ACORD 193 (2013/09) - OPEN CARGO SECTION
ACORD 193 (2013/09) - OPEN CARGO SECTION
ACORD 193, Open Cargo Section is used to provide basic information for marine coverage involving an open cargo policy.
Individual company manuals should be consulted for unique underwriting, rating, and other information required by specific companies.
This form is designed to be used in conjunction with ACORD 125, Commercial Insurance Application - Applicant Information Section.
Form Page 1
Section Name
Field Name
Description
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 date on which the form is completed.
IDENTIFICATION SECTION
Agency
Enter text: The full name of the producer / agency.
IDENTIFICATION SECTION
Policy Number
Enter identifier: The identifier assigned by the insurer to the policy, or submission, being
referenced exactly as it appears on the policy, including prefix and suffix symbols. If required for
self-insurance, the self-insured license or contract number.
IDENTIFICATION SECTION
Effective Date
Enter date: The effective date of the policy. The date that the terms and conditions of the policy
commence.
IDENTIFICATION SECTION
Carrier
Enter text: The insurer's full legal company name(s) as found in the file copy of the policy. Use
the actual name of the company within the group to which the policy has been issued. 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
Applicant / First Named
Insured
Enter text: The named insured(s) as it/they will appear on the policy declarations page.
INTEREST
Applicant Is-Freight
Forwarder (Checkbox)
Check the box (if applicable): Indicates if the applicant's interest is as a freight forwarder.
INTEREST
Shipper Of Owned Property
(Checkbox)
Check the box (if applicable): Indicate if an insurable interest in the property has been shipped
on owned vehicles or other vehicles while in transit by virtue of ownership.
INTEREST
Importer (Checkbox)
Check the box (if applicable): Indicates if the applicant's interest is as an importer.
INTEREST
Exporter (Checkbox)
Check the box (if applicable): Indicates if the applicant's interest is as an exporter.
INTEREST
Other (Checkbox)
Check the box (if applicable): Indicate if the insured's interest in the property being shipped is
other than those listed.
CONVEYANCE USED
Conveyance Used Field
Enter text: The description of the conveyance used.
ACORD 193 (2013/09) rev. 07-31-2013 P age 1 of 4
OPERATIONS
Property Shipped
Enter text: The description of property shipped.
OPERATIONS
Points of Origin
Enter text: The description of the points of origin.
OPERATIONS
Points of Destination
Enter text: The description of the points of destination.
GENERAL INFORMATION
Average Value ($)
Enter amount: The average value of the items shipped.
GENERAL INFORMATION
Per Field
Enter text: The description of what the average value applies to (i.e., per shipment).
GENERAL INFORMATION
Packing
Enter text: The description of the packing.
GENERAL INFORMATION
Annual Gross Sales ($)
Enter amount: The annual gross sales amount.
GENERAL INFORMATION
Coverage Form
Enter text: The description of the coverage form.
COVERAGES
Valuation
Enter code: Indicates the type of value used in determining the limit of insurance.
COVERAGES
Annual Values ($)
Enter amount: The annual values amount for international transit coverage.
COVERAGES
Limit ($)
Enter limit: The limit amount for international transit coverage.
COVERAGES
Per
Enter code: The code identifying what the limit applies to (i.e. per shipment).
COVERAGES
Ded ($)
Enter deductible: The deductible amount for international transit coverage.
COVERAGES
Other Coverage Type One
Enter code: The code for the coverage being requested.
COVERAGES
Valuation One
Enter code: Indicates the type of value used in determining the limit of insurance.
COVERAGES
Annual Values ($) One
Enter amount: The annual values amount for the coverage.
COVERAGES
Limit ($) One
Enter limit: The limit amount for the coverage.
COVERAGES
Per One
Enter code: The code identifying what the limit applies to (i.e. per shipment).
COVERAGES
Ded ($) One
Enter deductible: The deductible amount for the coverage.
COVERAGES
Other Coverage Type Two
Enter code: The code for the coverage being requested.
COVERAGES
Valuation Two
Enter code: Indicates the type of value used in determining the limit of insurance.
COVERAGES
Annual Values ($) Two
Enter amount: The annual values amount for the coverage.
COVERAGES
Limit ($) Two
Enter limit: The limit amount for the coverage.
COVERAGES
Per Two
Enter code: The code identifying what the limit applies to (i.e. per shipment).
COVERAGES
Ded ($) Two
Enter deductible: The deductible amount for the coverage.
COVERAGES
Other Coverage Type Three
Enter code: The code for the coverage being requested.
