ACORD 325 (2013/09) - Aviation Insurance Application

ACORD 325 (2013/09) - Aviation Insurance Application
ACORD 325, Aviation Insurance Application, Applicant Information Section, is used in the underwriting process for any aviation account and is the
foundation on which the ACORD aviation application program is built. This form contains information that is not duplicated on other ACORD
aviation application forms. ACORD 325, Aviation Insurance Application, Applicant Information Section, is a required part of every aviation
submission except Workers Compensation.
Form Page 1
Section Name
Field Name
Description
IDENTIFICATION SECTION
Date (MM/DD/YYYY)
Enter date: The date on which the form is completed.
IDENTIFICATION SECTION
Agency
Enter text: The full name of the producer / agency.
IDENTIFICATION SECTION
Enter text: The mailing address line one of the producer / agency.
IDENTIFICATION SECTION
Enter text: The mailing address line two of the producer / agency.
IDENTIFICATION SECTION
Enter text: The mailing address city name of the producer / agency.
IDENTIFICATION SECTION
Enter code: The mailing address state or province code of the producer / agency.
IDENTIFICATION SECTION
Enter code: The mailing address postal code of the producer / agency.
IDENTIFICATION SECTION
Contact Name
Enter text: The name of the individual at the producer's establishment that is the primary
contact.
IDENTIFICATION SECTION
Phone (A/C, No, Ext)
Enter number: The producer's contact person's phone number. If applicable, include the area
code and extension.
IDENTIFICATION SECTION
Fax No. (A/C, No, Ext)
Enter number: The fax number of the producer / agency.
IDENTIFICATION SECTION
E-Mail Address
Enter text: The producer's contact person e-mail address.
IDENTIFICATION SECTION
Code
Enter code: The identification code assigned to the producer (e.g., agency or brokerage firm) by
the insurer.
IDENTIFICATION SECTION
Subcode
Enter code: The identification code assigned by the insurer to the sub-producer (e.g., person)
within a producer's office (e.g., agency or brokerage).
IDENTIFICATION SECTION
Agency Customer ID
Enter identifier: The customer's identification number assigned by the producer (e.g., agency or
brokerage).
IDENTIFICATION SECTION
Carrier Name
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.
ACORD 325 (2013/09) rev. 07-31-2013 P age 1 of 25
IDENTIFICATION SECTION
Underwriter
Enter text: The company underwriter (or other company staff person) that this form should be
directed to.
IDENTIFICATION SECTION
Underwriter Office
Enter identifier: The company underwriting office that this application should be directed to.
IDENTIFICATION SECTION
Company Product
Enter text: The description of an independently filed policy or program that may be optionally
available from the insurance company. It may also be used to name the subsidiary company in
which the line of business will be placed.
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
Account Number
Enter identifier: The account number to be used for billing purposes. This is the billing number
assigned by the billing entity. If agency bill, the agency assigns; if direct bill, the insurer assigns.
If the account already exists, the agent should provide the previously assigned number.
IDENTIFICATION SECTION
Quote
Check the box (if applicable): Indicates the response expected from the company is a quote.
IDENTIFICATION SECTION
Issue
Check the box (if applicable): Indicates the response expected from the company is an issued
policy.
IDENTIFICATION SECTION
Renew
Check the box (if applicable): Indicates the response expected from the company is a renewed
policy.
IDENTIFICATION SECTION
Bound
Check the box (if applicable): Indicates the coverage has been bound. As used here, if the
policy is bound, give the date and time below.
IDENTIFICATION SECTION
Change
Check the box (if applicable): Indicates the policy is being submitted for a policy change. As
used here, if the policy is being changed, give the date and time below.
IDENTIFICATION SECTION
Cancel
Check the box (if applicable): Indicates the policy is being submitted for cancellation. As used
here, if the policy is being cancelled, give the date and time below.
IDENTIFICATION SECTION
Date
Enter date: The date the policy status becomes effective. This date is used for policy statuses
of bound, change, and cancel.
IDENTIFICATION SECTION
Time (hour)
Enter time: The time the policy status becomes effective. The time is used for policy statuses of
bound, change, and cancel.
IDENTIFICATION SECTION
AM
Check the box (if applicable): Indicates the effective time of the policy status is before 12:00 pm.
IDENTIFICATION SECTION
PM
Check the box (if applicable): Indicates the effective time of the policy status is 12:00 pm or
later.
IDENTIFICATION SECTION
Estimated Annual Premium
Enter amount: The estimated total cost amount of the policy.
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
Expiration Date
Enter date: The date on which the terms and conditions of the policy will expire.
ACORD 325 (2013/09)
Page 2 of 25
IDENTIFICATION SECTION
Direct Bill
Check the box (if applicable): Indicates if the policy is to be direct billed.
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 (i.e., AN - Annual, MO - Monthly, QT - Quarterly,
etc.).
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.
POLICY INFORMATION
Commercial
Check the box (if applicable): Indicates the policy is a commercial lines policy.
POLICY INFORMATION
Pleasure &Business
Check the box (if applicable): Indicates the type of policy is a pleasure and business policy.
POLICY INFORMATION
Aircraft
Check the box (if applicable): Indicates the Aircraft section is attached to this application.
POLICY INFORMATION
Airport &FBO
Check the box (if applicable): Indicates the Airport and FBO section is attached to this
application.
POLICY INFORMATION
Private Hangar
Check the box (if applicable): Indicates the Private Hangar section is attached to this
application.
POLICY INFORMATION
Property
Check the box (if applicable): Indicates the Property section is attached to this application.
POLICY INFORMATION
Products Liability
Check the box (if applicable): Indicates the Products Liability section is attached to this
application.
POLICY INFORMATION
Other Line of Business
Check the box (if applicable): Indicates that a section that is not listed specifically on the form is
attached to this application.
POLICY INFORMATION
Describe Other Line of
Business
Enter text: The type of section being attached to this application.
POLICY INFORMATION
Aircraft- Industrial Aid
Check the box (if applicable): Indicates the type of policy is aircraft - industrial aid.
POLICY INFORMATION
Airplane One
Check the box (if applicable): Indicates Airplane is the line of business subcode that further
refines the line of business code.
POLICY INFORMATION
Helicopter One
Check the box (if applicable): Indicates Helicopter is the line of business subcode that further
refines the line of business code.
POLICY INFORMATION
Mixed Fleet One
Check the box (if applicable): Indicates Mixed Fleet is the line of business subcode that further
refines the line of business code.
POLICY INFORMATION
Excess One
Check the box (if applicable): Indicates Excess is the line of business subcode that further
refines the line of business code.
POLICY INFORMATION
Quota Share One
Check the box (if applicable): Indicates Quota Share is the line of business subcode that further
refines the line of business code.
ACORD 325 (2013/09)
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POLICY INFORMATION
Other Policy Type One
Check the box (if applicable): Indicates the line of business subcode that further refines the line
of business code is other than those listed.
POLICY INFORMATION
Describe Other Policy Type
One
Enter text: The line of business subcode that further refines the line of business code.
