ACORD 6 (2009/05)

Section Name
Field Name
Field and/or Section Description
TITLE
ACORD 6 (2009/05)
Aviation Witness / Passenger
Schedule
ACORD 6, Aviation Witness / Passenger Schedule, is used when
additional space is required to list witnesses and / or passengers when reporting an
aviation loss.
IDENTIFICATION SECTION Agency Customer ID
Enter identifier: The customer's identification number assigned by the producer (e.g.
agency or brokerage).
IDENTIFICATION SECTION Page #
Enter number: The page number applicable to this page.
IDENTIFICATION SECTION of Total Pages
Enter number: The total number of pages applicable to this form (e.g., Page 1 of 4). If
only one page, indicate Page 1 of 1.
IDENTIFICATION SECTION Agency
Enter text: The full name of the producer/agency.
IDENTIFICATION SECTION Named Insured
Enter text: The named insured(s) as it/they will appear on the policy declarations page.
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 Effective Date
Enter date: The effective date of the policy. The date that the terms and conditions of the
policy commence.
IDENTIFICATION SECTION Carrier
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.
WITNESSES OR
PASSENGERS
#
Enter number: The producer assigned number for the witness.
WITNESSES OR
PASSENGERS
Name & Address
Enter text: The name of a person that was a witness to the incident or an uninjured
passenger.
WITNESSES OR
PASSENGERS
Enter text: The first address line of a person that was a witness to the incident.
WITNESSES OR
PASSENGERS
Enter text: The second address line of a person that was a witness to the incident.
WITNESSES OR
PASSENGERS
Enter text: The city of a person that was a witness to the incident.
WITNESSES OR
PASSENGERS
Enter code: The state or province code of a person that was a witness to the incident.
ACORD 6 (2009/05)
1 of 15
Section Name
Field Name
Field and/or Section Description
WITNESSES OR
PASSENGERS
Enter code: The postal code of a person that was a witness to the incident.
WITNESSES OR
PASSENGERS
Home Phone
Enter number: The primary phone number of a person that was a witness to the incident.
As used here, this is the home phone number.
WITNESSES OR
PASSENGERS
Business Phone
Enter number: The secondary phone number of the witness. As used here, this is the
business phone number.
WITNESSES OR
PASSENGERS
Cell Phone
Enter number: The third phone number of the witness. As used here, this is the cell phone
number.
WITNESSES OR
PASSENGERS
Insured Aircraft
Check the box (if applicable): Indicates if the witness was in the insured's aircraft at the
time of the incident or accident.
WITNESSES OR
PASSENGERS
Other Aircraft
Check the box (if applicable): Indicates if the witness was in an aircraft other than the
insured's aircraft at the time of the incident or accident.
WITNESSES OR
PASSENGERS
Other Checkbox
Enter text: Indicates the witness was in a location other than those listed. As used here, if
other, enter the location in Other Location Details.
WITNESSES OR
PASSENGERS
Other Location Details
Enter text: A description of the location of the witness if the witness was not in the
insured's vehicle or aircraft or other involved vehicle or aircraft at the time of the incident.
WITNESSES OR
PASSENGERS
#
Enter number: The producer assigned number for the witness.
WITNESSES OR
PASSENGERS
Name & Address
Enter text: The name of a person that was a witness to the incident or an uninjured
passenger.
WITNESSES OR
PASSENGERS
Enter text: The first address line of a person that was a witness to the incident.
WITNESSES OR
PASSENGERS
Enter text: The second address line of a person that was a witness to the incident.
WITNESSES OR
PASSENGERS
Enter text: The city of a person that was a witness to the incident.
WITNESSES OR
PASSENGERS
Enter code: The state or province code of a person that was a witness to the incident.
WITNESSES OR
PASSENGERS
Enter code: The postal code of a person that was a witness to the incident.
