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ACORD Form 81 Personal Inland Marine Section Instructions

 

 
ACORD 81 (2005/08) 1 of 15
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 81 (2005/08) Personal Inland Marine Application The title of the form. The ACORD 81 Personal Inland Marine Application is used as a stand-alone application or as a supplement to the Residential Application (ACORD 89) if scheduled personal property is being submitted as part of a homeowners transaction.
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 Enter text: The producer's mailing address line one.
IDENTIFICATION SECTION Enter text: The producer's mailing address line two.
IDENTIFICATION SECTION Enter text: The producer's mailing address city name.
IDENTIFICATION SECTION Enter code: The producer's mailing address state or province code.
IDENTIFICATION SECTION Enter code: The producer's mailing address postal code.
IDENTIFICATION SECTION Phone No. Enter number: The producer's contact person's phone number.
IDENTIFICATION SECTION Fax No. Enter number: The fax number of the producer.
IDENTIFICATION SECTION Code Enter code: The identification code assigned to the producer (e.g. agency or brokerage firm) by the insurer.
IDENTIFICATION SECTION Sub Code 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 Applicant's Name and Mailing Address Enter text: The named insuredís full name as it appears on the policy declarations page.
IDENTIFICATION SECTION Enter text: The named insured's mailing address line one.
IDENTIFICATION SECTION Enter text: The named insured's mailing address line two.

ACORD 81 (2005/08) 2 of 15

Section Name Field Name Field and/or Section Description
IDENTIFICATION SECTION Enter text: The named insured's mailing address city name.
IDENTIFICATION SECTION Enter text: The applicant's physical address county name.
IDENTIFICATION SECTION Enter code: The named insured's mailing address state or province code.
IDENTIFICATION SECTION Enter code: The named insured's mailing address postal code.
IDENTIFICATION SECTION NAIC Code Enter code: The identification code assigned to the insurer by the NAIC.
IDENTIFICATION SECTION Telephone Number Enter number: The named insured's primary phone number.
IDENTIFICATION SECTION CO/PLAN 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 Enter code: The product code of the insurer for the policy.
IDENTIFICATION SECTION POL# 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 ACCT# 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 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 Billing Plan - 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.
APPLICANT INFORMATION Birth Date Enter date: The date of birth of the insured.

ACORD 81 (2005/08) 3 of 15

Section Name Field Name Field and/or Section Description
APPLICANT INFORMATION Marital Status Enter code: The insured's marital status. The applicable codes are: � � * S Single � * M Married � * D Divorced � * P Separated � * W Widowed� * C Domestic Partner (unmarried)� * V Civil Union� * U Unknown� * O Other
APPLICANT INFORMATION Occupation/Spouse's Occupation Enter text: The named insured's primary occupation or business activity.
APPLICANT INFORMATION Spouse's Occupation Enter text: The named insured's primary occupation or business activity.
APPLICANT INFORMATION Terr Code Enter code: The industry or company specific code that identifies the rating territory for this item. The source of this code is individual insurer, Insurance Services Office or State Insurance Department manuals.
APPLICANT INFORMATION Protect Class Enter code: The fire rating protection class for this location.
APPLICANT INFORMATION Fire District/Code Number Enter text: The property's fire district name.
APPLICANT INFORMATION Enter code: The property's fire district code number which can be found in the individual states manual pages.
APPLICANT INFORMATION Additional Location Check the box (if applicable): Indicates this is an additional location.
APPLICANT INFORMATION Location of Property Enter text: The first address line of the physical location.
APPLICANT INFORMATION Enter text: The second address line of the physical location.
APPLICANT INFORMATION Enter text: The city of the physical location.
APPLICANT INFORMATION Enter text: The county of the location.
APPLICANT INFORMATION Enter code: The state or province of the physical location.