POLICY INFORMATION
Aircraft- Non-Owned
Check the box (if applicable): Indicates the type of policy is aircraft - non-owned.
POLICY INFORMATION
Liability Only
Check the box (if applicable): Indicates Liability Only is the line of business subcode that further
refines the line of business code.
POLICY INFORMATION
Hull & Liability
Check the box (if applicable): Indicates Hull & Liability is the line of business subcode that
further refines the line of business code.
POLICY INFORMATION
Hull Only
Check the box (if applicable): Indicates Hull Only is the line of business subcode that further
refines the line of business code.
POLICY INFORMATION
Other Policy Type Two
Check the box (if applicable): Indicates the line of business subcode that further refines the line
of business code is other than those listed.
POLICY INFORMATION
Describe Other Policy Type
Two
Enter text: The line of business subcode that further refines the line of business code.
POLICY INFORMATION
Aircraft-Pleasure &
Business
Check the box (if applicable): Indicates the type of policy is aircraft - pleasure and business.
POLICY INFORMATION
Airplane Two
Check the box (if applicable): Indicates Airplane is the line of business subcode that further
refines the line of business code.
POLICY INFORMATION
Helicopter Two
Check the box (if applicable): Indicates Helicopter is the line of business subcode that further
refines the line of business code.
POLICY INFORMATION
Mixed Fleet Two
Check the box (if applicable): Indicates Mixed Fleet is the line of business subcode that further
refines the line of business code.
POLICY INFORMATION
Excess Two
Check the box (if applicable): Indicates Excess is the line of business subcode that further
refines the line of business code.
POLICY INFORMATION
Quota Share Two
Check the box (if applicable): Indicates Quota Share is the line of business subcode that further
refines the line of business code.
POLICY INFORMATION
Other Policy Type Three
Check the box (if applicable): Indicates the line of business subcode that further refines the line
of business code is other than those listed.
POLICY INFORMATION
Describe Other Policy Type
Three
Enter text: The line of business subcode that further refines the line of business code.
POLICY INFORMATION
Aircraft- Commercial
Check the box (if applicable): Indicates the type of policy is aircraft - commercial.
POLICY INFORMATION
Airplane Three
Check the box (if applicable): Indicates Airplane is the line of business subcode that further
refines the line of business code.
ACORD 325 (2013/09)
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POLICY INFORMATION
Helicopter Three
Check the box (if applicable): Indicates Helicopter is the line of business subcode that further
refines the line of business code.
POLICY INFORMATION
Mixed Fleet Three
Check the box (if applicable): Indicates Mixed Fleet is the line of business subcode that further
refines the line of business code.
POLICY INFORMATION
Excess Three
Check the box (if applicable): Indicates Excess is the line of business subcode that further
refines the line of business code.
POLICY INFORMATION
Quota Share Three
Check the box (if applicable): Indicates Quota Share is the line of business subcode that further
refines the line of business code.
POLICY INFORMATION
Other Policy Type Four
Check the box (if applicable): Indicates the line of business subcode that further refines the line
of business code is other than those listed.
POLICY INFORMATION
Describe Other Policy Type
Four
Enter text: The line of business subcode that further refines the line of business code.
POLICY INFORMATION
Airport &FBO
Check the box (if applicable): Indicates the type of policy is an airport and fixed base operators
(FBO) policy.
POLICY INFORMATION
Airport
Check the box (if applicable): Indicates Airport is the line of business subcode that further
refines the line of business code.
POLICY INFORMATION
FBO/Commercial
Check the box (if applicable): Indicates FBO / Commercial is the line of business subcode that
further refines the line of business code.
POLICY INFORMATION
Premises Only
Check the box (if applicable): Indicates Premises Only is the line of business subcode that
further refines the line of business code.
POLICY INFORMATION
Excess
Check the box (if applicable): Indicates Excess is the line of business subcode that further
refines the line of business code.
POLICY INFORMATION
Quota Share
Check the box (if applicable): Indicates Quota Share is the line of business subcode that further
refines the line of business code.
POLICY INFORMATION
Other Policy Type Five
Check the box (if applicable): Indicates the line of business subcode that further refines the line
of business code is other than those listed.
POLICY INFORMATION
Describe Other Policy Type
Five
Enter text: The line of business subcode that further refines the line of business code.
POLICY INFORMATION
Products Liability
Check the box (if applicable): Indicates the type of policy is a products liability policy.
POLICY INFORMATION
Manufacturers Products
Check the box (if applicable): Indicates Manufacturers Products is the line of business subcode
that further refines the line of business code.
POLICY INFORMATION
Petroleum Liability
Check the box (if applicable): Indicates Petroleum Liability is the line of business subcode that
further refines the line of business code.
ACORD 325 (2013/09)
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POLICY INFORMATION
Run-Off
Check the box (if applicable): Indicates Run Off is the line of business subcode that further
refines the line of business code.
POLICY INFORMATION
Excess
Check the box (if applicable): Indicates Excess is the line of business subcode that further
refines the line of business code.
POLICY INFORMATION
Quota Share
Check the box (if applicable): Indicates Quota Share is the line of business subcode that further
refines the line of business code.
POLICY INFORMATION
Other Policy Type Six
Check the box (if applicable): Indicates the line of business subcode that further refines the line
of business code is other than those listed.
POLICY INFORMATION
Describe Other Policy Type
Six
Enter text: The line of business subcode that further refines the line of business code.
APPLICANT INFORMATION
(See Partners Section for
Additional Named Insured)
First Named Insured's Name
and Address
Enter text: The named insured(s) as it/they will appear on the policy declarations page.
APPLICANT INFORMATION
(See Partners Section for
Additional Named Insured)
Enter text: The named insured's mailing address line one.
APPLICANT INFORMATION
(See Partners Section for
Additional Named Insured)
Enter text: The named insured's mailing address line two.
APPLICANT INFORMATION
(See Partners Section for
Additional Named Insured)
Enter text: The named insured's mailing address city name.
APPLICANT INFORMATION
(See Partners Section for
Additional Named Insured)
Enter code: The named insured's mailing address state or province code.
APPLICANT INFORMATION
(See Partners Section for
Additional Named Insured)
Enter code: The named insured's mailing address postal code.
APPLICANT INFORMATION
(See Partners Section for
Additional Named Insured)
Home Phone
Enter number: The named insured's primary phone number. As used here, this is the home
phone number.
APPLICANT INFORMATION
(See Partners Section for
Additional Named Insured)
Business Phone
Enter number: The named insured's secondary phone number. As used here, this is the
business phone number.
ACORD 325 (2013/09)
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APPLICANT INFORMATION
(See Partners Section for
Additional Named Insured)
Mobile Phone
Enter number: The third phone number of the named insured. As used here, this is the cell
phone number.
APPLICANT INFORMATION
(See Partners Section for
Additional Named Insured)
Fax No. (A/C, No, Ext)
Enter number: The named insured's fax number.
APPLICANT INFORMATION
(See Partners Section for
Additional Named Insured)
Individual
Check the box (if applicable): Indicates the legal entity code for the named insured is
Individual.
