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ACORD 81 (2005/08) 1 of 15
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Universal wording updates to improve clarity and intent were made to all FIG text for this form on 10/07/2008. |
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Section Name |
Field Name |
Field and/or Section Description |
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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. |
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IDENTIFICATION SECTION |
Date |
Enter date: The month/day/year on which the form is completed. (MM/DD/YYYY) |
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IDENTIFICATION SECTION |
Agency |
Enter text: The producer's full name. |
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IDENTIFICATION SECTION |
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Enter text: The producer's mailing address line one. |
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IDENTIFICATION SECTION |
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Enter text: The producer's mailing address line two. |
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IDENTIFICATION SECTION |
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Enter text: The producer's mailing address city name. |
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IDENTIFICATION SECTION |
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Enter code: The producer's mailing address state or province code. |
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IDENTIFICATION SECTION |
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Enter code: The producer's mailing address postal code. |
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IDENTIFICATION SECTION |
Phone No. |
Enter number: The producer's contact person's phone number. |
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IDENTIFICATION SECTION |
Fax No. |
Enter number: The fax number of the producer. |
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IDENTIFICATION SECTION |
Code |
Enter code: The identification code assigned to the producer (e.g. agency or brokerage firm) by the insurer. |
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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). |
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IDENTIFICATION SECTION |
Agency Customer ID |
Enter identifier: The customer's identification number assigned by the producer (e.g. agency or brokerage). |
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IDENTIFICATION SECTION |
Applicant's Name and Mailing Address |
Enter text: The named insured’s full name as it appears on the policy declarations page. |
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IDENTIFICATION SECTION |
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Enter text: The named insured's mailing address line one. |
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IDENTIFICATION SECTION |
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Enter text: The named insured's mailing address line two. |
ACORD 81 (2005/08) 2 of 15
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Section Name |
Field Name |
Field and/or Section Description |
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IDENTIFICATION SECTION |
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Enter text: The named insured's mailing address city name. |
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IDENTIFICATION SECTION |
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Enter text: The applicant's physical address county name. |
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IDENTIFICATION SECTION |
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Enter code: The named insured's mailing address state or province code. |
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IDENTIFICATION SECTION |
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Enter code: The named insured's mailing address postal code. |
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IDENTIFICATION SECTION |
NAIC Code |
Enter code: The identification code assigned to the insurer by the NAIC. |
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IDENTIFICATION SECTION |
Telephone Number |
Enter number: The named insured's primary phone number. |
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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. |
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IDENTIFICATION SECTION |
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Enter code: The product code of the insurer for the policy. |
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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. |
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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. |
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IDENTIFICATION SECTION |
Effective Date |
Enter date: The effective date of the policy. |
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IDENTIFICATION SECTION |
Expiration Date |
Enter date: The date on which the terms and conditions of the policy will expire. |
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IDENTIFICATION SECTION |
Billing Plan - Direct Bill |
Check the box (if applicable): Indicates if the policy is to be direct billed. |
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IDENTIFICATION SECTION |
Agency Bill |
Check the box (if applicable): Indicates if the policy is to be producer/agency billed. |
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IDENTIFICATION SECTION |
Payment Plan |
Enter code: The payment plan for the policy. |
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APPLICANT INFORMATION |
Birth Date |
Enter date: The date of birth of the insured. |
ACORD 81 (2005/08) 3 of 15
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Section Name |
Field Name |
Field and/or Section Description |
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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 |
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APPLICANT INFORMATION |
Occupation/Spouse's Occupation |
Enter text: The named insured's primary occupation or business activity. |
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APPLICANT INFORMATION |
Spouse's Occupation |
Enter text: The named insured's primary occupation or business activity. |
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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. |
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APPLICANT INFORMATION |
Protect Class |
Enter code: The fire rating protection class for this location. |
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APPLICANT INFORMATION |
Fire District/Code Number |
Enter text: The property's fire district name. |
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APPLICANT INFORMATION |
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Enter code: The property's fire district code number which can be found in the individual states manual pages. |
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APPLICANT INFORMATION |
Additional Location |
Check the box (if applicable): Indicates this is an additional location. |
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APPLICANT INFORMATION |
Location of Property |
Enter text: The first address line of the physical location. |
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APPLICANT INFORMATION |
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Enter text: The second address line of the physical location. |
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APPLICANT INFORMATION |
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Enter text: The city of the physical location. |