ACORD 81 (2005/08) 4 of 15

Section Name Field Name Field and/or Section Description
APPLICANT INFORMATION Enter code: The postal code of the physical location.
APPLICANT INFORMATION Dwelling Type(s) Enter text: The description of the type of residence (e.g. apartment, condominium, etc.).
APPLICANT INFORMATION Construction Type(s) 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
APPLICANT INFORMATION # Families Enter number: The number of separate family units in the dwelling.
APPLICANT INFORMATION Other Enter text: Remarks associated with the Personal Inland Marine line of business.
COVERAGES 1 Jewelry Enter amount: The total actual value amount for the jewelry class.
COVERAGES Rate Enter rate: The rate or factor used to calculate the premium for the jewelry class.
COVERAGES Premium Enter amount: The total premium amount for the jewelry class.
COVERAGES 2 Furs Enter amount: The total actual value amount for the furs class.
COVERAGES Rate Enter rate: The rate or factor used to calculate the premium for the furs class.
COVERAGES Premium Enter amount: The total premium amount for the furs class.
COVERAGES 3 Fine Arts Enter amount: The total actual value amount for the fine arts class.
COVERAGES Rate Enter rate: The rate or factor used to calculate the premium for the fine arts class.
COVERAGES Premium Enter amount: The total premium amount for the fine arts class.
COVERAGES 4 Cameras Enter amount: The total actual value amount for the cameras class.
COVERAGES Rate Enter rate: The rate or factor used to calculate the premium for the cameras class.
COVERAGES Premium Enter amount: The total premium amount for the cameras class.
COVERAGES 5 Musical Instruments Enter amount: The total actual value amount for the musical instruments class.
COVERAGES Rate Enter rate: The rate or factor used to calculate the premium for the musical instruments class.
COVERAGES Premium Enter amount: The total premium amount for the musical instruments class.
COVERAGES 6 Silverware Enter amount: The total actual value amount for the silverware class.
COVERAGES Rate Enter rate: The rate or factor used to calculate the premium for the silverware class.
COVERAGES Premium Enter amount: The total premium amount for the silverware class.
COVERAGES 7 Stamps Enter amount: The total actual value amount for the stamps class.

ACORD 81 (2005/08) 5 of 15

Section Name Field Name Field and/or Section Description
COVERAGES Rate Enter rate: The rate or factor used to calculate the premium for the stamps class.
COVERAGES Premium Enter amount: The total premium amount for the stamps class.
COVERAGES 8 Coins Enter amount: The total actual value amount for the coins class.
COVERAGES Rate Enter rate: The rate or factor used to calculate the premium for the coins class.
COVERAGES Premium Enter amount: The total premium amount for the coins class.
COVERAGES 9 Golfer's Equipment Enter amount: The total actual value amount for the golfer's equipment class.
COVERAGES Rate Enter rate: The rate or factor used to calculate the premium for the golfer's equipment class.
COVERAGES Premium Enter amount: The total premium amount for the golfer's equipment class.
COVERAGES 10 Personal Computers Enter amount: The total actual value amount for the personal computers class.
COVERAGES Rate Enter rate: The rate or factor used to calculate the premium for the personal computers class.
COVERAGES Premium Enter amount: The total premium amount for the personal computers class.
COVERAGES 11 Enter text: The description of the property class.
COVERAGES Amount Of Insurance Enter amount: The total actual value amount for the property class.
COVERAGES Rate Enter rate: The rate or factor used to calculate the premium for the property class.
COVERAGES Premium Enter amount: The total premium amount for the property class.
COVERAGES 12 Enter text: The description of the property class.
COVERAGES Amount Of Insurance Enter amount: The total actual value amount for the property class.
COVERAGES Rate Enter rate: The rate or factor used to calculate the premium for the property class.
COVERAGES Premium Enter amount: The total premium amount for the property class.
COVERAGES 13 Enter text: The description of the property class.
COVERAGES Amount Of Insurance Enter amount: The total actual value amount for the property class.
COVERAGES Rate Enter rate: The rate or factor used to calculate the premium for the property class.
COVERAGES Premium Enter amount: The total premium amount for the property class.
COVERAGES 14 Enter text: The description of the property class.
COVERAGES Amount Of Insurance Enter amount: The total actual value amount for the property class.
COVERAGES Rate Enter rate: The rate or factor used to calculate the premium for the property class.
COVERAGES Premium Enter amount: The total premium amount for the property class.
COVERAGES Total Enter amount: The total premium amount for the personal inland marine line of business.
COVERAGES Unattended Car Coverage (Stamps and Coins) Check the box (if applicable): Indicates that unattended automobile coverage for stamps and coins applies to a property class.
COVERAGES Broad Form Pair and Set Coverage Check the box (if applicable): Indicates that broad form pair and set coverage applies to a property class.