APPLICANT INFORMATION
(See Partners Section for
Additional Named Insured)
Partnership
Check the box (if applicable): Indicates the legal entity code for the named insured is
Partnership.
APPLICANT INFORMATION
(See Partners Section for
Additional Named Insured)
Corporation
Check the box (if applicable): Indicates the legal entity code for the named insured is
Corporation.
APPLICANT INFORMATION
(See Partners Section for
Additional Named Insured)
Joint Venture
Check the box (if applicable): Indicates the legal entity code for the named insured is Joint
Venture.
APPLICANT INFORMATION
(See Partners Section for
Additional Named Insured)
Subchapter S Corp
Check the box (if applicable): Indicates the legal entity code for the named insured is
Subchapter S Corporation.
APPLICANT INFORMATION
(See Partners Section for
Additional Named Insured)
Not for Profit
Check the box (if applicable): Indicates the legal entity code for the named insured is Not For
Profit Organization.
APPLICANT INFORMATION
(See Partners Section for
Additional Named Insured)
LLC
Check the box (if applicable): Indicates the legal entity code for the named insured is Limited
Liability Corporation.
APPLICANT INFORMATION
(See Partners Section for
Additional Named Insured)
Other Legal Entity
Check the box (if applicable): Indicates the legal entity code for the named insured is not listed
on the form.
APPLICANT INFORMATION
(See Partners Section for
Additional Named Insured)
Describe Other Legal Entity
Enter text: The description of the legal entity if not listed on the form.
APPLICANT INFORMATION
(See Partners Section for
Additional Named Insured)
Email Address
Enter text: The named insured's primary e-mail address.
ACORD 325 (2013/09)
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APPLICANT INFORMATION
(See Partners Section for
Additional Named Insured)
Website Address
Enter text: The primary website address for the named insured.
APPLICANT INFORMATION
(See Partners Section for
Additional Named Insured)
FEIN
Enter identifier: The tax identifier of the named insured. As used here, this is the FEIN number.
APPLICANT INFORMATION
(See Partners Section for
Additional Named Insured)
Social Security Number
Enter identifier: The tax identifier of the named insured. As used here, this is the social security
number.
APPLICANT INFORMATION
(See Partners Section for
Additional Named Insured)
Ownership Percentage
Enter percentage: The percentage of ownership the named insured has in the item.
APPLICANT INFORMATION
(See Partners Section for
Additional Named Insured)
Occupation
Enter text: The named insured's primary occupation or business activity.
APPLICANT INFORMATION
(See Partners Section for
Additional Named Insured)
Title
Enter text: The title of the individual in the organization or his relationship to the organization.
APPLICANT INFORMATION
(See Partners Section for
Additional Named Insured)
Date Business Started
Enter date: The date the current owners purchased or started the business.
APPLICANT INFORMATION
(See Partners Section for
Additional Named Insured)
Inspection Contact Name
Enter text: The name of the person to contact to arrange for a premises inspection. This should
be an individual under the insured's employment, not the insurance agent's name and number.
APPLICANT INFORMATION
(See Partners Section for
Additional Named Insured)
Inspection Contact Phone
Enter number: The telephone number of the person to contact to arrange for a premises
inspection. This should be an individual under the insured's employment.
APPLICANT INFORMATION
(See Partners Section for
Additional Named Insured)
Inspection Contact Email
Enter text: The e-mail address (if applicable) of the person to contact to arrange for a premises
inspection. This should be an individual under the insured's employment, not the insurance
agent's name and number.
APPLICANT INFORMATION
(See Partners Section for
Additional Named Insured)
Accounting Records
Contact Name
Enter text: The name of the person to contact for accounting information. This should be an
individual under the insured's employment, not the insurance agent.
APPLICANT INFORMATION
(See Partners Section for
Additional Named Insured)
Accounting Records
Contact Phone
Enter number: The telephone number of the person to contact for accounting information. This
should be an individual under the insured's employment, not the insurance agent's name and
number.
ACORD 325 (2013/09)
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APPLICANT INFORMATION
(See Partners Section for
Additional Named Insured)
Accounting Records
Contact E-mail Address
Enter text: The e-mail address (if applicable) of the person to contact for accounting information.
This should be an individual under the insured's employment, not the insurance agent's name
and number.
PARTNERS
Name and Address
Enter text: The named insured(s) as it/they will appear on the policy declarations page. As used
here, this information is for a partner.
PARTNERS
Enter text: The named insured's mailing address line one. As used here, this information is for a
partner.
PARTNERS
Enter text: The named insured's mailing address line two. As used here, this information is for a
partner.
PARTNERS
Enter text: The named insured's mailing address city name. As used here, this information is for
a partner.
PARTNERS
Enter code: The named insured's mailing address state or province code. As used here, this
information is for a partner.
PARTNERS
Enter code: The named insured's mailing address postal code. As used here, this information is
for a partner.
PARTNERS
E-Mail Address
Enter text: The named insured's primary e-mail address. As used here, this information is for a
partner.
PARTNERS
FEIN
Enter identifier: The tax identifier of the named insured. As used here, this information is for a
partner.
PARTNERS
Social Security Number
Enter identifier: The tax identifier of the named insured. As used here, this information is for a
partner.
PARTNERS
Ownership Percentage
Enter percentage: The percentage of ownership the named insured has in the item. As used
here, this information is for a partner.
PARTNERS
Occupation
Enter text: The named insured's primary occupation or business activity. As used here, this
information is for a partner.
PARTNERS
Title
Enter text: The title of the individual in the organization or his relationship to the organization. As
used here, this information is for a partner.
PARTNERS
Home Phone
Enter number: The named insured's primary phone number. As used here, this is the home
phone for a partner.
PARTNERS
Business Phone
Enter number: The named insured's secondary phone number. As used here, this is the
business phone for a partner.
PARTNERS
Mobile Phone
Enter number: The third phone number of the named insured. As used here, this is the cell
phone for a partner.
PARTNERS
Name and Address
Enter text: The named insured(s) as it/they will appear on the policy declarations page. As used
here, this information is for a partner.
ACORD 325 (2013/09)
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PARTNERS
Enter text: The named insured's mailing address line one. As used here, this information is for a
partner.
PARTNERS
Enter text: The named insured's mailing address line two. As used here, this information is for a
partner.
PARTNERS
Enter text: The named insured's mailing address city name. As used here, this information is for
a partner.
PARTNERS
Enter code: The named insured's mailing address state or province code. As used here, this
information is for a partner.
PARTNERS
Enter code: The named insured's mailing address postal code. As used here, this information is
for a partner.
PARTNERS
E-Mail Address
Enter text: The named insured's primary e-mail address. As used here, this information is for a
partner.
PARTNERS
FEIN
Enter identifier: The tax identifier of the named insured. As used here, this information is for a
partner.
PARTNERS
Social Security Number
Enter identifier: The tax identifier of the named insured. As used here, this information is for a
partner.
PARTNERS
Ownership Percentage
Enter percentage: The percentage of ownership the named insured has in the item. As used
here, this information is for a partner.