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APPLICANT INFORMATION |
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Enter text: The county of the location. |
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APPLICANT INFORMATION |
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Enter code: The state or province of the physical location. |
ACORD 81 (2005/08) 4 of 15
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Section Name |
Field Name |
Field and/or Section Description |
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APPLICANT INFORMATION |
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Enter code: The postal code of the physical location. |
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APPLICANT INFORMATION |
Dwelling Type(s) |
Enter text: The description of the type of residence (e.g. apartment, condominium, etc.). |
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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 |
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APPLICANT INFORMATION |
# Families |
Enter number: The number of separate family units in the dwelling. |
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APPLICANT INFORMATION |
Other |
Enter text: Remarks associated with the Personal Inland Marine line of business. |
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COVERAGES |
1 Jewelry |
Enter amount: The total actual value amount for the jewelry class. |
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COVERAGES |
Rate |
Enter rate: The rate or factor used to calculate the premium for the jewelry class. |
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COVERAGES |
Premium |
Enter amount: The total premium amount for the jewelry class. |
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COVERAGES |
2 Furs |
Enter amount: The total actual value amount for the furs class. |
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COVERAGES |
Rate |
Enter rate: The rate or factor used to calculate the premium for the furs class. |
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COVERAGES |
Premium |
Enter amount: The total premium amount for the furs class. |
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COVERAGES |
3 Fine Arts |
Enter amount: The total actual value amount for the fine arts class. |
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COVERAGES |
Rate |
Enter rate: The rate or factor used to calculate the premium for the fine arts class. |
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COVERAGES |
Premium |
Enter amount: The total premium amount for the fine arts class. |
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COVERAGES |
4 Cameras |
Enter amount: The total actual value amount for the cameras class. |
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COVERAGES |
Rate |
Enter rate: The rate or factor used to calculate the premium for the cameras class. |
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COVERAGES |
Premium |
Enter amount: The total premium amount for the cameras class. |
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COVERAGES |
5 Musical Instruments |
Enter amount: The total actual value amount for the musical instruments class. |
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COVERAGES |
Rate |
Enter rate: The rate or factor used to calculate the premium for the musical instruments class. |
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COVERAGES |
Premium |
Enter amount: The total premium amount for the musical instruments class. |
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COVERAGES |
6 Silverware |
Enter amount: The total actual value amount for the silverware class. |
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COVERAGES |
Rate |
Enter rate: The rate or factor used to calculate the premium for the silverware class. |
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COVERAGES |
Premium |
Enter amount: The total premium amount for the silverware class. |
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COVERAGES |
7 Stamps |
Enter amount: The total actual value amount for the stamps class. |
ACORD 81 (2005/08) 5 of 15
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Section Name |
Field Name |
Field and/or Section Description |
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COVERAGES |
Rate |
Enter rate: The rate or factor used to calculate the premium for the stamps class. |
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COVERAGES |
Premium |
Enter amount: The total premium amount for the stamps class. |
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COVERAGES |
8 Coins |
Enter amount: The total actual value amount for the coins class. |
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COVERAGES |
Rate |
Enter rate: The rate or factor used to calculate the premium for the coins class. |
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COVERAGES |
Premium |
Enter amount: The total premium amount for the coins class. |
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COVERAGES |
9 Golfer's Equipment |
Enter amount: The total actual value amount for the golfer's equipment class. |
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COVERAGES |
Rate |
Enter rate: The rate or factor used to calculate the premium for the golfer's equipment class. |
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COVERAGES |
Premium |
Enter amount: The total premium amount for the golfer's equipment class. |
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COVERAGES |
10 Personal Computers |
Enter amount: The total actual value amount for the personal computers class. |
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COVERAGES |
Rate |
Enter rate: The rate or factor used to calculate the premium for the personal computers class. |
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COVERAGES |
Premium |
Enter amount: The total premium amount for the personal computers class. |
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COVERAGES |
11 |
Enter text: The description of the property class. |
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COVERAGES |
Amount Of Insurance |
Enter amount: The total actual value amount for the property class. |
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COVERAGES |
Rate |
Enter rate: The rate or factor used to calculate the premium for the property class. |
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COVERAGES |
Premium |
Enter amount: The total premium amount for the property class. |
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COVERAGES |
12 |
Enter text: The description of the property class. |
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COVERAGES |
Amount Of Insurance |
Enter amount: The total actual value amount for the property class. |
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COVERAGES |
Rate |
Enter rate: The rate or factor used to calculate the premium for the property class. |
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COVERAGES |
Premium |
Enter amount: The total premium amount for the property class. |
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COVERAGES |
13 |
Enter text: The description of the property class. |
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COVERAGES |
Amount Of Insurance |
Enter amount: The total actual value amount for the property class. |
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COVERAGES |
Rate |
Enter rate: The rate or factor used to calculate the premium for the property class. |
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COVERAGES |
Premium |
Enter amount: The total premium amount for the property class. |
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COVERAGES |
14 |
Enter text: The description of the property class. |