ACORD 81 (2005/08) 6 of 15

Section Name Field Name Field and/or Section Description
COVERAGES Non-Mobile Organ Coverage Check the box (if applicable): Indicates that non-mobile organ coverage applies to a property class.
COVERAGES Safe Credit Check the box (if applicable): Indicates that safe credit applies to a property class.
COVERAGES ACV Loss Settlement Check the box (if applicable): Indicates the loss settlement basis is the actual cash value of the item.
COVERAGES Replacement Cost Loss Settlement Check the box (if applicable): Indicates the loss settlement basis is the replacement cost of the item.
COVERAGES Breakage Coverage Check the box (if applicable): Indicates that breakage coverage applies to a property class.
COVERAGES Blanket Coverage Check the box (if applicable): Indicates that blanket coverage applies.
COVERAGES Additional Rating Information Enter text: Remarks associated with the Personal Inland Marine line of business.
GENERAL INFORMATION 1. Any protective devices/systems in use? - Yes Check the box (if applicable): Indicates a "Yes" response to the question, "Any protective devices/systems in use?".
GENERAL INFORMATION 1. Any protective devices/systems in use? - No Check the box (if applicable): Indicates a "No" response to the question, "Any protective devices/systems in use?".
GENERAL INFORMATION 2. Will any property be exhibited? -Yes Check the box (if applicable): Indicates a "Yes" response to the question, "Will any property be exhibited?".
GENERAL INFORMATION 2. Will any property be exhibited? -No Check the box (if applicable): Indicates a "No" response to the question, "Will any property be exhibited?".
GENERAL INFORMATION 3. Will any special restriction/endorsements apply? -Yes Check the box (if applicable): Indicates a "Yes" response to the question, "Will any special restrictions/endorsements apply?".
GENERAL INFORMATION 3. Will any special restriction/endorsements apply? -No Check the box (if applicable): Indicates a "No" response to the question, "Will any special restrictions/endorsements apply?".
GENERAL INFORMATION 4. Will any type of deductible apply? - Yes Check the box (if applicable): Indicates a "Yes" response to the question, "Will any type of deductible apply?".
GENERAL INFORMATION 4. Will any type of deductible apply? - No Check the box (if applicable): Indicates a "No" response to the question, "Will any type of deductible apply?".
GENERAL INFORMATION 5. Is any property used professionally/commercially? - Yes Check the box (if applicable): Indicates a "Yes" response to the question, "Is any property used professionally/commercially?".
GENERAL INFORMATION 5. Is any property used professionally/commercially? - No Check the box (if applicable): Indicates a "No" response to the question, "Is any property used professionally/commercially?".