PARTNERS
Occupation
Enter text: The named insured's primary occupation or business activity. As used here, this
information is for a partner.
PARTNERS
Title
Enter text: The title of the individual in the organization or his relationship to the organization. As
used here, this information is for a partner.
PARTNERS
Home Phone
Enter number: The named insured's primary phone number. As used here, this is the home
phone for a partner.
PARTNERS
Business Phone
Enter number: The named insured's secondary phone number. As used here, this is the
business phone for a partner.
PARTNERS
Mobile Phone
Enter number: The third phone number of the named insured. As used here, this is the cell
phone for a partner.
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).
ACORD 325 (2013/09)
Page 10 of 25
NATURE OF BUSINESS /
DESCRIPTION OF
OPERATIONS
Aerial Photography
Check the box (if applicable): Indicates the nature of business is aerial photography.
NATURE OF BUSINESS /
DESCRIPTION OF
OPERATIONS
Agricultural Aerial
Applications
Check the box (if applicable): Indicates the nature of business is agricultural aerial applications.
NATURE OF BUSINESS /
DESCRIPTION OF
OPERATIONS
Aircraft Assembly
Check the box (if applicable): Indicates the nature of business is aircraft assembly.
NATURE OF BUSINESS /
DESCRIPTION OF
OPERATIONS
Aircraft Museum
Check the box (if applicable): Indicates the nature of business is aircraft museum.
NATURE OF BUSINESS /
DESCRIPTION OF
OPERATIONS
Aircraft Part Sales
Check the box (if applicable): Indicates the nature of business is aircraft part sales.
NATURE OF BUSINESS /
DESCRIPTION OF
OPERATIONS
Aircraft Parts Manufacturer
Check the box (if applicable): Indicates the nature of business is aircraft parts manufacturer.
NATURE OF BUSINESS /
DESCRIPTION OF
OPERATIONS
Aircraft Repair
Check the box (if applicable): Indicates the nature of business is aircraft repair.
NATURE OF BUSINESS /
DESCRIPTION OF
OPERATIONS
Aircraft Sales
Check the box (if applicable): Indicates the nature of business is aircraft sales.
NATURE OF BUSINESS /
DESCRIPTION OF
OPERATIONS
Airline
Check the box (if applicable): Indicates the nature of business is an airline.
NATURE OF BUSINESS /
DESCRIPTION OF
OPERATIONS
Aviation Modification
Services
Check the box (if applicable): Indicates the nature of business is aviation modification services.
NATURE OF BUSINESS /
DESCRIPTION OF
OPERATIONS
Avionics
Check the box (if applicable): Indicates the nature of business is avionics.
NATURE OF BUSINESS /
DESCRIPTION OF
OPERATIONS
Charter Operation
Check the box (if applicable): Indicates the nature of business is charter operations.
ACORD 325 (2013/09)
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NATURE OF BUSINESS /
DESCRIPTION OF
OPERATIONS
Distributors
Check the box (if applicable): Indicates the nature of business is a distributor.
NATURE OF BUSINESS /
DESCRIPTION OF
OPERATIONS
Fixed Based Operator
Check the box (if applicable): Indicates the nature of business is a fixed based operator.
NATURE OF BUSINESS /
DESCRIPTION OF
OPERATIONS
Flight School
Check the box (if applicable): Indicates the nature of business is a flight school.
NATURE OF BUSINESS /
DESCRIPTION OF
OPERATIONS
Fuel Farm
Check the box (if applicable): Indicates the nature of business is a fuel farm.
NATURE OF BUSINESS /
DESCRIPTION OF
OPERATIONS
Helicopter Operator
Check the box (if applicable): Indicates the nature of business is helicopter operator.
NATURE OF BUSINESS /
DESCRIPTION OF
OPERATIONS
Holding Company
Check the box (if applicable): Indicates the nature of business is a holding company.
NATURE OF BUSINESS /
DESCRIPTION OF
OPERATIONS
Private Hangar
Check the box (if applicable): Indicates the nature of business is a private hangar.
NATURE OF BUSINESS /
DESCRIPTION OF
OPERATIONS
Orig Equipment
Designers/Manufacturers
Check the box (if applicable): Indicates the nature of business is an original equipment designer
and / or manufacturer.
NATURE OF BUSINESS /
DESCRIPTION OF
OPERATIONS
Regional/Municipal Airport
Check the box (if applicable): Indicates the nature of business is a regional or municipal airport.
NATURE OF BUSINESS /
DESCRIPTION OF
OPERATIONS
Repair Services
Check the box (if applicable): Indicates the nature of business is repair services.
NATURE OF BUSINESS /
DESCRIPTION OF
OPERATIONS
Subcontractors
Check the box (if applicable): Indicates the nature of business is subcontractor.
NATURE OF BUSINESS /
DESCRIPTION OF
OPERATIONS
Other Nature of Business
Check the box (if applicable): Indicates the nature of business is other than those listed.
ACORD 325 (2013/09)
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NATURE OF BUSINESS /
DESCRIPTION OF
OPERATIONS
Description of Other Nature
of Business
Enter text: The description of the nature/type of business.
NATURE OF BUSINESS /
DESCRIPTION OF
OPERATIONS
Description of Operations
Enter text: The description of the operations of this risk. A restatement of the products
classification wording is often not sufficient (e.g., Metal Goods Manufacturing NOC could
include anything from paper clips to bridge girders).
PARENT AND SUBSIDIARY
INFORMATION
Is the applicant a subsidiary
of another entity?
Enter Y for a Yes response. Input N for No response. Indicates the response to the question,
Is this company a subsidiary of another entity?.
PARENT AND SUBSIDIARY
INFORMATION
Parent Company
Enter text: The name of the parent organization.
PARENT AND SUBSIDIARY
INFORMATION
Street, City, State, Zip
Enter text: The first address line of the parent organization's mailing address.
PARENT AND SUBSIDIARY
INFORMATION
Enter text: The second address line of the parent organization's mailing address.
PARENT AND SUBSIDIARY
INFORMATION
Enter text: The city of the parent organization's mailing address.
PARENT AND SUBSIDIARY
INFORMATION
Enter code: The state or province code of the parent organization's mailing address.
PARENT AND SUBSIDIARY
INFORMATION
Enter code: The postal code of the parent organization's mailing address.
PARENT AND SUBSIDIARY
INFORMATION
Does the applicant have any
owned, subsidiary,
affiliated, managed or
controlled companies?
Enter Y for a Yes response. Input N for No response. Indicates the response to the question,
Does the applicant have any owned, subsidiary, affiliated, managed, or controlled companies?.
PARENT AND SUBSIDIARY
INFORMATION
Company Name, street, city,
state, zip
Enter text: The name of the subsidiary of the company. This may also contain owned
foundations or charitable trusts.
PARENT AND SUBSIDIARY
INFORMATION
Enter text: The first address line of the subsidiary's mailing address.
PARENT AND SUBSIDIARY
INFORMATION
Enter text: The second address line of the subsidiary's mailing address.
