION Description of Property Covered Enter text: The description of property to be covered for spoilage.
PREMISES INFORMATION Limit Enter limit: The limit applicable to the spoilage coverage.
PREMISES INFORMATION Deductible Enter deductible: The deductible applicable to the spoilage coverage.
PREMISES INFORMATION Refrigeration Maintenance Agreement Yes Enter code: Indicates if there is a refrigerator maintenance agreement.
PREMISES INFORMATION Options Enter text: The description of optional coverages that apply.
PREMISES INFORMATION Remarks Enter text: The remarks associated with a specific location or sublocation.
PREMISES INFORMATION # Of Open Sides on Structure Enter number: The number of open sides on a structure.

ACORD 140 (2007/09) 8 of 24 ACORD 140 (2007/09) 24 of 24

ACORD 140 (2007/09) 9 of 24

Section Name Field Name Field and/or Section Description
PREMISES INFORMATION Construction Type Enter code: The primary construction type of the premises. Common construction classifications are: * Frame * Joisted Masonry * Non-Combustible * Masonry Non-Combustible * Modified Fire Resistive * Fire Resistive
PREMISES INFORMATION Distance to Hydrant Enter number: The distance in feet from the nearest hydrant that supports the protection class used.
PREMISES INFORMATION Distance to Fire Station Enter number: The distance in miles from the nearest fire station that supports the protection class used.
PREMISES INFORMATION Fire District/Code Number Enter text: The property's fire district name.
PREMISES INFORMATION Enter code: The property's fire district code number which can be found in the individual states manual pages.
PREMISES INFORMATION Prot Cl Enter code: The fire rating protection class for this location.
PREMISES INFORMATION # Stories Enter number: The number of stories for this building not including any basement.
PREMISES INFORMATION # Basm'ts Enter number: The number of basements for this building.
PREMISES INFORMATION Yr Built Enter year: The year the building at each location was originally constructed. Specify in the Remarks section any significant additions or renovations and the year they were completed.
PREMISES INFORMATION Total Area Enter number: The number of square feet of the building or area occupied at this location for which insurance is being requested.
PREMISES INFORMATION Building Improvements Wiring Check the box (if applicable): Indicates if any wiring improvements have been made since the original construction.
PREMISES INFORMATION Building Improvements Wiring Year Enter year: The year the wiring improvements took place.
PREMISES INFORMATION Building Improvements Roofing Check the box (if applicable): Indicates if any roofing improvements have been made since the original construction.
PREMISES INFORMATION Building Improvements Roofing Year Enter year: The year the roofing improvements took place.
PREMISES INFORMATION Building Improvements Plumbing Check the box (if applicable): Indicates if any plumbing improvements have been made since the original construction.
PREMISES INFORMATION Building Improvements Plumbing Year Enter year: The year the plumbing improvements took place.

ACORD 140 (2007/09) 10 of 24

Section Name Field Name Field and/or Section Description
PREMISES INFORMATION Building Improvements Heating Check the box (if applicable): Indicates if any heating improvements have been made since the original construction.
PREMISES INFORMATION Building Improvements Heating Year Enter year: The year the heating improvements took place.
PREMISES INFORMATION Building Improvements Other Check the box (if applicable): Indicates if any other improvements have been made since the original construction.
PREMISES INFORMATION Building Improvements Other Description Enter text: The description of other improvements that have been made to the structure.
PREMISES INFORMATION Building Improvements Other Year Enter year: The year the other improvements took place.
PREMISES INFORMATION Bldg Code Grade Enter code: The industry code used to collect the building code effectiveness grade code. The source of this code list is public protection classification or individual insurer rating manuals.
PREMISES INFORMATION Tax Code Enter code: The city, county or state tax code, if applicable.
PREMISES INFORMATION Roof Type Enter code: The material used to construct the roof. Examples: * Composition (fiberglass, asphalt, etc.) * Metal * Poured * Slate * Tile * Wood Shake/Shingle
PREMISES INFORMATION Other Occupancies Enter text: The description of any other occupancies located in the building not operated by the insured and not listed in the Description of Operations section on the ACORD 125. If no other occupancy, enter None.
PREMISES INFORMATION Wind Class Resistive Check the box (if applicable): Indicates the wind class is resistive.
PREMISES INFORMATION Wind Class Semi Resistive Check the box (if applicable): Indicates the wind class is semi-resistive.
PREMISES INFORMATION Wind Class Other Check the box (if applicable): Indicates the wind class is other than those listed.
PREMISES INFORMATION Wind Class Other Enter text: The description of the wind class when "other" has been checked.
PREMISES INFORMATION Heating Boiler Yes Enter code: Indicates if there is a heating boiler on the premises.
PREMISES INFORMATION If Yes Is insurance placed elsewhere? Yes Enter code: Indicates if the heating boiler is insured elsewhere.
PREMISES INFORMATION Right Exposure/Right Distance Enter text: The description of the buildings, structures, activities conducted, or use of the adjacent property to the right of the insured premises.
PREMISES INFORMATION Enter number: The distance to the adjacent exposure on the right of the insured premises in linear feet.