COVERAGES
Valuation Three
Enter code: Indicates the type of value used in determining the limit of insurance.
ACORD 193 (2013/09)
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COVERAGES
Annual Values ($) Three
Enter amount: The annual values amount for the coverage.
COVERAGES
Limit ($) Three
Enter limit: The limit amount for the coverage.
COVERAGES
Per Three
Enter code: The code identifying what the limit applies to (i.e. per shipment).
COVERAGES
Ded ($) Three
Enter deductible: The deductible amount for the coverage.
COVERAGES
Other Coverage Type Four
Enter code: The code for the coverage being requested.
COVERAGES
Valuation Four
Enter code: Indicates the type of value used in determining the limit of insurance.
COVERAGES
Annual Values ($) Four
Enter amount: The annual values amount for the coverage.
COVERAGES
Limit ($) Four
Enter limit: The limit amount for the coverage.
COVERAGES
Per Four
Enter code: The code identifying what the limit applies to (i.e. per shipment).
COVERAGES
Ded ($) Four
Enter deductible: The deductible amount for the coverage.
ADDITIONAL COVERAGES
Returned / Refused
(Checkbox)
Check the box (if applicable): Indicates returned / refused coverage is requested.
ADDITIONAL COVERAGES
FOB Shipments (Checkbox)
Check the box (if applicable): Indicates FOB shipments coverage is requested.
ADDITIONAL COVERAGES
Fraudulent B/L & Receipt
(Checkbox)
Check the box (if applicable): Indicates fraudulent bill of lading and receipts coverage is
requested.
ADDITIONAL COVERAGES
War (Checkbox)
Check the box (if applicable): Indicates war coverage is requested.
ADDITIONAL COVERAGES
Duty (Checkbox)
Check the box (if applicable): Indicates duty coverage is requested.
ADDITIONAL COVERAGES
DE / Consolidation
(Checkbox)
Check the box (if applicable): Indicates de / consolidation coverage is requested.
ADDITIONAL COVERAGES
Brands / Labels (Checkbox)
Check the box (if applicable): Indicates brands / labels coverage is requested.
ADDITIONAL COVERAGES
Pairs / Sets (Checkbox)
Check the box (if applicable): Indicates pairs / sets coverage is requested.
ADDITIONAL COVERAGES
Dic (Checkbox)
Check the box (if applicable): Indicates DIC coverage is requested.
ADDITIONAL COVERAGES
Other (Checkbox)
Check the box (if applicable): Indicates other coverage is requested.
EXCLUSIONS
Marring, Denting, Chipping
& Scratching (Checkbox)
Check the box (if applicable): Indicates marring, denting, chipping and scratching is excluded.
EXCLUSIONS
Breakage (Checkbox)
Check the box (if applicable): Indicates breakage is excluded.
EXCLUSIONS
Rust (Checkbox)
Check the box (if applicable): Indicates rust is excluded.
EXCLUSIONS
Discoloration & Oxidation
(Checkbox)
Check the box (if applicable): Indicates discoloration and oxidation is excluded.
ACORD 193 (2013/09)
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EXCLUSIONS
Mechanical/Electrical
(Checkbox)
Check the box (if applicable): Indicates mechanical and electrical are excluded.
EXCLUSIONS
Other (Checkbox)
Check the box (if applicable): Indicates there are other exclusions.
REMARKS
Remarks
Enter text: The general remarks associated with the commercial inland marine line of business.
Use this section to provide any additional information required for underwriting or rating.
Form Page 2
Section Name
Field Name
Description
IDENTIFICATION SECTION
Agency Customer ID
Enter identifier: The customer's identification number assigned by the producer (e.g., agency or
brokerage).
SIGNATURE
Producer's Signature
Sign here: Accommodates the signature of the authorized representative (e.g., producer, agent,
broker, etc.) of the company(ies) listed on the document. This is required in most states.
SIGNATURE
Producer's Name (Please
Print)
Enter text: The name of the authorized representative of the producer, agency and/or broker
that signed the form.
SIGNATURE
State Producer License No
(Required in FL)
Enter identifier: The State License Number of the producer.
SIGNATURE
Applicant's Signature
Sign here: Accommodates the signature of the applicant or named insured.
SIGNATURE
Date
Enter date: The date the form was signed by the named insured.
SIGNATURE
National Producer Number
Enter identifier: The National Producer Number (NPN) as defined in the National Insurance
Producer Registry (NIPR). Note: The NPN is not the same as the producer state license
number.
ACORD 193 (2013/09)
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