PARENT AND SUBSIDIARY
INFORMATION
Enter text: The city of the subsidiary's mailing address.
PARENT AND SUBSIDIARY
INFORMATION
Enter code: The state or province code of the subsidiary's mailing address.
ACORD 325 (2013/09)
Page 13 of 25
PARENT AND SUBSIDIARY
INFORMATION
Enter code: The postal code of the subsidiary's mailing address.
PARENT AND SUBSIDIARY
INFORMATION
Business Start Date
Enter date: The date the subsidiary, foundation or charitable trust was acquired / created.
PARENT AND SUBSIDIARY
INFORMATION
Owned
Check the box (if applicable): Indicates the business is owned by the insured.
PARENT AND SUBSIDIARY
INFORMATION
Subsidiary
Check the box (if applicable): Indicates the business is a subsidiary of the insured.
PARENT AND SUBSIDIARY
INFORMATION
Affiliated
Check the box (if applicable): Indicates the business is a affiliated with the insured.
PARENT AND SUBSIDIARY
INFORMATION
Managed
Check the box (if applicable): Indicates the business is managed by the insured.
PARENT AND SUBSIDIARY
INFORMATION
Controlled
Check the box (if applicable): Indicates the business is controlled by the insured.
PARENT AND SUBSIDIARY
INFORMATION
Other Company Type
Check the box (if applicable): Indicates the relationship of the subsidiary to the insured is other
than those listed.
PARENT AND SUBSIDIARY
INFORMATION
Other Company Type
Description
Enter text: The description of the relationship between the parent company and the subsidiary.
PARENT AND SUBSIDIARY
INFORMATION
Company Name, street, city,
state, zip
Enter text: The name of the subsidiary of the company. This may also contain owned
foundations or charitable trusts.
PARENT AND SUBSIDIARY
INFORMATION
Enter text: The first address line of the subsidiary's mailing address.
PARENT AND SUBSIDIARY
INFORMATION
Enter text: The second address line of the subsidiary's mailing address.
PARENT AND SUBSIDIARY
INFORMATION
Enter text: The city of the subsidiary's mailing address.
PARENT AND SUBSIDIARY
INFORMATION
Enter code: The state or province code of the subsidiary's mailing address.
PARENT AND SUBSIDIARY
INFORMATION
Enter code: The postal code of the subsidiary's mailing address.
PARENT AND SUBSIDIARY
INFORMATION
Business Start Date
Enter date: The date the subsidiary, foundation or charitable trust was acquired / created.
PARENT AND SUBSIDIARY
INFORMATION
Owned
Check the box (if applicable): Indicates the business is owned by the insured.
ACORD 325 (2013/09)
Page 14 of 25
PARENT AND SUBSIDIARY
INFORMATION
Subsidiary
Check the box (if applicable): Indicates the business is a subsidiary of the insured.
PARENT AND SUBSIDIARY
INFORMATION
Affiliated
Check the box (if applicable): Indicates the business is a affiliated with the insured.
PARENT AND SUBSIDIARY
INFORMATION
Managed
Check the box (if applicable): Indicates the business is managed by the insured.
PARENT AND SUBSIDIARY
INFORMATION
Controlled
Check the box (if applicable): Indicates the business is controlled by the insured.
PARENT AND SUBSIDIARY
INFORMATION
Other Company Type
Check the box (if applicable): Indicates the relationship of the subsidiary to the insured is other
than those listed.
PARENT AND SUBSIDIARY
INFORMATION
Other Company Type
Description
Enter text: The description of the relationship between the parent company and the subsidiary.
PARENT AND SUBSIDIARY
INFORMATION
Company Name, street, city,
state, zip
Enter text: The name of the subsidiary of the company. This may also contain owned
foundations or charitable trusts.
PARENT AND SUBSIDIARY
INFORMATION
Enter text: The first address line of the subsidiary's mailing address.
PARENT AND SUBSIDIARY
INFORMATION
Enter text: The second address line of the subsidiary's mailing address.
PARENT AND SUBSIDIARY
INFORMATION
Enter text: The city of the subsidiary's mailing address.
PARENT AND SUBSIDIARY
INFORMATION
Enter code: The state or province code of the subsidiary's mailing address.
PARENT AND SUBSIDIARY
INFORMATION
Enter code: The postal code of the subsidiary's mailing address.
PARENT AND SUBSIDIARY
INFORMATION
Business Start Date
Enter date: The date the subsidiary, foundation or charitable trust was acquired / created.
PARENT AND SUBSIDIARY
INFORMATION
Owned
Check the box (if applicable): Indicates the business is owned by the insured.
PARENT AND SUBSIDIARY
INFORMATION
Subsidiary
Check the box (if applicable): Indicates the business is a subsidiary of the insured.
PARENT AND SUBSIDIARY
INFORMATION
Affiliated
Check the box (if applicable): Indicates the business is a affiliated with the insured.
PARENT AND SUBSIDIARY
INFORMATION
Managed
Check the box (if applicable): Indicates the business is managed by the insured.
ACORD 325 (2013/09)
Page 15 of 25
PARENT AND SUBSIDIARY
INFORMATION
Controlled
Check the box (if applicable): Indicates the business is controlled by the insured.
PARENT AND SUBSIDIARY
INFORMATION
Other Company Type
Check the box (if applicable): Indicates the relationship of the subsidiary to the insured is other
than those listed.
PARENT AND SUBSIDIARY
INFORMATION
Other Company Type
Description
Enter text: The description of the relationship between the parent company and the subsidiary.
PARENT AND SUBSIDIARY
INFORMATION
Distributors
Check the box (if applicable): Indicates the nature of business is a distributor. As used here,
indicates all related companies have the same nature of business.
PARENT AND SUBSIDIARY
INFORMATION
Repair Service
Check the box (if applicable): Indicates the nature of business is repair services. As used here,
indicates all related companies have the same nature of business.
PARENT AND SUBSIDIARY
INFORMATION
Modification Service
Check the box (if applicable): Indicates the nature of business is aviation modification services.
As used here, indicates all related companies have the same nature of business.
PARENT AND SUBSIDIARY
INFORMATION
Subcontractors
Check the box (if applicable): Indicates the nature of business is subcontractor. As used here,
indicates all related companies have the same nature of business.
PARENT AND SUBSIDIARY
INFORMATION
Orig Equipment
Designers/Manufacturers
Check the box (if applicable): Indicates the nature of business is an original equipment designer
and / or manufacturer. As used here, indicates all related companies have the same nature of
business.
PARENT AND SUBSIDIARY
INFORMATION
Other
Check the box (if applicable): Indicates the nature of business is other than those listed. As used
here, indicates all related companies have the same nature of business.
PARENT AND SUBSIDIARY
INFORMATION
Describe Other
Enter text: The description of the nature/type of business. As used here, the nature of business
of all related companies.
AIRPORT AND BUILDING
INFORMATION
Location Number
Enter number: The producer assigned number of the location.
AIRPORT AND BUILDING
INFORMATION
Building Number
Enter number: The building number for the premises. Used when more than one building exists
at an individual location.
