ACORD 1 (2011/07) rev. 06-30-2011
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Section Name
Field Name
Field and/or Section Description
TITLE
ACORD 1 (2011/07)
Property Loss Notice
ACORD 1, Property Loss Notice, is used for reporting commercial
and personal lines property losses including Homeowners, Dwelling Fire, Inland Marine,
Commercial Property, Flood, Wind and others.
IDENTIFICATION SECTION Date
Enter date: The month/day/year on which the form is completed. (MM/DD/YYYY)
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
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).
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Section Name
Field Name
Field and/or Section Description
IDENTIFICATION SECTION Insured Location Code
Enter code: The code the policyholder defines that is used to allocate loss experience to
cost centers. For example, if a grocery store chain is insured and the entire chain was
under one policy, the grocery store chain might choose to allocate the losses for each
store. To do this they would provide a store number or store code (something the insured
defines) when they report a claim. The insured would include that store number in the
Insured Location Code field so that the carrier can record the code in their claim system
and then the right store is assessed the loss experience.
IDENTIFICATION SECTION Date of Loss
Enter date: The date that the loss occurred.
IDENTIFICATION SECTION Time of Loss
Enter time: The approximate time that the loss occurred.
IDENTIFICATION SECTION AM
Check the box (if applicable): Indicates the loss occurred in the morning.
IDENTIFICATION SECTION PM
Check the box (if applicable): Indicates the loss occurred in the afternoon or evening.
IDENTIFICATION SECTION Property/Home Company
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.
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 Flood Company
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.
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 Wind Company
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.
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Section Name
Field Name
Field and/or Section Description
IDENTIFICATION SECTION NAIC Code
Enter code: The identification code assigned to the insurer by the NAIC.
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.
INSURED
Name of Insured
Enter text: The named insured(s) as it/they will appear on the policy declarations page.
INSURED
Date of Birth
Enter date: The date of birth of the insured.
INSURED
FEIN (if applicable)
Enter identifier: The tax identifier of the named insured. As used here, this is the Federal
Employer's Identification Number, if applicable.
INSURED
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
INSURED
Primary Phone Number
Enter number: The named insured's primary phone number.
INSURED
Home
Check the box (if applicable): Indicates the primary phone number is for a home phone.
INSURED
Business
Check the box (if applicable): Indicates the primary phone number is for a business
phone.
INSURED
Cell
Check the box (if applicable): Indicates the primary phone number is for a cell phone.
INSURED
Secondary Phone
Enter number: The named insured's secondary phone number.
INSURED
Home
Check the box (if applicable): Indicates the secondary phone number is for a home phone.
INSURED
Business
Check the box (if applicable): Indicates the secondary phone number is for a business
phone.
INSURED
Cell
Check the box (if applicable): Indicates the phone number is for a cell phone.
INSURED
Insured's Mailing Address
Enter text: The named insured's mailing address line one.
INSURED
Enter text: The named insured's mailing address line two.
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Section Name
Field Name
Field and/or Section Description
INSURED
Enter text: The named insured's mailing address city name.
INSURED
Enter code: The named insured's mailing address state or province code.
INSURED
Enter code: The named insured's mailing address postal code.
INSURED
Primary E-Mail Address
Enter text: The named insured's primary e-mail address.
INSURED
Secondary E-Mail Address
Enter text: The named insured's secondary e-mail address.
INSURED
Name of Spouse
Enter text: The named insured(s) as it/they will appear on the policy declarations page.
INSURED
Date of Birth
Enter date: The date of birth of the insured.
INSURED
FEIN (if applicable)
Enter identifier: The tax identifier of the named insured. As used here, this is the Federal
Employer's Identification Number, if applicable.
INSURED
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
INSURED
Primary Phone Number
Enter number: The named insured's primary phone number.
INSURED
Home
Check the box (if applicable): Indicates the primary phone number is for a home phone.
INSURED
Business
Check the box (if applicable): Indicates the primary phone number is for a business
phone.
INSURED
Cell
Check the box (if applicable): Indicates the primary phone number is for a cell phone.
INSURED
Secondary Phone
Enter number: The named insured's secondary phone number.
INSURED
Home
Check the box (if applicable): Indicates the secondary phone number is for a home phone.
INSURED
Business
Check the box (if applicable): Indicates the secondary phone number is for a business
phone.
INSURED
Cell
Check the box (if applicable): Indicates the phone number is for a cell phone.
INSURED
Spouse's Mailing Address
Enter text: The named insured's mailing address line one.
INSURED
Enter text: The named insured's mailing address line two.
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Section Name
Field Name
Field and/or Section Description
INSURED
Enter text: The named insured's mailing address city name.
INSURED
Enter code: The named insured's mailing address state or province code.