WITNESSES OR
PASSENGERS
Home Phone
Enter number: The primary phone number of a person that was a witness to the incident.
As used here, this is the home phone number.
WITNESSES OR
PASSENGERS
Business Phone
Enter number: The secondary phone number of the witness. As used here, this is the
business phone number.
ACORD 6 (2009/05)
2 of 15
Section Name
Field Name
Field and/or Section Description
WITNESSES OR
PASSENGERS
Cell Phone
Enter number: The third phone number of the witness. As used here, this is the cell phone
number.
WITNESSES OR
PASSENGERS
Insured Aircraft
Check the box (if applicable): Indicates if the witness was in the insured's aircraft at the
time of the incident or accident.
WITNESSES OR
PASSENGERS
Other Aircraft
Check the box (if applicable): Indicates if the witness was in an aircraft other than the
insured's aircraft at the time of the incident or accident.
WITNESSES OR
PASSENGERS
Other Checkbox
Enter text: Indicates the witness was in a location other than those listed. As used here, if
other, enter the location in Other Location Details.
WITNESSES OR
PASSENGERS
Other Location Details
Enter text: A description of the location of the witness if the witness was not in the
insured's vehicle or aircraft or other involved vehicle or aircraft at the time of the incident.
WITNESSES OR
PASSENGERS
#
Enter number: The producer assigned number for the witness.
WITNESSES OR
PASSENGERS
Name & Address
Enter text: The name of a person that was a witness to the incident or an uninjured
passenger.
WITNESSES OR
PASSENGERS
Enter text: The first address line of a person that was a witness to the incident.
WITNESSES OR
PASSENGERS
Enter text: The second address line of a person that was a witness to the incident.
WITNESSES OR
PASSENGERS
Enter text: The city of a person that was a witness to the incident.
WITNESSES OR
PASSENGERS
Enter code: The state or province code of a person that was a witness to the incident.
WITNESSES OR
PASSENGERS
Enter code: The postal code of a person that was a witness to the incident.
WITNESSES OR
PASSENGERS
Home Phone
Enter number: The primary phone number of a person that was a witness to the incident.
As used here, this is the home phone number.
WITNESSES OR
PASSENGERS
Business Phone
Enter number: The secondary phone number of the witness. As used here, this is the
business phone number.
WITNESSES OR
PASSENGERS
Cell Phone
Enter number: The third phone number of the witness. As used here, this is the cell phone
number.
WITNESSES OR
PASSENGERS
Insured Aircraft
Check the box (if applicable): Indicates if the witness was in the insured's aircraft at the
time of the incident or accident.
WITNESSES OR
PASSENGERS
Other Aircraft
Check the box (if applicable): Indicates if the witness was in an aircraft other than the
insured's aircraft at the time of the incident or accident.
ACORD 6 (2009/05)
3 of 15
Section Name
Field Name
Field and/or Section Description
WITNESSES OR
PASSENGERS
Other Checkbox
Enter text: Indicates the witness was in a location other than those listed. As used here, if
other, enter the location in Other Location Details.
WITNESSES OR
PASSENGERS
Other Location Details
Enter text: A description of the location of the witness if the witness was not in the
insured's vehicle or aircraft or other involved vehicle or aircraft at the time of the incident.
WITNESSES OR
PASSENGERS
#
Enter number: The producer assigned number for the witness.
WITNESSES OR
PASSENGERS
Name & Address
Enter text: The name of a person that was a witness to the incident or an uninjured
passenger.
WITNESSES OR
PASSENGERS
Enter text: The first address line of a person that was a witness to the incident.
WITNESSES OR
PASSENGERS
Enter text: The second address line of a person that was a witness to the incident.
WITNESSES OR
PASSENGERS
Enter text: The city of a person that was a witness to the incident.
WITNESSES OR
PASSENGERS
Enter code: The state or province code of a person that was a witness to the incident.
WITNESSES OR
PASSENGERS
Enter code: The postal code of a person that was a witness to the incident.