AIRPORT AND BUILDING
INFORMATION
Airport Number
Enter identifier: The Federal Aviation Administration's designator for the airport (e.g. ORD -
O'Hare International Airport).
AIRPORT AND BUILDING
INFORMATION
Name, Street, City, State, Zip
Enter text: The full name of the location.
AIRPORT AND BUILDING
INFORMATION
Enter text: The first address line of the physical location.
AIRPORT AND BUILDING
INFORMATION
Enter text: The second address line of the physical location.
ACORD 325 (2013/09)
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AIRPORT AND BUILDING
INFORMATION
Enter text: The city of the physical location.
AIRPORT AND BUILDING
INFORMATION
Enter code: The state or province of the physical location.
AIRPORT AND BUILDING
INFORMATION
Enter code: The postal code of the physical location.
AIRPORT AND BUILDING
INFORMATION
On Airport
Check the box (if applicable): Indicates, for rating purposes, the location is situated on an
airport.
AIRPORT AND BUILDING
INFORMATION
Off Airport
Check the box (if applicable): Indicates, for rating purposes, the location is situated off an
airport.
AIRPORT AND BUILDING
INFORMATION
Owner
Check the box (if applicable): Indicates the named insured's interest in the building is as its
owner.
AIRPORT AND BUILDING
INFORMATION
Tenant
Check the box (if applicable): Indicates the named insured's interest in the building is as its
tenant.
AIRPORT AND BUILDING
INFORMATION
Other Interest
Check the box (if applicable): Indicates the named insured's interest in the building is other than
as its owner or tenant.
AIRPORT AND BUILDING
INFORMATION
Describe Other Interest
Enter text: The description of the insured's interest in the building when it is other than as its
owner or tenant.
AIRPORT AND BUILDING
INFORMATION
Annual Revenue
Enter amount: The annual revenue amount for this location.
AIRPORT AND BUILDING
INFORMATION
Percentage Occupied
Enter percentage: The percentage of the building the named Insured or tenant occupies.
AIRPORT AND BUILDING
INFORMATION
Number of Employees
Enter number: The total number of employee in this location.
AIRPORT AND BUILDING
INFORMATION
Year 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.
AIRPORT AND BUILDING
INFORMATION
Aerial Photography
Check the box (if applicable): Indicates the nature of business is aerial photography.
AIRPORT AND BUILDING
INFORMATION
Agricultural Aerial
Applications
Check the box (if applicable): Indicates the nature of business is agricultural aerial applications.
AIRPORT AND BUILDING
INFORMATION
Aircraft Assembly
Check the box (if applicable): Indicates the nature of business is aircraft assembly.
AIRPORT AND BUILDING
INFORMATION
Aircraft Museum
Check the box (if applicable): Indicates the nature of business is aircraft museum.
ACORD 325 (2013/09)
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AIRPORT AND BUILDING
INFORMATION
Aircraft Part Sales
Check the box (if applicable): Indicates the nature of business is aircraft part sales.
AIRPORT AND BUILDING
INFORMATION
Aircraft Parts Manufacturer
Check the box (if applicable): Indicates the nature of business is aircraft parts manufacturer.
AIRPORT AND BUILDING
INFORMATION
Aircraft Repair
Check the box (if applicable): Indicates the nature of business is aircraft repair.
AIRPORT AND BUILDING
INFORMATION
Aircraft Sales
Check the box (if applicable): Indicates the nature of business is aircraft sales.
AIRPORT AND BUILDING
INFORMATION
Airline
Check the box (if applicable): Indicates the nature of business is an airline.
AIRPORT AND BUILDING
INFORMATION
Aviation Modification
Services
Check the box (if applicable): Indicates the nature of business is aviation modification services.
AIRPORT AND BUILDING
INFORMATION
Avionics
Check the box (if applicable): Indicates the nature of business is avionics.
AIRPORT AND BUILDING
INFORMATION
Charter Operation
Check the box (if applicable): Indicates the nature of business is charter operations.
AIRPORT AND BUILDING
INFORMATION
Distributors
Check the box (if applicable): Indicates the nature of business is a distributor.
AIRPORT AND BUILDING
INFORMATION
Fixed Based Operator
Check the box (if applicable): Indicates the nature of business is a fixed based operator.
AIRPORT AND BUILDING
INFORMATION
Flight School
Check the box (if applicable): Indicates the nature of business is a flight school.
AIRPORT AND BUILDING
INFORMATION
Fuel Farm
Check the box (if applicable): Indicates the nature of business is a fuel farm.
AIRPORT AND BUILDING
INFORMATION
Helicopter Operator
Check the box (if applicable): Indicates the nature of business is helicopter operator.
AIRPORT AND BUILDING
INFORMATION
Holding Company
Check the box (if applicable): Indicates the nature of business is a holding company.
AIRPORT AND BUILDING
INFORMATION
Private Hangar
Check the box (if applicable): Indicates the nature of business is a private hangar.
AIRPORT AND BUILDING
INFORMATION
Orig Equipment
Designers/Manufacturers
Check the box (if applicable): Indicates the nature of business is an original equipment designer
and / or manufacturer.
AIRPORT AND BUILDING
INFORMATION
Regional/Municipal Airport
Check the box (if applicable): Indicates the nature of business is a regional or municipal airport.
ACORD 325 (2013/09)
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AIRPORT AND BUILDING
INFORMATION
Repair Services
Check the box (if applicable): Indicates the nature of business is repair services.
AIRPORT AND BUILDING
INFORMATION
Subcontractors
Check the box (if applicable): Indicates the nature of business is subcontractor.
AIRPORT AND BUILDING
INFORMATION
Other Nature of Business
Check the box (if applicable): Indicates the nature of business is other than those listed.
AIRPORT AND BUILDING
INFORMATION
Description of Other Nature
of Business
Enter text: The description of the nature/type of business.
AIRPORT AND BUILDING
INFORMATION
Description of Operations
Enter text: The description of the operations of this risk. A restatement of the products
classification wording is often not sufficient (e.g., Metal Goods Manufacturing NOC could
include anything from paper clips to bridge girders).
AIRPORT AND BUILDING
INFORMATION
Location Number
Enter number: The producer assigned number of the location.
AIRPORT AND BUILDING
INFORMATION
Building Number
Enter number: The building number for the premises. Used when more than one building exists
at an individual location.
AIRPORT AND BUILDING
INFORMATION
Airport Number
Enter identifier: The Federal Aviation Administration's designator for the airport (e.g. ORD -
O'Hare International Airport).
AIRPORT AND BUILDING
INFORMATION
Name, Street, City, State, Zip
Enter text: The full name of the location.
AIRPORT AND BUILDING
INFORMATION
Enter text: The first address line of the physical location.
AIRPORT AND BUILDING
INFORMATION
Enter text: The second address line of the physical location.
AIRPORT AND BUILDING
INFORMATION
Enter text: The city of the physical location.
AIRPORT AND BUILDING
INFORMATION
Enter code: The state or province of the physical location.
AIRPORT AND BUILDING
INFORMATION
Enter code: The postal code of the physical location.