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COVERAGES |
Amount Of Insurance |
Enter amount: The total actual value amount for the property class. |
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COVERAGES |
Rate |
Enter rate: The rate or factor used to calculate the premium for the property class. |
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COVERAGES |
Premium |
Enter amount: The total premium amount for the property class. |
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COVERAGES |
Total |
Enter amount: The total premium amount for the personal inland marine line of business. |
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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. |
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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
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Section Name |
Field Name |
Field and/or Section Description |
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COVERAGES |
Non-Mobile Organ Coverage |
Check the box (if applicable): Indicates that non-mobile organ coverage applies to a property class. |
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COVERAGES |
Safe Credit |
Check the box (if applicable): Indicates that safe credit applies to a property class. |
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COVERAGES |
ACV Loss Settlement |
Check the box (if applicable): Indicates the loss settlement basis is the actual cash value of the item. |
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COVERAGES |
Replacement Cost Loss Settlement |
Check the box (if applicable): Indicates the loss settlement basis is the replacement cost of the item. |
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COVERAGES |
Breakage Coverage |
Check the box (if applicable): Indicates that breakage coverage applies to a property class. |
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COVERAGES |
Blanket Coverage |
Check the box (if applicable): Indicates that blanket coverage applies. |
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COVERAGES |
Additional Rating Information |
Enter text: Remarks associated with the Personal Inland Marine line of business. |
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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?". |
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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?". |
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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?". |
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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?". |
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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?". |
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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?". |
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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?". |
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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?". |
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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?". |
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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
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Section Name |
Field Name |
Field and/or Section Description |
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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?". |
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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?". |
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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?". |
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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?". |
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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?". |
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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?". |
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GENERAL INFORMATION |
Prior Insurance & Policy Number |
Enter text: The name of the previous insurer. |
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GENERAL INFORMATION |
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Enter identifier: The policy number of the previous coverage. |
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GENERAL INFORMATION |
Remarks |
Enter text: Remarks associated with the Personal Inland Marine line of business. |
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SCHEDULE OF PROPERTY |
Schd # |
Enter number: The number associated with the property class (e.g. 1 - Jewelry, 2 - Furs). |
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SCHEDULE OF PROPERTY |
Item # |
Enter number: The number assigned to the item by the producer. |
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SCHEDULE OF PROPERTY |
Detail Description |
Enter text: The full description of the item including serial numbers, if applicable. |
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SCHEDULE OF PROPERTY |
Appraisal - Yes |
Check the box (if applicable): Indicates that an appraisal has been made on the item. |
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SCHEDULE OF PROPERTY |
Appraisal - No |
Check the box (if applicable): Indicates that an appraisal has not been made on the item. |
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SCHEDULE OF PROPERTY |
Purchase/Appraisal Date |
Enter date: The date on which the item described was either purchased or last appraised. |
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SCHEDULE OF PROPERTY |
Amount of Insurance |
Enter amount: The value (limit of liability) of the item described. |
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SCHEDULE OF PROPERTY |
Schd # |
Enter number: The number associated with the property class (e.g. 1 - Jewelry, 2 - Furs). |
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SCHEDULE OF PROPERTY |
Item # |
Enter number: The number assigned to the item by the producer. |
ACORD 81 (2005/08) 8 of 15
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Section Name |
Field Name |
Field and/or Section Description |
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SCHEDULE OF PROPERTY |
Detail Description |
Enter text: The full description of the item including serial numbers, if applicable. |
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SCHEDULE OF PROPERTY |
Appraisal - Yes |
Check the box (if applicable): Indicates that an appraisal has been made on the item. |
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SCHEDULE OF PROPERTY |
Appraisal - No |
Check the box (if applicable): Indicates that an appraisal has not been made on the item. |
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SCHEDULE OF PROPERTY |
Purchase/Appraisal Date |
Enter date: The date on which the item described was either purchased or last appraised. |
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SCHEDULE OF PROPERTY |
Amount of Insurance |
Enter amount: The value (limit of liability) of the item described. |
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SCHEDULE OF PROPERTY |
Schd # |
Enter number: The number associated with the property class (e.g. 1 - Jewelry, 2 - Furs). |
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SCHEDULE OF PROPERTY |
Item # |
Enter number: The number assigned to the item by the producer. |
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SCHEDULE OF PROPERTY |
Detail Description |
Enter text: The full description of the item including serial numbers, if applicable. |
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SCHEDULE OF PROPERTY |