WITNESSES OR
PASSENGERS
Home Phone
Enter number: The primary phone number of a person that was a witness to the incident.
As used here, this is the home phone number.
WITNESSES OR
PASSENGERS
Business Phone
Enter number: The secondary phone number of the witness. As used here, this is the
business phone number.
WITNESSES OR
PASSENGERS
Cell Phone
Enter number: The third phone number of the witness. As used here, this is the cell phone
number.
WITNESSES OR
PASSENGERS
Insured Aircraft
Check the box (if applicable): Indicates if the witness was in the insured's aircraft at the
time of the incident or accident.
WITNESSES OR
PASSENGERS
Other Aircraft
Check the box (if applicable): Indicates if the witness was in an aircraft other than the
insured's aircraft at the time of the incident or accident.
WITNESSES OR
PASSENGERS
Other Checkbox
Enter text: Indicates the witness was in a location other than those listed. As used here, if
other, enter the location in Other Location Details.
WITNESSES OR
PASSENGERS
Other Location Details
Enter text: A description of the location of the witness if the witness was not in the
insured's vehicle or aircraft or other involved vehicle or aircraft at the time of the incident.
WITNESSES OR
PASSENGERS
#
Enter number: The producer assigned number for the witness.
ACORD 6 (2009/05)
4 of 15
Section Name
Field Name
Field and/or Section Description
WITNESSES OR
PASSENGERS
Name & Address
Enter text: The name of a person that was a witness to the incident or an uninjured
passenger.
WITNESSES OR
PASSENGERS
Enter text: The first address line of a person that was a witness to the incident.
WITNESSES OR
PASSENGERS
Enter text: The second address line of a person that was a witness to the incident.
WITNESSES OR
PASSENGERS
Enter text: The city of a person that was a witness to the incident.
WITNESSES OR
PASSENGERS
Enter code: The state or province code of a person that was a witness to the incident.
WITNESSES OR
PASSENGERS
Enter code: The postal code of a person that was a witness to the incident.
WITNESSES OR
PASSENGERS
Home Phone
Enter number: The primary phone number of a person that was a witness to the incident.
As used here, this is the home phone number.
WITNESSES OR
PASSENGERS
Business Phone
Enter number: The secondary phone number of the witness. As used here, this is the
business phone number.
WITNESSES OR
PASSENGERS
Cell Phone
Enter number: The third phone number of the witness. As used here, this is the cell phone
number.
WITNESSES OR
PASSENGERS
Insured Aircraft
Check the box (if applicable): Indicates if the witness was in the insured's aircraft at the
time of the incident or accident.
WITNESSES OR
PASSENGERS
Other Aircraft
Check the box (if applicable): Indicates if the witness was in an aircraft other than the
insured's aircraft at the time of the incident or accident.
WITNESSES OR
PASSENGERS
Other Checkbox
Enter text: Indicates the witness was in a location other than those listed. As used here, if
other, enter the location in Other Location Details.
WITNESSES OR
PASSENGERS
Other Location Details
Enter text: A description of the location of the witness if the witness was not in the
insured's vehicle or aircraft or other involved vehicle or aircraft at the time of the incident.
WITNESSES OR
PASSENGERS
#
Enter number: The producer assigned number for the witness.
WITNESSES OR
PASSENGERS
Name & Address
Enter text: The name of a person that was a witness to the incident or an uninjured
passenger.
WITNESSES OR
PASSENGERS
Enter text: The first address line of a person that was a witness to the incident.
WITNESSES OR
PASSENGERS
Enter text: The second address line of a person that was a witness to the incident.
ACORD 6 (2009/05)
5 of 15
Section Name
Field Name
Field and/or Section Description
WITNESSES OR
PASSENGERS
Enter text: The city of a person that was a witness to the incident.
WITNESSES OR
PASSENGERS
Enter code: The state or province code of a person that was a witness to the incident.