AIRPORT AND BUILDING
INFORMATION
On Airport
Check the box (if applicable): Indicates, for rating purposes, the location is situated on an
airport.
AIRPORT AND BUILDING
INFORMATION
Off Airport
Check the box (if applicable): Indicates, for rating purposes, the location is situated off an
airport.
ACORD 325 (2013/09)
Page 19 of 25
AIRPORT AND BUILDING
INFORMATION
Owner
Check the box (if applicable): Indicates the named insured's interest in the building is as its
owner.
AIRPORT AND BUILDING
INFORMATION
Tenant
Check the box (if applicable): Indicates the named insured's interest in the building is as its
tenant.
AIRPORT AND BUILDING
INFORMATION
Other Interest
Check the box (if applicable): Indicates the named insured's interest in the building is other than
as its owner or tenant.
AIRPORT AND BUILDING
INFORMATION
Describe Other Interest
Enter text: The description of the insured's interest in the building when it is other than as its
owner or tenant.
AIRPORT AND BUILDING
INFORMATION
Annual Revenue
Enter amount: The annual revenue amount for this location.
AIRPORT AND BUILDING
INFORMATION
Percentage Occupied
Enter percentage: The percentage of the building the named Insured or tenant occupies.
AIRPORT AND BUILDING
INFORMATION
Number of Employees
Enter number: The total number of employee in this location.
AIRPORT AND BUILDING
INFORMATION
Year 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.
AIRPORT AND BUILDING
INFORMATION
Aerial Photography
Check the box (if applicable): Indicates the nature of business is aerial photography.
AIRPORT AND BUILDING
INFORMATION
Agricultural Aerial
Applications
Check the box (if applicable): Indicates the nature of business is agricultural aerial applications.
AIRPORT AND BUILDING
INFORMATION
Aircraft Assembly
Check the box (if applicable): Indicates the nature of business is aircraft assembly.
AIRPORT AND BUILDING
INFORMATION
Aircraft Museum
Check the box (if applicable): Indicates the nature of business is aircraft museum.
AIRPORT AND BUILDING
INFORMATION
Aircraft Part Sales
Check the box (if applicable): Indicates the nature of business is aircraft part sales.
AIRPORT AND BUILDING
INFORMATION
Aircraft Parts Manufacturer
Check the box (if applicable): Indicates the nature of business is aircraft parts manufacturer.
AIRPORT AND BUILDING
INFORMATION
Aircraft Repair
Check the box (if applicable): Indicates the nature of business is aircraft repair.
AIRPORT AND BUILDING
INFORMATION
Aircraft Sales
Check the box (if applicable): Indicates the nature of business is aircraft sales.
AIRPORT AND BUILDING
INFORMATION
Airline
Check the box (if applicable): Indicates the nature of business is an airline.
ACORD 325 (2013/09)
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AIRPORT AND BUILDING
INFORMATION
Aviation Modification
Services
Check the box (if applicable): Indicates the nature of business is aviation modification services.
AIRPORT AND BUILDING
INFORMATION
Avionics
Check the box (if applicable): Indicates the nature of business is avionics.
AIRPORT AND BUILDING
INFORMATION
Charter Operation
Check the box (if applicable): Indicates the nature of business is charter operations.
AIRPORT AND BUILDING
INFORMATION
Distributors
Check the box (if applicable): Indicates the nature of business is a distributor.
AIRPORT AND BUILDING
INFORMATION
Fixed Based Operator
Check the box (if applicable): Indicates the nature of business is a fixed based operator.
AIRPORT AND BUILDING
INFORMATION
Flight School
Check the box (if applicable): Indicates the nature of business is a flight school.
AIRPORT AND BUILDING
INFORMATION
Fuel Farm
Check the box (if applicable): Indicates the nature of business is a fuel farm.
AIRPORT AND BUILDING
INFORMATION
Helicopter Operator
Check the box (if applicable): Indicates the nature of business is helicopter operator.
AIRPORT AND BUILDING
INFORMATION
Holding Company
Check the box (if applicable): Indicates the nature of business is a holding company.
AIRPORT AND BUILDING
INFORMATION
Private Hangar
Check the box (if applicable): Indicates the nature of business is a private hangar.
AIRPORT AND BUILDING
INFORMATION
Orig Equipment
Designers/Manufacturers
Check the box (if applicable): Indicates the nature of business is an original equipment designer
and / or manufacturer.
AIRPORT AND BUILDING
INFORMATION
Regional/Municipal Airport
Check the box (if applicable): Indicates the nature of business is a regional or municipal airport.
AIRPORT AND BUILDING
INFORMATION
Repair Services
Check the box (if applicable): Indicates the nature of business is repair services.
AIRPORT AND BUILDING
INFORMATION
Subcontractors
Check the box (if applicable): Indicates the nature of business is subcontractor.
AIRPORT AND BUILDING
INFORMATION
Other Nature of Business
Check the box (if applicable): Indicates the nature of business is other than those listed.
AIRPORT AND BUILDING
INFORMATION
Description of Other Nature
of Business
Enter text: The description of the nature/type of business.
ACORD 325 (2013/09)
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AIRPORT AND BUILDING
INFORMATION
Description of Operations
Enter text: The description of the operations of this risk. A restatement of the products
classification wording is often not sufficient (e.g., Metal Goods Manufacturing NOC could
include anything from paper clips to bridge girders).
Form Page 3
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).
PRIOR CARRIER
Name of Last of Present
Aviation Insurance Carrier
Enter text: The name of the previous insurer. As used here, this is the name of the last or
present aviation insurance carrier.
PRIOR CARRIER
Line of Business
Enter text: The type of policy issued to the insured. e. g., personal auto, truckers, garage liability.
PRIOR CARRIER
Policy Number
Enter identifier: The policy number of the previous coverage.
PRIOR CARRIER
Expiration Date
Enter date: The expiration date of the previous coverage.
PRIOR CARRIER
Name of Last of Present
Aviation Insurance Carrier
Enter text: The name of the previous insurer. As used here, this is the name of the last or
present aviation insurance carrier.
PRIOR CARRIER
Line of Business
Enter text: The type of policy issued to the insured. e. g., personal auto, truckers, garage liability.
PRIOR CARRIER
Policy Number
Enter identifier: The policy number of the previous coverage.
PRIOR CARRIER
Expiration Date
Enter date: The expiration date of the previous coverage.
PRIOR CARRIER
Name of Last of Present
Aviation Insurance Carrier
Enter text: The name of the previous insurer. As used here, this is the name of the last or
present aviation insurance carrier.
PRIOR CARRIER
Line of Business
Enter text: The type of policy issued to the insured. e. g., personal auto, truckers, garage liability.
PRIOR CARRIER
Policy Number
Enter identifier: The policy number of the previous coverage.
PRIOR CARRIER
Expiration Date
Enter date: The expiration date of the previous coverage.
PRIOR CARRIER
Name of Last of Present
Aviation Insurance Carrier
Enter text: The name of the previous insurer. As used here, this is the name of the last or
present aviation insurance carrier.