ACORD 81 (2005/08) 7 of 15

Section Name Field Name Field and/or Section Description
GENERAL INFORMATION 6. Any other insurance with this company? - Yes Check the box (if applicable): Indicates a "Yes" response to the question, "Any other insurance with this company?".
GENERAL INFORMATION 6. Any other insurance with this company? - No Check the box (if applicable): Indicates a "No" response to the question, "Any other insurance with this company?".
GENERAL INFORMATION 7. Did any loss occur during the last 3 years? - Yes Check the box (if applicable): Indicates a "Yes" response to the question, "Did any loss occur during the last mandated number of years?".
GENERAL INFORMATION 7. Did any loss occur during the last 3 years? - No Check the box (if applicable): Indicates a "No" response to the question, "Did any loss occur during the last mandated number of years?".
GENERAL INFORMATION 8. Any coverage declined/canceled/non renewed? -Yes Check the box (if applicable): Indicates a "Yes" response to the question, "Any policy or coverage declined, cancelled or non-renewed during the mandated number of years?".
GENERAL INFORMATION 8. Any coverage declined/canceled/non renewed? -No Check the box (if applicable): Indicates a "No" response to the question, "Any policy or coverage declined, cancelled or non-renewed during the mandated number of years?".
GENERAL INFORMATION Prior Insurance & Policy Number Enter text: The name of the previous insurer.
GENERAL INFORMATION Enter identifier: The policy number of the previous coverage.
GENERAL INFORMATION Remarks Enter text: Remarks associated with the Personal Inland Marine line of business.
SCHEDULE OF PROPERTY Schd # Enter number: The number associated with the property class (e.g. 1 - Jewelry, 2 - Furs).
SCHEDULE OF PROPERTY Item # Enter number: The number assigned to the item by the producer.
SCHEDULE OF PROPERTY Detail Description Enter text: The full description of the item including serial numbers, if applicable.
SCHEDULE OF PROPERTY Appraisal - Yes Check the box (if applicable): Indicates that an appraisal has been made on the item.
SCHEDULE OF PROPERTY Appraisal - No Check the box (if applicable): Indicates that an appraisal has not been made on the item.
SCHEDULE OF PROPERTY Purchase/Appraisal Date Enter date: The date on which the item described was either purchased or last appraised.
SCHEDULE OF PROPERTY Amount of Insurance Enter amount: The value (limit of liability) of the item described.
SCHEDULE OF PROPERTY Schd # Enter number: The number associated with the property class (e.g. 1 - Jewelry, 2 - Furs).
SCHEDULE OF PROPERTY Item # Enter number: The number assigned to the item by the producer.

ACORD 81 (2005/08) 8 of 15

Section Name Field Name Field and/or Section Description
SCHEDULE OF PROPERTY Detail Description Enter text: The full description of the item including serial numbers, if applicable.
SCHEDULE OF PROPERTY Appraisal - Yes Check the box (if applicable): Indicates that an appraisal has been made on the item.
SCHEDULE OF PROPERTY Appraisal - No Check the box (if applicable): Indicates that an appraisal has not been made on the item.
SCHEDULE OF PROPERTY Purchase/Appraisal Date Enter date: The date on which the item described was either purchased or last appraised.
SCHEDULE OF PROPERTY Amount of Insurance Enter amount: The value (limit of liability) of the item described.
SCHEDULE OF PROPERTY Schd # Enter number: The number associated with the property class (e.g. 1 - Jewelry, 2 - Furs).
SCHEDULE OF PROPERTY Item # Enter number: The number assigned to the item by the producer.
SCHEDULE OF PROPERTY Detail Description Enter text: The full description of the item including serial numbers, if applicable.
SCHEDULE OF PROPERTY Appraisal - Yes Check the box (if applicable): Indicates that an appraisal has been made on the item.
SCHEDULE OF PROPERTY Appraisal - No Check the box (if applicable): Indicates that an appraisal has not been made on the item.
SCHEDULE OF PROPERTY Purchase/Appraisal Date Enter date: The date on which the item described was either purchased or last appraised.
SCHEDULE OF PROPERTY Amount of Insurance Enter amount: The value (limit of liability) of the item described.
SCHEDULE OF PROPERTY Schd # Enter number: The number associated with the property class (e.g. 1 - Jewelry, 2 - Furs).
SCHEDULE OF PROPERTY Item # Enter number: The number assigned to the item by the producer.
SCHEDULE OF PROPERTY Detail Description Enter text: The full description of the item including serial numbers, if applicable.
SCHEDULE OF PROPERTY Appraisal - Yes Check the box (if applicable): Indicates that an appraisal has been made on the item.
SCHEDULE OF PROPERTY Appraisal - No Check the box (if applicable): Indicates that an appraisal has not been made on the item.
SCHEDULE OF PROPERTY Purchase/Appraisal Date Enter date: The date on which the item described was either purchased or last appraised.