ACORD 140 (2007/09) 11 of 24

Section Name Field Name Field and/or Section Description
PREMISES INFORMATION Left Exposure/Left Distance Enter text: The description of the buildings, structures, activities conducted, or use of the adjacent property to the left of the insured premises.
PREMISES INFORMATION Enter number: The distance to the adjacent exposure on the left of the insured premises in linear feet.
PREMISES INFORMATION Front Exposure/Front Distance Enter text: The description of the buildings, structures, activities conducted, or use of the adjacent property to the front of the insured premises.
PREMISES INFORMATION Enter number: The distance to the adjacent exposure on the front of the insured premises in linear feet.
PREMISES INFORMATION Rear Exposure/Rear Distance Enter text: The description of the buildings, structures, activities conducted, or use of the adjacent property to the rear of the insured premises.
PREMISES INFORMATION Enter number: The distance to the adjacent exposure on the rear of the insured premises in linear feet.
PREMISES INFORMATION Burglar Alarm Type Enter text: The description of any burglar alarm protecting the building or contents. Descriptive terms such as safe, premises, perimeter, or ultrasonic may be suitable.
PREMISES INFORMATION Certificate Number Enter identifier: The Underwriters Laboratories or other testing organization Certificate Number, if applicable. Attach a copy of the certificate to the application.
PREMISES INFORMATION Expiration Date Enter date: The expiration date of the certificate.
PREMISES INFORMATION Central Station Check the box (if applicable): Indicates the burglar alarm rings at an alarm company or police department.
PREMISES INFORMATION With Keys Check the box (if applicable): Indicates the alarm company, located off the insured's premises, has keys to the applicant's property.
PREMISES INFORMATION Burglar Alarm Installed and Serviced by Enter text: The name of the alarm company that installed and services the alarm.
PREMISES INFORMATION Extent Enter code: The designated extent of protection as described in the Insurance Services Office crime rating manual.
PREMISES INFORMATION Grade Enter code: The alarm grade as described in the Insurance Services Office crime rating manual (e.g., AA, A, B, C).
PREMISES INFORMATION # Guards/Watchmen Enter number: The number of guards and or watchmen employed or contracted for by the insured.
PREMISES INFORMATION Clock Hourly Check the box (if applicable): Indicates the guard/watchman is required to make hourly rounds using a special time recording device or in connection with the central station service. If other than hourly, indicate the time interval in the Other box.
PREMISES INFORMATION Other Check the box (if applicable): Indicates the guard/watchman is required to make some other type of rounds.
PREMISES INFORMATION Other Description Enter text: The description of the rounds the guards/watchmen are required to make.

ACORD 140 (2007/09) 12 of 24

Section Name Field Name Field and/or Section Description
PREMISES INFORMATION Premises Fire Protection Enter text: The description of the type of fire protection for the premises (e.g. sprinklers, standpipes, Chemical Systems).
PREMISES INFORMATION % Sprnk Enter percentage: The percentage of the structure area covered by the sprinkler system.
PREMISES INFORMATION Fire Alarm Manufacturer Enter text: The name of the manufacturer of the alarm, and if it is UL listed.
PREMISES INFORMATION Central Station Check the box (if applicable): Indicates the fire alarm rings at an alarm company, police department or fire department.
PREMISES INFORMATION Local Gong Check the box (if applicable): Indicates the fire alarm rings on an audible gong located outside of the building.
ADDITIONAL INTEREST Rank Enter number: The ranking of 'this' additional interest when multiple additional interests are associated with the same item.
ADDITIONAL INTEREST Loss Payee Check the box (if applicable): Indicates the additional interest type is a loss payee.
ADDITIONAL INTEREST Mortgagee Check the box (if applicable): Indicates the additional interest type is a mortgagee.
ADDITIONAL INTEREST Other Check the box (if applicable): Indicates the additional interest is not any of the types listed on the form.
ADDITIONAL INTEREST Other Description Enter text: The description of the type of interest in the item.
ADDITIONAL INTEREST Reference # Enter identifier: The account number (loan number).
ADDITIONAL INTEREST Certificate Required Check the box (if applicable): Indicates if the additional interest requires a Certificate of Insurance,
ADDITIONAL INTEREST Name and Address Enter text: The additional interest's full name.
ADDITIONAL INTEREST Enter text: The additional interest's mailing address line one.
ADDITIONAL INTEREST Enter text: The additional interest's mailing address line two.
ADDITIONAL INTEREST Enter text: The additional interest's mailing address city name.
ADDITIONAL INTEREST Enter code: The additional interest's mailing address state or province code.
ADDITIONAL INTEREST Enter code: The additional interest's mailing address postal code.
ADDITIONAL INTEREST Item Description Enter text: The description of the item of interest if needed to further clarify. For a vehicle, list the make, model and VIN number. For a scheduled item, list the description, such as three carat diamond in six point setting.
ADDITIONAL INTEREST Location Enter number: The producer assigned number of the location which has an additional interest.
ADDITIONAL INTEREST Building Enter number: The producer assigned number of the building which has an additional interest.
ADDITIONAL INTEREST Scheduled Item Number Enter number: The producer assigned number of the scheduled item which has an additional interest.
ADDITIONAL INTEREST Other Enter text: The description of the item which has an additional interest.