WITNESSES OR
PASSENGERS
Enter code: The postal code of a person that was a witness to the incident.
WITNESSES OR
PASSENGERS
Home Phone
Enter number: The primary phone number of a person that was a witness to the incident.
As used here, this is the home phone number.
WITNESSES OR
PASSENGERS
Business Phone
Enter number: The secondary phone number of the witness. As used here, this is the
business phone number.
WITNESSES OR
PASSENGERS
Cell Phone
Enter number: The third phone number of the witness. As used here, this is the cell phone
number.
WITNESSES OR
PASSENGERS
Insured Aircraft
Check the box (if applicable): Indicates if the witness was in the insured's aircraft at the
time of the incident or accident.
WITNESSES OR
PASSENGERS
Other Aircraft
Check the box (if applicable): Indicates if the witness was in an aircraft other than the
insured's aircraft at the time of the incident or accident.
WITNESSES OR
PASSENGERS
Other Checkbox
Enter text: Indicates the witness was in a location other than those listed. As used here, if
other, enter the location in Other Location Details.
WITNESSES OR
PASSENGERS
Other Location Details
Enter text: A description of the location of the witness if the witness was not in the
insured's vehicle or aircraft or other involved vehicle or aircraft at the time of the incident.
WITNESSES OR
PASSENGERS
#
Enter number: The producer assigned number for the witness.
WITNESSES OR
PASSENGERS
Name & Address
Enter text: The name of a person that was a witness to the incident or an uninjured
passenger.
WITNESSES OR
PASSENGERS
Enter text: The first address line of a person that was a witness to the incident.
WITNESSES OR
PASSENGERS
Enter text: The second address line of a person that was a witness to the incident.
WITNESSES OR
PASSENGERS
Enter text: The city of a person that was a witness to the incident.
WITNESSES OR
PASSENGERS
Enter code: The state or province code of a person that was a witness to the incident.
WITNESSES OR
PASSENGERS
Enter code: The postal code of a person that was a witness to the incident.
ACORD 6 (2009/05)
6 of 15
Section Name
Field Name
Field and/or Section Description
WITNESSES OR
PASSENGERS
Home Phone
Enter number: The primary phone number of a person that was a witness to the incident.
As used here, this is the home phone number.
WITNESSES OR
PASSENGERS
Business Phone
Enter number: The secondary phone number of the witness. As used here, this is the
business phone number.
WITNESSES OR
PASSENGERS
Cell Phone
Enter number: The third phone number of the witness. As used here, this is the cell phone
number.
WITNESSES OR
PASSENGERS
Insured Aircraft
Check the box (if applicable): Indicates if the witness was in the insured's aircraft at the
time of the incident or accident.
WITNESSES OR
PASSENGERS
Other Aircraft
Check the box (if applicable): Indicates if the witness was in an aircraft other than the
insured's aircraft at the time of the incident or accident.
WITNESSES OR
PASSENGERS
Other Checkbox
Enter text: Indicates the witness was in a location other than those listed. As used here, if
other, enter the location in Other Location Details.
WITNESSES OR
PASSENGERS
Other Location Details
Enter text: A description of the location of the witness if the witness was not in the
insured's vehicle or aircraft or other involved vehicle or aircraft at the time of the incident.
WITNESSES OR
PASSENGERS
#
Enter number: The producer assigned number for the witness.
WITNESSES OR
PASSENGERS
Name & Address
Enter text: The name of a person that was a witness to the incident or an uninjured
passenger.
WITNESSES OR
PASSENGERS
Enter text: The first address line of a person that was a witness to the incident.
WITNESSES OR
PASSENGERS
Enter text: The second address line of a person that was a witness to the incident.
WITNESSES OR
PASSENGERS
Enter text: The city of a person that was a witness to the incident.
WITNESSES OR
PASSENGERS
Enter code: The state or province code of a person that was a witness to the incident.