ACORD 81 (2005/08) 9 of 15

Section Name Field Name Field and/or Section Description
SCHEDULE OF PROPERTY Amount of Insurance Enter amount: The value (limit of liability) of the item described.
SCHEDULE OF PROPERTY Schd # Enter number: The number associated with the property class (e.g. 1 - Jewelry, 2 - Furs).
SCHEDULE OF PROPERTY Item # Enter number: The number assigned to the item by the producer.
SCHEDULE OF PROPERTY Detail Description Enter text: The full description of the item including serial numbers, if applicable.
SCHEDULE OF PROPERTY Appraisal - Yes Check the box (if applicable): Indicates that an appraisal has been made on the item.
SCHEDULE OF PROPERTY Appraisal - No Check the box (if applicable): Indicates that an appraisal has not been made on the item.
SCHEDULE OF PROPERTY Purchase/Appraisal Date Enter date: The date on which the item described was either purchased or last appraised.
SCHEDULE OF PROPERTY Amount of Insurance Enter amount: The value (limit of liability) of the item described.
SCHEDULE OF PROPERTY Schd # Enter number: The number associated with the property class (e.g. 1 - Jewelry, 2 - Furs).
SCHEDULE OF PROPERTY Item # Enter number: The number assigned to the item by the producer.
SCHEDULE OF PROPERTY Detail Description Enter text: The full description of the item including serial numbers, if applicable.
SCHEDULE OF PROPERTY Appraisal - Yes Check the box (if applicable): Indicates that an appraisal has been made on the item.
SCHEDULE OF PROPERTY Appraisal - No Check the box (if applicable): Indicates that an appraisal has not been made on the item.
SCHEDULE OF PROPERTY Purchase/Appraisal Date Enter date: The date on which the item described was either purchased or last appraised.
SCHEDULE OF PROPERTY Amount of Insurance Enter amount: The value (limit of liability) of the item described.
SCHEDULE OF PROPERTY Schd # Enter number: The number associated with the property class (e.g. 1 - Jewelry, 2 - Furs).
SCHEDULE OF PROPERTY Item # Enter number: The number assigned to the item by the producer.
SCHEDULE OF PROPERTY Detail Description Enter text: The full description of the item including serial numbers, if applicable.

ACORD 81 (2005/08) 10 of 15

Section Name Field Name Field and/or Section Description
SCHEDULE OF PROPERTY Appraisal - Yes Check the box (if applicable): Indicates that an appraisal has been made on the item.
SCHEDULE OF PROPERTY Appraisal - No Check the box (if applicable): Indicates that an appraisal has not been made on the item.
SCHEDULE OF PROPERTY Purchase/Appraisal Date Enter date: The date on which the item described was either purchased or last appraised.
SCHEDULE OF PROPERTY Amount of Insurance Enter amount: The value (limit of liability) of the item described.
SCHEDULE OF PROPERTY Schd # Enter number: The number associated with the property class (e.g. 1 - Jewelry, 2 - Furs).
SCHEDULE OF PROPERTY Item # Enter number: The number assigned to the item by the producer.
SCHEDULE OF PROPERTY Detail Description Enter text: The full description of the item including serial numbers, if applicable.
SCHEDULE OF PROPERTY Appraisal - Yes Check the box (if applicable): Indicates that an appraisal has been made on the item.
SCHEDULE OF PROPERTY Appraisal - No Check the box (if applicable): Indicates that an appraisal has not been made on the item.
SCHEDULE OF PROPERTY Purchase/Appraisal Date Enter date: The date on which the item described was either purchased or last appraised.
SCHEDULE OF PROPERTY Amount of Insurance Enter amount: The value (limit of liability) of the item described.
SCHEDULE OF PROPERTY Schd # Enter number: The number associated with the property class (e.g. 1 - Jewelry, 2 - Furs).
SCHEDULE OF PROPERTY Item # Enter number: The number assigned to the item by the producer.
SCHEDULE OF PROPERTY Detail Description Enter text: The full description of the item including serial numbers, if applicable.
SCHEDULE OF PROPERTY Appraisal - Yes Check the box (if applicable): Indicates that an appraisal has been made on the item.
SCHEDULE OF PROPERTY Appraisal - No Check the box (if applicable): Indicates that an appraisal has not been made on the item.
SCHEDULE OF PROPERTY Purchase/Appraisal Date Enter date: The date on which the item described was either purchased or last appraised.
SCHEDULE OF PROPERTY Amount of Insurance Enter amount: The value (limit of liability) of the item described.