INSURED
Enter code: The named insured's mailing address postal code.
INSURED
Primary E-Mail Address
Enter text: The named insured's primary e-mail address.
INSURED
Secondary E-Mail Address
Enter text: The named insured's secondary e-mail address.
CONTACT
Contact Insured
Check the box (if applicable): Indicates If the individual to contact is the same as the
insured, check this box and leave blank the areas for contact name, address and phone
numbers.
CONTACT
Name of Contact
Enter text: The full name (First, Middle, Last) of the individual to be contacted as a
representative of the insured on all subsequent business relating to this incident. No entry
is needed if the 'Contact Insured' option is checked.
CONTACT
Primary Phone Number
Enter number: The loss contact's primary telephone number including area code.
CONTACT
Home
Check the box (if applicable): Indicates the primary phone number is for a home phone.
CONTACT
Business
Check the box (if applicable): Indicates the primary phone number is for a business
phone.
CONTACT
Cell
Check the box (if applicable): Indicates the primary phone number is for a cell phone.
CONTACT
Secondary Phone
Enter number: The loss contact's secondary telephone number including area code.
CONTACT
Home
Check the box (if applicable): Indicates the secondary phone number is for a home phone.
CONTACT
Business
Check the box (if applicable): Indicates the secondary phone number is for a business
phone.
CONTACT
Cell
Check the box (if applicable): Indicates the secondary phone number is for a cell phone.
CONTACT
When to Contact
Enter text: The best time of the day to contact this individual (e.g., evenings, days, noon to
3:00 P.M.).
CONTACT
Contact's Mailing Address
Enter text: The loss contact's first address line.
CONTACT
Enter text: The loss contact's second address line.
CONTACT
Enter text: The loss contact's city.
CONTACT
Enter code: The loss contact's state.
CONTACT
Enter code: The loss contact's postal code.
CONTACT
Primary E-Mail Address
Enter text: The loss contact's primary e-mail address.
CONTACT
Secondary E-Mail Address
Enter text: The loss contact's secondary e-mail address.
LOSS
Location of Loss Street
Enter text: The loss location's physical street address.
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Section Name
Field Name
Field and/or Section Description
LOSS
Location of Loss City, State, Zip
Enter text: The loss location's city.
LOSS
Enter code: The loss location's state or province code.
LOSS
Enter code: The loss location's postal code.
LOSS
Location of Loss Country
Enter code: The loss location's country code.
LOSS
Describe Location of Loss if not at
Specific Street Address
Enter text: The description of the location of loss if not at a specific street address.
LOSS
Police or Fire Department
Contacted
Enter text: The name of the municipal, county or other police department, fire department
or other authority to which the accident was reported, including any precinct or station
number, if available.
LOSS
Report Number
Enter identifier: The report number assigned by the authority contacted. For example, the
number of the vehicle incident report filed by the police after an automobile accident.
LOSS
Kind of Loss
Check the box (if applicable): Indicates the loss was due to fire.
LOSS
Kind of Loss
Check the box (if applicable): Indicates the loss was due to theft.
LOSS
Kind of Loss
Check the box (if applicable): Indicates the loss was due to lightning.
LOSS
Kind of Loss
Check the box (if applicable): Indicates the loss was due to hail.
LOSS
Kind of Loss
Check the box (if applicable): Indicates the loss was due to flooding.
LOSS
Kind of Loss
Check the box (if applicable): Indicates the loss was due to wind.
LOSS
Kind of Loss
Check the box (if applicable): Indicates the loss was due to other that those types listed.
LOSS
Kind of Loss
Enter text: The description of the cause of the loss.
LOSS
Probable Amount Entire Loss
Enter amount: The estimated dollar amount which may be paid on all claims arising from
this incident. If no dollar estimate is available, provide a description such as small or
substantial.
LOSS
Description of Loss & Damage
Enter text: The description of the cause of the loss and resulting damage, including the
areas of buildings which were damaged. Note: If the loss resulted in bodily injury to
individuals or damage to the property of others, indicate in the Remarks Section and
complete the appropriate additional claim form.
LOSS
Reported By
Enter text: The name of the individual that reported the loss.
LOSS
Reported To
Enter text: The name of the individual within the agency or company to whom this loss
was reported.
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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Section Name
Field Name
Field and/or Section Description
REMARKS
Enter text: The property loss notice general remarks. Describe any other additional
information that will assist in properly reporting and settling this claim. Include the
adjusters name if known. Attach ACORD 101, Additional Remarks Schedule, if more
space is required.
IDENTIFICATION SECTION Agency Customer ID
Enter identifier: The customer's identification number assigned by the producer (e.g.
agency or brokerage).
Edition
Date
The edition identifier of the form including the form number and edition (the date is
typically formatted YYYY/MM).