WITNESSES OR
PASSENGERS
Enter code: The postal code of a person that was a witness to the incident.
WITNESSES OR
PASSENGERS
Home Phone
Enter number: The primary phone number of a person that was a witness to the incident.
As used here, this is the home phone number.
WITNESSES OR
PASSENGERS
Business Phone
Enter number: The secondary phone number of the witness. As used here, this is the
business phone number.
WITNESSES OR
PASSENGERS
Cell Phone
Enter number: The third phone number of the witness. As used here, this is the cell phone
number.
ACORD 6 (2009/05)
7 of 15
Section Name
Field Name
Field and/or Section Description
WITNESSES OR
PASSENGERS
Insured Aircraft
Check the box (if applicable): Indicates if the witness was in the insured's aircraft at the
time of the incident or accident.
WITNESSES OR
PASSENGERS
Other Aircraft
Check the box (if applicable): Indicates if the witness was in an aircraft other than the
insured's aircraft at the time of the incident or accident.
WITNESSES OR
PASSENGERS
Other Checkbox
Enter text: Indicates the witness was in a location other than those listed. As used here, if
other, enter the location in Other Location Details.
WITNESSES OR
PASSENGERS
Other Location Details
Enter text: A description of the location of the witness if the witness was not in the
insured's vehicle or aircraft or other involved vehicle or aircraft at the time of the incident.
WITNESSES OR
PASSENGERS
#
Enter number: The producer assigned number for the witness.
WITNESSES OR
PASSENGERS
Name & Address
Enter text: The name of a person that was a witness to the incident or an uninjured
passenger.
WITNESSES OR
PASSENGERS
Enter text: The first address line of a person that was a witness to the incident.
WITNESSES OR
PASSENGERS
Enter text: The second address line of a person that was a witness to the incident.
WITNESSES OR
PASSENGERS
Enter text: The city of a person that was a witness to the incident.
WITNESSES OR
PASSENGERS
Enter code: The state or province code of a person that was a witness to the incident.
WITNESSES OR
PASSENGERS
Enter code: The postal code of a person that was a witness to the incident.
WITNESSES OR
PASSENGERS
Home Phone
Enter number: The primary phone number of a person that was a witness to the incident.
As used here, this is the home phone number.
WITNESSES OR
PASSENGERS
Business Phone
Enter number: The secondary phone number of the witness. As used here, this is the
business phone number.
WITNESSES OR
PASSENGERS
Cell Phone
Enter number: The third phone number of the witness. As used here, this is the cell phone
number.
WITNESSES OR
PASSENGERS
Insured Aircraft
Check the box (if applicable): Indicates if the witness was in the insured's aircraft at the
time of the incident or accident.
WITNESSES OR
PASSENGERS
Other Aircraft
Check the box (if applicable): Indicates if the witness was in an aircraft other than the
insured's aircraft at the time of the incident or accident.
WITNESSES OR
PASSENGERS
Other Checkbox
Enter text: Indicates the witness was in a location other than those listed. As used here, if
other, enter the location in Other Location Details.
ACORD 6 (2009/05)
8 of 15
Section Name
Field Name
Field and/or Section Description
WITNESSES OR
PASSENGERS
Other Location Details
Enter text: A description of the location of the witness if the witness was not in the
insured's vehicle or aircraft or other involved vehicle or aircraft at the time of the incident.
WITNESSES OR
PASSENGERS
#
Enter number: The producer assigned number for the witness.
WITNESSES OR
PASSENGERS
Name & Address
Enter text: The name of a person that was a witness to the incident or an uninjured
passenger.
WITNESSES OR
PASSENGERS
Enter text: The first address line of a person that was a witness to the incident.
WITNESSES OR
PASSENGERS
Enter text: The second address line of a person that was a witness to the incident.
WITNESSES OR
PASSENGERS
Enter text: The city of a person that was a witness to the incident.