ACORD 81 (2005/08) 11 of 15

Section Name Field Name Field and/or Section Description
SCHEDULE OF PROPERTY Schd # Enter number: The number associated with the property class (e.g. 1 - Jewelry, 2 - Furs).
SCHEDULE OF PROPERTY Item # Enter number: The number assigned to the item by the producer.
SCHEDULE OF PROPERTY Detail Description Enter text: The full description of the item including serial numbers, if applicable.
SCHEDULE OF PROPERTY Appraisal - Yes Check the box (if applicable): Indicates that an appraisal has been made on the item.
SCHEDULE OF PROPERTY Appraisal - No Check the box (if applicable): Indicates that an appraisal has not been made on the item.
SCHEDULE OF PROPERTY Purchase/Appraisal Date Enter date: The date on which the item described was either purchased or last appraised.
SCHEDULE OF PROPERTY Amount of Insurance Enter amount: The value (limit of liability) of the item described.
SCHEDULE OF PROPERTY Schd # Enter number: The number associated with the property class (e.g. 1 - Jewelry, 2 - Furs).
SCHEDULE OF PROPERTY Item # Enter number: The number assigned to the item by the producer.
SCHEDULE OF PROPERTY Detail Description Enter text: The full description of the item including serial numbers, if applicable.
SCHEDULE OF PROPERTY Appraisal - Yes Check the box (if applicable): Indicates that an appraisal has been made on the item.
SCHEDULE OF PROPERTY Appraisal - No Check the box (if applicable): Indicates that an appraisal has not been made on the item.
SCHEDULE OF PROPERTY Purchase/Appraisal Date Enter date: The date on which the item described was either purchased or last appraised.
SCHEDULE OF PROPERTY Amount of Insurance Enter amount: The value (limit of liability) of the item described.
SCHEDULE OF PROPERTY Schd # Enter number: The number associated with the property class (e.g. 1 - Jewelry, 2 - Furs).
SCHEDULE OF PROPERTY Item # Enter number: The number assigned to the item by the producer.
SCHEDULE OF PROPERTY Detail Description Enter text: The full description of the item including serial numbers, if applicable.
SCHEDULE OF PROPERTY Appraisal - Yes Check the box (if applicable): Indicates that an appraisal has been made on the item.

