Section Name
Field Name
Field and/or Section Description
TITLE
ACORD 813 (2005/03)
Request for Proof of Property
Insurance
This form may be provided to a mortgage holder, loss payee, or other entity that requests
proof of property insurance, but does not clearly describe what information is needed on
an evidence of property insurance or certificate of property insurance.
IDENTIFICATION SECTION Date
Month/day/year (MM/DD/YYYY) on which the form is completed.
IDENTIFICATION SECTION Fax this Request to
Name of requester or service organization making the request.
IDENTIFICATION SECTION Phone
Requester's telephone number. (Include area code and extension if applicable)
IDENTIFICATION SECTION Fax
Requester's fax number. (Include area code)
IDENTIFICATION SECTION E-Mail Address
Requester's e-mail address.
IDENTIFICATION SECTION Name and Address of Requester
Name and address of requester.
IDENTIFICATION SECTION Requester Interest in Property
Enter Owner, Lessor, Mortgage Holder or other indication of the requester's interest
in the property.
IDENTIFICATION SECTION address below)
Name of Unit Owner(s) and Mailing
Address (If different from property
Enter this information, if applicable
PROPERTY AND
MORTGAGE INFORMATION Applicable)
Condominium Association or Co-
op Association Name (If
Enter this information, if applicable
PROPERTY AND
MORTGAGE INFORMATION Property Type
Check the appropriate box and enter the type of ownership, if not a condo unit.
PROPERTY AND
MORTGAGE INFORMATION Transaction Type
Indicate the type of transaction and enter additional information where necessary.
PROPERTY AND
MORTGAGE INFORMATION Lender's Position
Provide the lender's name and check the applicable box.
PROPERTY AND
MORTGAGE INFORMATION applicable)
Property Address - Legal
Description (Include Unit #, if
Provide the complete address of the property. Include the Unit Number, if applicable.
ACORD 813 (2005/03)
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Section Name
Field Name
Field and/or Section Description
PROPERTY AND
MORTGAGE INFORMATION Mortgage Clause
Describe the type of mortgage clause used in the policy.
PROPERTY AND
MORTGAGE INFORMATION Mortgage Loan No. (If Applicable)
Provide the mortgage loan number, if applicable.
PROPERTY AND
MORTGAGE INFORMATION Special Instructions
Provide instructions with respect to any additional information required to complete the
proof of property insurance.
PROPERTY AND
MORTGAGE INFORMATION Remarks
Space for any additional comments or to list any special conditions that may exist upon the
policy.
ACORD 813 (2005/03)
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