ACORD 140 (2007/09) 13 of 24

Section Name Field Name Field and/or Section Description
IDENTIFICATION SECTION Agency Customer ID Enter identifier: The customer's identification number assigned by the producer (e.g. agency or brokerage).
ADDITIONAL PREMISES INFORMATION Premises # Enter number: The location number for the premises.
ADDITIONAL PREMISES INFORMATION Street Address Enter text: The first address line of the commercial structure.
ADDITIONAL PREMISES INFORMATION Building # Enter number: The building number for the premises. Used when more than one building exists at an individual location.
ADDITIONAL PREMISES INFORMATION Building Description Enter text: This describes the particular sublocation in a manner sufficient to distinguish it from other sublocations at a given location. An example might be "3 story blue structure on the left of the main building".
ADDITIONAL PREMISES INFORMATION Subject of Insurance Enter code: Enter all units at risk/coverages that are to be insured at this particular location number/building number combination. Examples: * Building * Personal Property * Extra Expense * Business Income
ADDITIONAL PREMISES INFORMATION Amount Enter limit: The maximum amount of coverage provided for this subject of insurance or premium-bearing option.
ADDITIONAL PREMISES INFORMATION Coins % Enter percentage: The Coinsurance Percentage is the percentage of the total value of the subject of insurance being insured. If the amount of insurance falls below this percentage, the insured must share in the amount of the loss. This field should be completed even when writing agreed amount coverage.
ADDITIONAL PREMISES INFORMATION Valuation Enter code: Indicate the method which will be used to determine the amount paid on a claim. Valuation methods are: ACV . . . . . . . . . . . . . . . . . . . . . . . . . Actual Cash Value RC. . . . . . . . . . . . . . . . . . . . . . . . . . .Replacement Cost AA . . . . . . . . . . . . . . . . . . . . . . . . . . Agreed Amount MV . . . . . . . . . . . . . . . . . . . . . . . . . . Market Value
ADDITIONAL PREMISES INFORMATION Causes of Loss Enter code: The causes of loss the subject of insurance is to be covered for. Examples: * Basic * Broad * Special excluding theft * Earthquake

ACORD 140 (2007/09) 14 of 24

Section Name Field Name Field and/or Section Description
ADDITIONAL PREMISES INFORMATION Inflation Guard % Enter percentage: The inflation guard percentage gives an automatic increase in the amount of coverage based on a percentage over time. List both the percentage amount and the period of time during which it applies (e.g., 4% per year).
ADDITIONAL PREMISES INFORMATION Deductible(s) Enter deductible: The deductible amount that is to apply to this subject of insurance.
ADDITIONAL PREMISES INFORMATION Blkt # Enter number: The identifying number for the blanket under which this subject of insurance is rated. Leave blank if the subject of insurance is not included under a blanket.
ADDITIONAL PREMISES INFORMATION Forms and Conditions to Apply Enter text: The form numbers and special conditions that apply to this subject of insurance. Also indicate here if coverage is blanket or average rated.
ADDITIONAL PREMISES INFORMATION Subject of Insurance Enter code: Enter all units at risk/coverages that are to be insured at this particular location number/building number combination. Examples: * Building * Personal Property * Extra Expense * Business Income
ADDITIONAL PREMISES INFORMATION Amount Enter limit: The maximum amount of coverage provided for this subject of insurance or premium-bearing option.
ADDITIONAL PREMISES INFORMATION Coins % Enter percentage: The Coinsurance Percentage is the percentage of the total value of the subject of insurance being insured. If the amount of insurance falls below this percentage, the insured must share in the amount of the loss. This field should be completed even when writing agreed amount coverage.
ADDITIONAL PREMISES INFORMATION Valuation Enter code: Indicate the method which will be used to determine the amount paid on a claim. Valuation methods are: ACV . . . . . . . . . . . . . . . . . . . . . . . . . Actual Cash Value RC. . . . . . . . . . . . . . . . . . . . . . . . . . .Replacement Cost AA . . . . . . . . . . . . . . . . . . . . . . . . . . Agreed Amount MV . . . . . . . . . . . . . . . . . . . . . . . . . . Market Value
ADDITIONAL PREMISES INFORMATION Causes of Loss Enter code: The causes of loss the subject of insurance is to be covered for. Examples: * Basic * Broad * Special excluding theft * Earthquake