ACORD 81 (2005/08) 12 of 15

Section Name Field Name Field and/or Section Description
SCHEDULE OF PROPERTY Appraisal - No Check the box (if applicable): Indicates that an appraisal has not been made on the item.
SCHEDULE OF PROPERTY Purchase/Appraisal Date Enter date: The date on which the item described was either purchased or last appraised.
SCHEDULE OF PROPERTY Amount of Insurance Enter amount: The value (limit of liability) of the item described.
SCHEDULE OF PROPERTY Schd # Enter number: The number associated with the property class (e.g. 1 - Jewelry, 2 - Furs).
SCHEDULE OF PROPERTY Item # Enter number: The number assigned to the item by the producer.
SCHEDULE OF PROPERTY Detail Description Enter text: The full description of the item including serial numbers, if applicable.
SCHEDULE OF PROPERTY Appraisal - Yes Check the box (if applicable): Indicates that an appraisal has been made on the item.
SCHEDULE OF PROPERTY Appraisal - No Check the box (if applicable): Indicates that an appraisal has not been made on the item.
SCHEDULE OF PROPERTY Purchase/Appraisal Date Enter date: The date on which the item described was either purchased or last appraised.
SCHEDULE OF PROPERTY Amount of Insurance Enter amount: The value (limit of liability) of the item described.
SCHEDULE OF PROPERTY Schd # Enter number: The number associated with the property class (e.g. 1 - Jewelry, 2 - Furs).
SCHEDULE OF PROPERTY Item # Enter number: The number assigned to the item by the producer.
SCHEDULE OF PROPERTY Detail Description Enter text: The full description of the item including serial numbers, if applicable.
SCHEDULE OF PROPERTY Appraisal - Yes Check the box (if applicable): Indicates that an appraisal has been made on the item.
SCHEDULE OF PROPERTY Appraisal - No Check the box (if applicable): Indicates that an appraisal has not been made on the item.
SCHEDULE OF PROPERTY Purchase/Appraisal Date Enter date: The date on which the item described was either purchased or last appraised.
SCHEDULE OF PROPERTY Amount of Insurance Enter amount: The value (limit of liability) of the item described.
SCHEDULE OF PROPERTY Schd # Enter number: The number associated with the property class (e.g. 1 - Jewelry, 2 - Furs).

ACORD 81 (2005/08) 13 of 15

Section Name Field Name Field and/or Section Description
SCHEDULE OF PROPERTY Item # Enter number: The number assigned to the item by the producer.
SCHEDULE OF PROPERTY Detail Description Enter text: The full description of the item including serial numbers, if applicable.
SCHEDULE OF PROPERTY Appraisal - Yes Check the box (if applicable): Indicates that an appraisal has been made on the item.
SCHEDULE OF PROPERTY Appraisal - No Check the box (if applicable): Indicates that an appraisal has not been made on the item.
SCHEDULE OF PROPERTY Purchase/Appraisal Date Enter date: The date on which the item described was either purchased or last appraised.
SCHEDULE OF PROPERTY Amount of Insurance Enter amount: The value (limit of liability) of the item described.
SCHEDULE OF PROPERTY Schd # Enter number: The number associated with the property class (e.g. 1 - Jewelry, 2 - Furs).
SCHEDULE OF PROPERTY Item # Enter number: The number assigned to the item by the producer.
SCHEDULE OF PROPERTY Detail Description Enter text: The full description of the item including serial numbers, if applicable.
SCHEDULE OF PROPERTY Appraisal - Yes Check the box (if applicable): Indicates that an appraisal has been made on the item.
SCHEDULE OF PROPERTY Appraisal - No Check the box (if applicable): Indicates that an appraisal has not been made on the item.
SCHEDULE OF PROPERTY Purchase/Appraisal Date Enter date: The date on which the item described was either purchased or last appraised.
SCHEDULE OF PROPERTY Amount of Insurance Enter amount: The value (limit of liability) of the item described.
SCHEDULE OF PROPERTY Schd # Enter number: The number associated with the property class (e.g. 1 - Jewelry, 2 - Furs).
SCHEDULE OF PROPERTY Item # Enter number: The number assigned to the item by the producer.
SCHEDULE OF PROPERTY Detail Description Enter text: The full description of the item including serial numbers, if applicable.
SCHEDULE OF PROPERTY Appraisal - Yes Check the box (if applicable): Indicates that an appraisal has been made on the item.
SCHEDULE OF PROPERTY Appraisal - No Check the box (if applicable): Indicates that an appraisal has not been made on the item.