Appraisal - Yes |
Check the box (if applicable): Indicates that an appraisal has been made on the item. |
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SCHEDULE OF PROPERTY |
Appraisal - No |
Check the box (if applicable): Indicates that an appraisal has not been made on the item. |
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SCHEDULE OF PROPERTY |
Purchase/Appraisal Date |
Enter date: The date on which the item described was either purchased or last appraised. |
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SCHEDULE OF PROPERTY |
Amount of Insurance |
Enter amount: The value (limit of liability) of the item described. |
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SCHEDULE OF PROPERTY |
Schd # |
Enter number: The number associated with the property class (e.g. 1 - Jewelry, 2 - Furs). |
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SCHEDULE OF PROPERTY |
Item # |
Enter number: The number assigned to the item by the producer. |
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SCHEDULE OF PROPERTY |
Detail Description |
Enter text: The full description of the item including serial numbers, if applicable. |
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SCHEDULE OF PROPERTY |
Appraisal - Yes |
Check the box (if applicable): Indicates that an appraisal has been made on the item. |
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SCHEDULE OF PROPERTY |
Appraisal - No |
Check the box (if applicable): Indicates that an appraisal has not been made on the item. |
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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
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Section Name |
Field Name |
Field and/or Section Description |
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SCHEDULE OF PROPERTY |
Amount of Insurance |
Enter amount: The value (limit of liability) of the item described. |
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SCHEDULE OF PROPERTY |
Schd # |
Enter number: The number associated with the property class (e.g. 1 - Jewelry, 2 - Furs). |
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SCHEDULE OF PROPERTY |
Item # |
Enter number: The number assigned to the item by the producer. |
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SCHEDULE OF PROPERTY |
Detail Description |
Enter text: The full description of the item including serial numbers, if applicable. |
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SCHEDULE OF PROPERTY |
Appraisal - Yes |
Check the box (if applicable): Indicates that an appraisal has been made on the item. |
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SCHEDULE OF PROPERTY |
Appraisal - No |
Check the box (if applicable): Indicates that an appraisal has not been made on the item. |
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SCHEDULE OF PROPERTY |
Purchase/Appraisal Date |
Enter date: The date on which the item described was either purchased or last appraised. |
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SCHEDULE OF PROPERTY |
Amount of Insurance |
Enter amount: The value (limit of liability) of the item described. |
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SCHEDULE OF PROPERTY |
Schd # |
Enter number: The number associated with the property class (e.g. 1 - Jewelry, 2 - Furs). |
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SCHEDULE OF PROPERTY |
Item # |
Enter number: The number assigned to the item by the producer. |
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SCHEDULE OF PROPERTY |
Detail Description |
Enter text: The full description of the item including serial numbers, if applicable. |
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SCHEDULE OF PROPERTY |
Appraisal - Yes |
Check the box (if applicable): Indicates that an appraisal has been made on the item. |
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SCHEDULE OF PROPERTY |
Appraisal - No |
Check the box (if applicable): Indicates that an appraisal has not been made on the item. |
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SCHEDULE OF PROPERTY |
Purchase/Appraisal Date |
Enter date: The date on which the item described was either purchased or last appraised. |
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SCHEDULE OF PROPERTY |
Amount of Insurance |
Enter amount: The value (limit of liability) of the item described. |
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SCHEDULE OF PROPERTY |
Schd # |
Enter number: The number associated with the property class (e.g. 1 - Jewelry, 2 - Furs). |
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SCHEDULE OF PROPERTY |
Item # |
Enter number: The number assigned to the item by the producer. |
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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
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Section Name |
Field Name |
Field and/or Section Description |
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SCHEDULE OF PROPERTY |
Appraisal - Yes |
Check the box (if applicable): Indicates that an appraisal has been made on the item. |
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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. |
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SCHEDULE OF PROPERTY |
Amount of Insurance |
Enter amount: The value (limit of liability) of the item described. |
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SCHEDULE OF PROPERTY |
Schd # |
Enter number: The number associated with the property class (e.g. 1 - Jewelry, 2 - Furs). |
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SCHEDULE OF PROPERTY |
Item # |
Enter number: The number assigned to the item by the producer. |
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SCHEDULE OF PROPERTY |
Detail Description |
Enter text: The full description of the item including serial numbers, if applicable. |
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SCHEDULE OF PROPERTY |
Appraisal - Yes |
Check the box (if applicable): Indicates that an appraisal has been made on the item. |
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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). |
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SCHEDULE OF PROPERTY |
Item # |
Enter number: The number assigned to the item by the producer. |
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SCHEDULE OF PROPERTY |
Detail Description |
Enter text: The full description of the item including serial numbers, if applicable. |
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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. |
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SCHEDULE OF PROPERTY |
Amount of Insurance |
Enter amount: The value (limit of liability) of the item described. |
ACORD 81 (2005/08) 11 of 15
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Section Name |
Field Name |
Field and/or Section Description |
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SCHEDULE OF PROPERTY |
Schd # |
Enter number: The number associated with the property class (e.g. 1 - Jewelry, 2 - Furs). |
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SCHEDULE OF PROPERTY |
Item # |
Enter number: The number assigned to the item by the producer. |
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SCHEDULE OF PROPERTY |
Detail Description |
Enter text: The full description of the item including serial numbers, if applicable. |
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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). |
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SCHEDULE OF PROPERTY |
Item # |
Enter number: The number assigned to the item by the producer. |
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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
|