ACORD 140 (2007/09) 15 of 24

Section Name Field Name Field and/or Section Description
ADDITIONAL PREMISES INFORMATION Inflation Guard % Enter percentage: The inflation guard percentage gives an automatic increase in the amount of coverage based on a percentage over time. List both the percentage amount and the period of time during which it applies (e.g., 4% per year).
ADDITIONAL PREMISES INFORMATION Deductible(s) Enter deductible: The deductible amount that is to apply to this subject of insurance.
ADDITIONAL PREMISES INFORMATION Blkt # Enter number: The identifying number for the blanket under which this subject of insurance is rated. Leave blank if the subject of insurance is not included under a blanket.
ADDITIONAL PREMISES INFORMATION Forms and Conditions to Apply Enter text: The form numbers and special conditions that apply to this subject of insurance. Also indicate here if coverage is blanket or average rated.
ADDITIONAL PREMISES INFORMATION Subject of Insurance Enter code: Enter all units at risk/coverages that are to be insured at this particular location number/building number combination. Examples: * Building * Personal Property * Extra Expense * Business Income
ADDITIONAL PREMISES INFORMATION Amount Enter limit: The maximum amount of coverage provided for this subject of insurance or premium-bearing option.
ADDITIONAL PREMISES INFORMATION Coins % Enter percentage: The Coinsurance Percentage is the percentage of the total value of the subject of insurance being insured. If the amount of insurance falls below this percentage, the insured must share in the amount of the loss. This field should be completed even when writing agreed amount coverage.
ADDITIONAL PREMISES INFORMATION Valuation Enter code: Indicate the method which will be used to determine the amount paid on a claim. Valuation methods are: ACV . . . . . . . . . . . . . . . . . . . . . . . . . Actual Cash Value RC. . . . . . . . . . . . . . . . . . . . . . . . . . .Replacement Cost AA . . . . . . . . . . . . . . . . . . . . . . . . . . Agreed Amount MV . . . . . . . . . . . . . . . . . . . . . . . . . . Market Value
ADDITIONAL PREMISES INFORMATION Causes of Loss Enter code: The causes of loss the subject of insurance is to be covered for. Examples: * Basic * Broad * Special excluding theft * Earthquake

ACORD 140 (2007/09) 16 of 24

Section Name Field Name Field and/or Section Description
ADDITIONAL PREMISES INFORMATION Inflation Guard % Enter percentage: The inflation guard percentage gives an automatic increase in the amount of coverage based on a percentage over time. List both the percentage amount and the period of time during which it applies (e.g., 4% per year).
ADDITIONAL PREMISES INFORMATION Deductible(s) Enter deductible: The deductible amount that is to apply to this subject of insurance.
ADDITIONAL PREMISES INFORMATION Blkt # Enter number: The identifying number for the blanket under which this subject of insurance is rated. Leave blank if the subject of insurance is not included under a blanket.
ADDITIONAL PREMISES INFORMATION Forms and Conditions to Apply Enter text: The form numbers and special conditions that apply to this subject of insurance. Also indicate here if coverage is blanket or average rated.
ADDITIONAL PREMISES INFORMATION Subject of Insurance Enter code: Enter all units at risk/coverages that are to be insured at this particular location number/building number combination. Examples: * Building * Personal Property * Extra Expense * Business Income
ADDITIONAL PREMISES INFORMATION Amount Enter limit: The maximum amount of coverage provided for this subject of insurance or premium-bearing option.
ADDITIONAL PREMISES INFORMATION Coins % Enter percentage: The Coinsurance Percentage is the percentage of the total value of the subject of insurance being insured. If the amount of insurance falls below this percentage, the insured must share in the amount of the loss. This field should be completed even when writing agreed amount coverage.
ADDITIONAL PREMISES INFORMATION Valuation Enter code: Indicate the method which will be used to determine the amount paid on a claim. Valuation methods are: ACV . . . . . . . . . . . . . . . . . . . . . . . . . Actual Cash Value RC. . . . . . . . . . . . . . . . . . . . . . . . . . .Replacement Cost AA . . . . . . . . . . . . . . . . . . . . . . . . . . Agreed Amount MV . . . . . . . . . . . . . . . . . . . . . . . . . . Market Value
ADDITIONAL PREMISES INFORMATION Causes of Loss Enter code: The causes of loss the subject of insurance is to be covered for. Examples: * Basic * Broad * Special excluding theft * Earthquake