ACORD 81 (2005/08) 14 of 15

Section Name Field Name Field and/or Section Description
SCHEDULE OF PROPERTY Purchase/Appraisal Date Enter date: The date on which the item described was either purchased or last appraised.
SCHEDULE OF PROPERTY Amount of Insurance Enter amount: The value (limit of liability) of the item described.
SCHEDULE OF PROPERTY Schd # Enter number: The number associated with the property class (e.g. 1 - Jewelry, 2 - Furs).
SCHEDULE OF PROPERTY Item # Enter number: The number assigned to the item by the producer.
SCHEDULE OF PROPERTY Detail Description Enter text: The full description of the item including serial numbers, if applicable.
SCHEDULE OF PROPERTY Appraisal - Yes Check the box (if applicable): Indicates that an appraisal has been made on the item.
SCHEDULE OF PROPERTY Appraisal - No Check the box (if applicable): Indicates that an appraisal has not been made on the item.
SCHEDULE OF PROPERTY Purchase/Appraisal Date Enter date: The date on which the item described was either purchased or last appraised.
SCHEDULE OF PROPERTY Amount of Insurance Enter amount: The value (limit of liability) of the item described.
SCHEDULE OF PROPERTY Schd # Enter number: The number associated with the property class (e.g. 1 - Jewelry, 2 - Furs).
SCHEDULE OF PROPERTY Item # Enter number: The number assigned to the item by the producer.
SCHEDULE OF PROPERTY Detail Description Enter text: The full description of the item including serial numbers, if applicable.
SCHEDULE OF PROPERTY Appraisal - Yes Check the box (if applicable): Indicates that an appraisal has been made on the item.
SCHEDULE OF PROPERTY Appraisal - No Check the box (if applicable): Indicates that an appraisal has not been made on the item.
SCHEDULE OF PROPERTY Purchase/Appraisal Date Enter date: The date on which the item described was either purchased or last appraised.
SCHEDULE OF PROPERTY Amount of Insurance Enter amount: The value (limit of liability) of the item described.
FOR COMPANY USE ONLY For Company Use Only Enter text: This area is to be completed by the insurer.
ATTACHMENTS State Supplement(s) Check the box (if applicable): Indicates that a state supplement is attached.
ATTACHMENTS Photograph Check the box (if applicable): Indicates that a photograph is attached.
Section Name Field Name Field and/or Section Description
ATTACHMENTS Appraisal Check the box (if applicable): Indicates that an appraisal is attached.
ATTACHMENTS Bill Of Sale Check the box (if applicable): Indicates that a bill of sale is attached.
ATTACHMENTS Protective Device Certificate Check the box (if applicable): Indicates that a protective device certificate is attached.
ATTACHMENTS Other Attachment Check the box (if applicable): Indicates that there is an attachment other than those listed.
ATTACHMENTS Other Attachment Description Enter text: The description of the attachment.
BINDER/SIGNATURE SECTIONS Effective Date Enter date: The effective date of the binder.
BINDER/SIGNATURE SECTIONS Time Enter time: The time of the binder effective date that the binder becomes effective.
BINDER/SIGNATURE SECTIONS Expiration Date Enter date: The expiration date of the binder.
BINDER/SIGNATURE 12:01/ Noon Check the box (if applicable): Indicates the binder expires at 12:01 AM on the expiration date.
BINDER/SIGNATURE Noon Check the box (if applicable): Indicates the binder expires at 12:00 noon on the expiration date.
BINDER/SIGNATURE Coverage Is Not Bound Check the box (if applicable): Indicates the coverage has not been bound.
BINDER/SIGNATURE Notice of Information Practices Check the box (if applicable): Indicates that a copy of the Notice of Information Practices has been given to the applicant.
BINDER/SIGNATURE Applicant's Signature Sign here: Accommodates the signature of the applicant or named insured.
BINDER/SIGNATURE Date Enter date: The date the form was signed by the named insured.
BINDER/SIGNATURE Producer's Signature Sign here: Accommodates the signature of the authorized representative (e.g. producer, agent, broker, etc.). by all companies to issue Certificates.
BINDER/SIGNATURE National Producer Number Enter identifier: The National Producer Number (NPN) as defined in the National Insurance Producer Registry (NIPR).
Edition Date The edition identifier of the form including the form number and edition (the date is typically formatted YYYY/MM).

ACORD 81 (2005/08) 15 of 15