|
Section Name |
Field Name |
Field and/or Section Description |
|
ACORD 819 (2007/08) |
Producer Appointment - Additional Appointment Or Termination |
The ACORD 819, Producer Appointment - Additional Appointment or Termination form serves two different uses. It may be used to request an appointment update, such as appointments in additional states. It's other use involves the termination of an appointment. |
|
IDENTIFICATION SECTION |
Date (MM/DD/YYYY) |
The date the form is completed. |
|
IDENTIFICATION SECTION |
Carrier |
The full name of the insurance company to whom the appointment form/request is being submitted. |
|
IDENTIFICATION SECTION |
NAIC Code |
The identification code assigned to the company by the NAIC. |
|
FORM TYPE |
Additional Appointment (checkbox) |
Indicates the purpose of this form is to request an update to an existing producer appointment. |
|
FORM TYPE |
Termination (checkbox) |
|
|
FORM TYPE |
Termination Type |
|
|
FORM TYPE |
Termination Reason |
|
|
FORM TYPE |
Termination Date (MM/DD/YYYY) |
|
|
PRODUCER INFORMATION |
Full Legal Name - Prefix |
Any phrase to precede the name which is not part of the actual name, such as Dr. or Mrs. |
|
PRODUCER INFORMATION |
Full Legal Name - First Name |
The person's "first name". |
|
PRODUCER INFORMATION |
Full Legal Name - Middle Name |
The person's "middle name". |
|
PRODUCER INFORMATION |
Full Legal Name - Surname |
This is the family's or individual's surname, also known in the USA as "Last Name". |
|
PRODUCER INFORMATION |
Full Legal Name - Suffix |
Name Suffix. For example, "Jr.", or "III". |
|
PRODUCER INFORMATION |
National Producer Number |
|
|
AGENCY INFORMATION |
Agency Name and Address |
The full name and address of the agency at which the producer (person) is employed with regards to this appointment request. |
|
AGENCY INFORMATION |
Licensing Contact: |
The name of the licensing contact person within the agency. Contact this person if there are any questions about the appointment form. |
|
AGENCY INFORMATION |
Contact Phone (A/C, No, Ext): |
The licensing contact person's business phone number. |
|
AGENCY INFORMATION |
Contact Fax (A/C, No): |
The licensing contact person's fax number. |
|
AGENCY INFORMATION |
Contact E-Mail: |
The licensing contact person's email address. |