ACORD 140 (2007/09) 17 of 24

Section Name Field Name Field and/or Section Description
ADDITIONAL PREMISES INFORMATION Inflation Guard % Enter percentage: The inflation guard percentage gives an automatic increase in the amount of coverage based on a percentage over time. List both the percentage amount and the period of time during which it applies (e.g., 4% per year).
ADDITIONAL PREMISES INFORMATION Deductible(s) Enter deductible: The deductible amount that is to apply to this subject of insurance.
ADDITIONAL PREMISES INFORMATION Blkt # Enter number: The identifying number for the blanket under which this subject of insurance is rated. Leave blank if the subject of insurance is not included under a blanket.
ADDITIONAL PREMISES INFORMATION Forms and Conditions to Apply Enter text: The form numbers and special conditions that apply to this subject of insurance. Also indicate here if coverage is blanket or average rated.
ADDITIONAL PREMISES INFORMATION Subject of Insurance Enter code: Enter all units at risk/coverages that are to be insured at this particular location number/building number combination. Examples: * Building * Personal Property * Extra Expense * Business Income
ADDITIONAL PREMISES INFORMATION Amount Enter limit: The maximum amount of coverage provided for this subject of insurance or premium-bearing option.
ADDITIONAL PREMISES INFORMATION Coins % Enter percentage: The Coinsurance Percentage is the percentage of the total value of the subject of insurance being insured. If the amount of insurance falls below this percentage, the insured must share in the amount of the loss. This field should be completed even when writing agreed amount coverage.
ADDITIONAL PREMISES INFORMATION Valuation Enter code: Indicate the method which will be used to determine the amount paid on a claim. Valuation methods are: ACV . . . . . . . . . . . . . . . . . . . . . . . . . Actual Cash Value RC. . . . . . . . . . . . . . . . . . . . . . . . . . .Replacement Cost AA . . . . . . . . . . . . . . . . . . . . . . . . . . Agreed Amount MV . . . . . . . . . . . . . . . . . . . . . . . . . . Market Value
ADDITIONAL PREMISES INFORMATION Causes of Loss Enter code: The causes of loss the subject of insurance is to be covered for. Examples: * Basic * Broad * Special excluding theft * Earthquake

ACORD 140 (2007/09) 18 of 24

Section Name Field Name Field and/or Section Description
ADDITIONAL PREMISES INFORMATION Inflation Guard % Enter percentage: The inflation guard percentage gives an automatic increase in the amount of coverage based on a percentage over time. List both the percentage amount and the period of time during which it applies (e.g., 4% per year).
ADDITIONAL PREMISES INFORMATION Deductible(s) Enter deductible: The deductible amount that is to apply to this subject of insurance.
ADDITIONAL PREMISES INFORMATION Blkt # Enter number: The identifying number for the blanket under which this subject of insurance is rated. Leave blank if the subject of insurance is not included under a blanket.
ADDITIONAL PREMISES INFORMATION Forms and Conditions to Apply Enter text: The form numbers and special conditions that apply to this subject of insurance. Also indicate here if coverage is blanket or average rated.
ADDITIONAL PREMISES INFORMATION Subject of Insurance Enter code: Enter all units at risk/coverages that are to be insured at this particular location number/building number combination. Examples: * Building * Personal Property * Extra Expense * Business Income
ADDITIONAL PREMISES INFORMATION Amount Enter limit: The maximum amount of coverage provided for this subject of insurance or premium-bearing option.
ADDITIONAL PREMISES INFORMATION Coins % Enter percentage: The Coinsurance Percentage is the percentage of the total value of the subject of insurance being insured. If the amount of insurance falls below this percentage, the insured must share in the amount of the loss. This field should be completed even when writing agreed amount coverage.
ADDITIONAL PREMISES INFORMATION Valuation Enter code: Indicate the method which will be used to determine the amount paid on a claim. Valuation methods are: ACV . . . . . . . . . . . . . . . . . . . . . . . . . Actual Cash Value RC. . . . . . . . . . . . . . . . . . . . . . . . . . .Replacement Cost AA . . . . . . . . . . . . . . . . . . . . . . . . . . Agreed Amount MV . . . . . . . . . . . . . . . . . . . . . . . . . . Market Value
ADDITIONAL PREMISES INFORMATION Causes of Loss Enter code: The causes of loss the subject of insurance is to be covered for. Examples: * Basic * Broad * Special excluding theft * Earthquake