PRIOR CARRIER
Line of Business
Enter text: The type of policy issued to the insured. e. g., personal auto, truckers, garage liability.
PRIOR CARRIER
Policy Number
Enter identifier: The policy number of the previous coverage.
PRIOR CARRIER
Expiration Date
Enter date: The expiration date of the previous coverage.
PRIOR CARRIER
Name of Last of Present
Aviation Insurance Carrier
Enter text: The name of the previous insurer. As used here, this is the name of the last or
present aviation insurance carrier.
ACORD 325 (2013/09)
Page 22 of 25
PRIOR CARRIER
Line of Business
Enter text: The type of policy issued to the insured. e. g., personal auto, truckers, garage liability.
PRIOR CARRIER
Policy Number
Enter identifier: The policy number of the previous coverage.
PRIOR CARRIER
Expiration Date
Enter date: The expiration date of the previous coverage.
LOSS HISTORY
Have you had aviation
losses?
Enter Y for a Yes response. Input N for No response. Indicates the response to the question,
Have you had any aviation losses?.
LOSS HISTORY
Name of Carrier
Enter text: The name of the insurance carrier at the time of loss.
LOSS HISTORY
Policy Number
Enter identifier: The policy number at the time of loss.
LOSS HISTORY
Policy Type
Enter text: The line of business involved in the loss (e.g. Automobile Liability, Property, General
Liability).
LOSS HISTORY
Type of Loss
Enter code: The basic coverage provided, under which the loss was incurred.
LOSS HISTORY
Date of Loss
Enter date: The date when the accident or incident occurred that resulted in the filing of a claim.
LOSS HISTORY
Date Reported
Enter date: The date the claim was filed.
LOSS HISTORY
Claim Status
Enter code: Indicates the status of the claim (e.g. open, closed, etc.).
LOSS HISTORY
Amount Paid
Enter amount: The amount that has been paid on this claim to date.
LOSS HISTORY
Description of Occurrence
Enter text: A brief description of the loss.
LOSS HISTORY
Name of Carrier
Enter text: The name of the insurance carrier at the time of loss.
LOSS HISTORY
Policy Number
Enter identifier: The policy number at the time of loss.
LOSS HISTORY
Policy Type
Enter text: The line of business involved in the loss (e.g. Automobile Liability, Property, General
Liability).
LOSS HISTORY
Type of Loss
Enter code: The basic coverage provided, under which the loss was incurred.
LOSS HISTORY
Date of Loss
Enter date: The date when the accident or incident occurred that resulted in the filing of a claim.
LOSS HISTORY
Date Reported
Enter date: The date the claim was filed.
LOSS HISTORY
Claim Status
Enter code: Indicates the status of the claim (e.g. open, closed, etc.).
LOSS HISTORY
Amount Paid
Enter amount: The amount that has been paid on this claim to date.
LOSS HISTORY
Description of Occurrence
Enter text: A brief description of the loss.
GENERAL INFORMATION
1. Any other insurance with
this company or being
submitted?
Enter Y for a Yes response. Input N for No response. Indicates the response to the question,
Any other insurance with this company?.
ACORD 325 (2013/09)
Page 23 of 25
GENERAL INFORMATION
Remarks
Enter text: An explanation as to whether the applicant has any other insurance with this
company.
GENERAL INFORMATION
2. Has any insurer
cancelled or non-renewed
any aviation insurance for
the applicant?
Enter Y for a Yes response. Input N for No response. Indicates the response to the question,
Has any insurer cancelled or non-renewed any aviation insurance for the applicant?.
GENERAL INFORMATION
Remarks
Enter text: An explanation as to whether any insurer cancelled or non-renewed any aviation
insurance for the applicant,
GENERAL INFORMATION
3. During the last five 5
years [ten (10) in Rhode
Island], has any applicant
been indicted for or
convicted of any degree of
the crime of fraud, bribery,
arson or other arson-related
crime in connection with
this or any other property?
Enter Y for a Yes response. Input N for No response. Indicates the response to the question,
During the mandated number of years, has any applicant been indicted for or convicted of any
degree of the crime of fraud, bribery, arson or any other arson related crime in connection with
this or any other property?.
GENERAL INFORMATION
Remarks
Enter text: An explanation as to whether any applicant has been indicted or convicted of fraud or
any arson related crime in connection with a property with in the last five (5) years.
GENERAL INFORMATION
4. Has the applicant been
indicted or convicted of a
felony?
Enter Y for a Yes response. Input N for No response. Indicates the response to the question,
Has the applicant been indicted or convicted of a felony?.
GENERAL INFORMATION
Remarks
Enter text: An explanation as to whether the applicant has ever been indicted or convicted of a
felony.
GENERAL INFORMATION
5. Has any applicant had
any sanctions, violations or
suspensions from the FAA
or any other regulatory
body?
Enter Y for a Yes response. Input N for No response. Indicates the response to the question,
Has the applicant had any sanctions, violations or suspensions from the FAA or any other
regulatory body?.
GENERAL INFORMATION
Remarks
Enter text: An explanation of or any sanctions, violations or suspensions from the FAA or any
other regulatory body.
GENERAL INFORMATION
6. Any uncorrected fire
code violations?
Enter Y for a Yes response. Input N for No response. Indicates the response to the question,
Any uncorrected fire code violations?.
GENERAL INFORMATION
Remarks
Enter text: An explanation of or any uncorrected fire code violations.
ACORD 325 (2013/09)
Page 24 of 25
GENERAL INFORMATION
7. Any bankruptcies, tax or
credit liens against the
applicant in the past seven
(7) years?
Enter Y for a Yes response. Input N for No response. Indicates the response to the question,
Any bankruptcies, tax or credit liens against the applicant in the past 7 years?.
GENERAL INFORMATION
Remarks
Enter text: An explanation as to whether the applicant has had any bankruptcies, tax or credit
liens in the past mandated number of years.
REMARKS / PROCESSING
INSTRUCTIONS
Remarks / Processing
Instructions
Enter text: The general remarks associated with the aviation policy. Use this section to provide
any additional information required for underwriting or rating. ACORD 101, Additional Remarks
Schedule, may be attached if more space is required.
Form Page 4
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).
REMARKS
Remarks
Enter text: The general remarks associated with the aviation policy. Use this section to provide
any additional information required for underwriting or rating. ACORD 101, Additional Remarks
Schedule, may be attached if more space is required.
SIGNATURE
Notice of Information
Practices (Privacy)
checkbox
Check the box (if applicable): Indicates that a copy of the Notice of Information Practices
(ACORD 38 or state specific ACORD 38) has been given to the applicant. State specific 38s
are available for applicants in AZ, DE, KS, MN, ND, NY, OR, VA, and WV. In addition, ACORD
38 contains CA and MA state specific language.
SIGNATURE
Applicant's Initials
Initial here: The named insured's initials.
SIGNATURE
Producers 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
Enter identifier: The State License Number of the producer. As used here, this is required in
Florida.
SIGNATURE
Applicants 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 325 (2013/09)
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