ACORD 140 (2007/09) 19 of 24

Section Name Field Name Field and/or Section Description
Enter percentage: The inflation guard percentage gives an automatic increase in the
ADDITIONAL PREMISES amount of coverage based on a percentage over time. List both the percentage amount
INFORMATION Inflation Guard % and the period of time during which it applies (e.g., 4% per year).
ADDITIONAL PREMISES
INFORMATION Deductible(s) Enter deductible: The deductible amount that is to apply to this subject of insurance.
ADDITIONAL PREMISES Enter number: The identifying number for the blanket under which this subject of
INFORMATION Blkt # insurance is rated. Leave blank if the subject of insurance is not included under a blanket.
ADDITIONAL PREMISES Enter text: The form numbers and special conditions that apply to this subject of
INFORMATION Forms and Conditions to Apply insurance. Also indicate here if coverage is blanket or average rated.
ADDITIONAL PREMISES Additional Information - Business Check the box (if applicable): Indicates the ACORD 810 Business Income/Extra Expense
INFORMATION Income/Extra Expense. supplement is attached for this location.
ADDITIONAL PREMISES Check the box (if applicable): Indicates the ACORD 811 Value Reporting Information form
INFORMATION Value Reporting Information is attached for this location.
ADDITIONAL PREMISES Enter Y for a “Yes” response. Input N for “No” response. Indicates if spoilage coverage
INFORMATION Spoilage Coverage Yes applies.
ADDITIONAL PREMISES
INFORMATION Description of Property Covered Enter text: The description of property to be covered for spoilage.
ADDITIONAL PREMISES
INFORMATION Limit Enter limit: The limit applicable to the spoilage coverage.
ADDITIONAL PREMISES
INFORMATION Deductible Enter deductible: The deductible applicable to the spoilage coverage.
ADDITIONAL PREMISES Refrigeration Maintenance
INFORMATION Agreement Yes Enter code: Indicates if there is a refrigerator maintenance agreement.
ADDITIONAL PREMISES
INFORMATION Options Enter text: The description of optional coverages that apply.
ADDITIONAL PREMISES
INFORMATION Remarks Enter text: The remarks associated with a specific location or sublocation.
ADDITIONAL PREMISES
INFORMATION # Of Open Sides on Structure Enter number: The number of open sides on a structure.

ACORD 140 (2007/09) 20 of 24

Section Name Field Name Field and/or Section Description
Enter code: The primary construction type of the premises. Common construction classifications are:
* Frame
* Joisted Masonry * Non-Combustible
ADDITIONAL PREMISES * Masonry Non-Combustible * Modified Fire Resistive
INFORMATION Construction Type * Fire Resistive
ADDITIONAL PREMISES Enter number: The distance in feet from the nearest hydrant that supports the protection
INFORMATION Distance to Hydrant class used.
ADDITIONAL PREMISES Enter number: The distance in miles from the nearest fire station that supports the
INFORMATION Distance to Fire Station protection class used.
ADDITIONAL PREMISES
INFORMATION Fire District/Code Number Enter text: The property's fire district name.
ADDITIONAL PREMISES Enter code: The property's fire district code number which can be found in the individual
INFORMATION states manual pages.
ADDITIONAL PREMISES
INFORMATION Prot Cl Enter code: The fire rating protection class for this location.
ADDITIONAL PREMISES
INFORMATION # Stories Enter number: The number of stories for this building not including any basement.
ADDITIONAL PREMISES
INFORMATION # Basm'ts Enter number: The number of basements for this building.
Enter year: The year the building at each location was originally constructed. Specify in the
ADDITIONAL PREMISES Remarks section any significant additions or renovations and the year they were
INFORMATION Yr Built completed.
ADDITIONAL PREMISES Enter number: The number of square feet of the building or area occupied at this location
INFORMATION Total Area for which insurance is being requested.
ADDITIONAL PREMISES Check the box (if applicable): Indicates if any wiring improvements have been made since
INFORMATION Building Improvements Wiring the original construction.
ADDITIONAL PREMISES Building Improvements Wiring
INFORMATION Year Enter year: The year the wiring improvements took place.
ADDITIONAL PREMISES Check the box (if applicable): Indicates if any roofing improvements have been made
INFORMATION Building Improvements Roofing since the original construction.
ADDITIONAL PREMISES Building Improvements Roofing
INFORMATION Year Enter year: The year the roofing improvements took place.

ACORD 140 (2007/09) 21 of 24

Section Name Field Name Field and/or Section Description
ADDITIONAL PREMISES Check the box (if applicable): Indicates if any plumbing improvements have been made
INFORMATION Building Improvements Plumbing since the original construction.
ADDITIONAL PREMISES Building Improvements Plumbing
INFORMATION Year Enter year: The year the plumbing improvements took place.
ADDITIONAL PREMISES Check the box (if applicable): Indicates if any heating improvements have been made
INFORMATION Building Improvements Heating since the original construction.
ADDITIONAL PREMISES Building Improvements Heating
INFORMATION Year Enter year: The year the heating improvements took place.
ADDITIONAL PREMISES Check the box (if applicable): Indicates if any other improvements have been made since
INFORMATION Building Improvements Other the original construction.
ADDITIONAL PREMISES Building Improvements Other
INFORMATION Description Enter text: The description of other improvements that have been made to the structure.
ADDITIONAL PREMISES
INFORMATION Building Improvements Other Year Enter year: The year the other improvements took place.
Enter code: The industry code used to collect the building code effectiveness grade code.
ADDITIONAL PREMISES The source of this code list is public protection classification or individual insurer rating
INFORMATION Bldg Code Grade manuals.
ADDITIONAL PREMISES
INFORMATION Tax Code Enter code: The city, county or state tax code, if applicable.
Enter code: The material used to construct the roof. Examples: * Composition (fiberglass, asphalt, etc.) * Metal
* Poured
* Slate
ADDITIONAL PREMISES * Tile
INFORMATION Roof Type * Wood Shake/Shingle
Enter text: The description of any other occupancies located in the building not operated
ADDITIONAL PREMISES by the insured and not listed in the Description of Operations section on the ACORD 125.
INFORMATION Other Occupancies If no other occupancy, enter None.
ADDITIONAL PREMISES
INFORMATION Wind Class Resistive Check the box (if applicable): Indicates the wind class is resistive.
ADDITIONAL PREMISES
INFORMATION Wind Class Semi Resistive Check the box (if applicable): Indicates the wind class is semi-resistive.
ADDITIONAL PREMISES
INFORMATION Wind Class Other Check the box (if applicable): Indicates the wind class is other than those listed.

ACORD 140 (2007/09) 22 of 24

Section Name Field Name Field and/or Section Description
ADDITIONAL PREMISES
INFORMATION Wind Class Other Enter text: The description of the wind class when "other" has been checked.
ADDITIONAL PREMISES
INFORMATION Heating Boiler Yes Enter code: Indicates if there is a heating boiler on the premises.
ADDITIONAL PREMISES If Yes Is Insurance Placed
INFORMATION Elsewhere? YES Enter code: Indicates if the heating boiler is insured elsewhere.
ADDITIONAL PREMISES Enter text: The description of the buildings, structures, activities conducted, or use of the
INFORMATION Right Exposure/Right Distance adjacent property to the right of the insured premises.
ADDITIONAL PREMISES Enter number: The distance to the adjacent exposure on the right of the insured premises
INFORMATION in linear feet.
ADDITIONAL PREMISES Enter text: The description of the buildings, structures, activities conducted, or use of the
INFORMATION Left Exposure/Left Distance adjacent property to the left of the insured premises.
ADDITIONAL PREMISES Enter number: The distance to the adjacent exposure on the left of the insured premises in
INFORMATION linear feet.
ADDITIONAL PREMISES Enter text: The description of the buildings, structures, activities conducted, or use of the
INFORMATION Front Exposure/Front Distance adjacent property to the front of the insured premises.
ADDITIONAL PREMISES Enter number: The distance to the adjacent exposure on the front of the insured premises
INFORMATION in linear feet.
ADDITIONAL PREMISES Enter text: The description of the buildings, structures, activities conducted, or use of the
INFORMATION Rear Exposure/Rear Distance adjacent property to the rear of the insured premises.
ADDITIONAL PREMISES Enter number: The distance to the adjacent exposure on the rear of the insured premises
INFORMATION in linear feet.
ADDITIONAL PREMISES Enter text: The description of any burglar alarm protecting the building or contents.
INFORMATION Burglar Alarm Type Descriptive terms such as safe, premises, perimeter, or ultrasonic may be suitable.
ADDITIONAL PREMISES Enter identifier: The Underwriters Laboratories or other testing organization Certificate
INFORMATION Certificate Number Number, if applicable. Attach a copy of the certificate to the application.
ADDITIONAL PREMISES
INFORMATION Expiration Date Enter date: The expiration date of the certificate.
ADDITIONAL PREMISES Check the box (if applicable): Indicates the burglar alarm rings at an alarm company or
INFORMATION Central Station police department.
ADDITIONAL PREMISES Check the box (if applicable): Indicates the alarm company, located off the insured's
INFORMATION With Keys premises, has keys to the applicant's property.
ADDITIONAL PREMISES Burglar Alarm Installed and
INFORMATION Serviced by Enter text: The name of the alarm company that installed and services the alarm.
ADDITIONAL PREMISES Enter code: The designated extent of protection as described in the Insurance Services
INFORMATION Extent Office crime rating manual.

ACORD 140 (2007/09) 23 of 24

Section Name Field Name Field and/or Section Description
ADDITIONAL PREMISES INFORMATION Grade Enter code: The alarm grade as described in the Insurance Services Office crime rating manual (e.g., AA, A, B, C).
ADDITIONAL PREMISES INFORMATION # Guards/Watchmen Enter number: The number of guards and or watchmen employed or contracted for by the insured.
ADDITIONAL PREMISES INFORMATION Clock Hourly Check the box (if applicable): Indicates the guard/watchman is required to make hourly rounds using a special time recording device or in connection with the central station service. If other than hourly, indicate the time interval in the Other box.
ADDITIONAL PREMISES INFORMATION Other Check the box (if applicable): Indicates the guard/watchman is required to make some other type of rounds.
ADDITIONAL PREMISES INFORMATION Other Description Enter text: The description of the rounds the guards/watchmen are required to make.
ADDITIONAL PREMISES INFORMATION Premises Fire Protection Enter text: The description of the type of fire protection for the premises (e.g. sprinklers, standpipes, Chemical Systems).
ADDITIONAL PREMISES INFORMATION % Sprnk Enter percentage: The percentage of the structure area covered by the sprinkler system.
ADDITIONAL PREMISES INFORMATION Fire Alarm Manufacturer Enter text: The name of the manufacturer of the alarm, and if it is UL listed.
ADDITIONAL PREMISES INFORMATION Central Station Check the box (if applicable): Indicates the fire alarm rings at an alarm company, police department or fire department.
ADDITIONAL PREMISES INFORMATION Local Gong Check the box (if applicable): Indicates the fire alarm rings on an audible gong located outside of the building.
ADDITIONAL INTEREST Rank Enter number: The ranking of 'this' additional interest when multiple additional interests are associated with the same item.
ADDITIONAL INTEREST Interest Loss Payee Check the box (if applicable): Indicates the additional interest type is a loss payee.
ADDITIONAL INTEREST Interest Mortgagee Check the box (if applicable): Indicates the additional interest type is a mortgagee.
ADDITIONAL INTEREST Interest Other Check the box (if applicable): Indicates the additional interest is not any of the types listed on the form.
ADDITIONAL INTEREST Interest Other Description Enter text: The description of the type of interest in the item.
ADDITIONAL INTEREST Reference # Enter identifier: The account number (loan number).
ADDITIONAL INTEREST Evidence/Certificate Required Check the box (if applicable): Indicates if the additional interest requires a Certificate of Insurance,
ADDITIONAL INTEREST Name and Address Enter text: The additional interest's full name.
ADDITIONAL INTEREST Enter text: The additional interest's mailing address line one.
ADDITIONAL INTEREST Enter text: The additional interest's mailing address line two.
ADDITIONAL INTEREST Enter text: The additional interest's mailing address city name.
ADDITIONAL INTEREST Enter code: The additional interest's mailing address state or province code.
Section Name Field Name Field and/or Section Description
ADDITIONAL INTEREST Enter code: The additional interest's mailing address postal code.
ADDITIONAL INTEREST Item Description Enter text: The description of the item of interest if needed to further clarify. For a vehicle, list the make, model and VIN number. For a scheduled item, list the description, such as three carat diamond in six point setting.
ADDITIONAL INTEREST Location Enter number: The producer assigned number of the location which has an additional interest.
ADDITIONAL INTEREST Building Enter number: The producer assigned number of the building which has an additional interest.
ADDITIONAL INTEREST Scheduled Item Number Enter number: The producer assigned number of the scheduled item which has an additional interest.
ADDITIONAL INTEREST Other Enter text: The description of the item which has an additional interest.
Edition Date The edition identifier of the form including the form number and edition (the date is typically formatted YYYY/MM).