WITNESSES OR
PASSENGERS
Enter code: The state or province code of a person that was a witness to the incident.
WITNESSES OR
PASSENGERS
Enter code: The postal code of a person that was a witness to the incident.
WITNESSES OR
PASSENGERS
Home Phone
Enter number: The primary phone number of a person that was a witness to the incident.
As used here, this is the home phone number.
WITNESSES OR
PASSENGERS
Business Phone
Enter number: The secondary phone number of the witness. As used here, this is the
business phone number.
WITNESSES OR
PASSENGERS
Cell Phone
Enter number: The third phone number of the witness. As used here, this is the cell phone
number.
WITNESSES OR
PASSENGERS
Insured Aircraft
Check the box (if applicable): Indicates if the witness was in the insured's aircraft at the
time of the incident or accident.
WITNESSES OR
PASSENGERS
Other Aircraft
Check the box (if applicable): Indicates if the witness was in an aircraft other than the
insured's aircraft at the time of the incident or accident.
WITNESSES OR
PASSENGERS
Other Checkbox
Enter text: Indicates the witness was in a location other than those listed. As used here, if
other, enter the location in Other Location Details.
WITNESSES OR
PASSENGERS
Other Location Details
Enter text: A description of the location of the witness if the witness was not in the
insured's vehicle or aircraft or other involved vehicle or aircraft at the time of the incident.
WITNESSES OR
PASSENGERS
#
Enter number: The producer assigned number for the witness.
WITNESSES OR
PASSENGERS
Name & Address
Enter text: The name of a person that was a witness to the incident or an uninjured
passenger.
ACORD 6 (2009/05)
9 of 15
Section Name
Field Name
Field and/or Section Description
WITNESSES OR
PASSENGERS
Enter text: The first address line of a person that was a witness to the incident.
WITNESSES OR
PASSENGERS
Enter text: The second address line of a person that was a witness to the incident.
WITNESSES OR
PASSENGERS
Enter text: The city of a person that was a witness to the incident.
WITNESSES OR
PASSENGERS
Enter code: The state or province code of a person that was a witness to the incident.
WITNESSES OR
PASSENGERS
Enter code: The postal code of a person that was a witness to the incident.
WITNESSES OR
PASSENGERS
Home Phone
Enter number: The primary phone number of a person that was a witness to the incident.
As used here, this is the home phone number.
WITNESSES OR
PASSENGERS
Business Phone
Enter number: The secondary phone number of the witness. As used here, this is the
business phone number.
WITNESSES OR
PASSENGERS
Cell Phone
Enter number: The third phone number of the witness. As used here, this is the cell phone
number.
WITNESSES OR
PASSENGERS
Insured Aircraft
Check the box (if applicable): Indicates if the witness was in the insured's aircraft at the
time of the incident or accident.
WITNESSES OR
PASSENGERS
Other Aircraft
Check the box (if applicable): Indicates if the witness was in an aircraft other than the
insured's aircraft at the time of the incident or accident.
WITNESSES OR
PASSENGERS
Other Checkbox
Enter text: Indicates the witness was in a location other than those listed. As used here, if
other, enter the location in Other Location Details.
WITNESSES OR
PASSENGERS
Other Location Details
Enter text: A description of the location of the witness if the witness was not in the
insured's vehicle or aircraft or other involved vehicle or aircraft at the time of the incident.
WITNESSES OR
PASSENGERS
#
Enter number: The producer assigned number for the witness.
WITNESSES OR
PASSENGERS
Name & Address
Enter text: The name of a person that was a witness to the incident or an uninjured
passenger.
WITNESSES OR
PASSENGERS
Enter text: The first address line of a person that was a witness to the incident.
WITNESSES OR
PASSENGERS
Enter text: The second address line of a person that was a witness to the incident.
WITNESSES OR
PASSENGERS
Enter text: The city of a person that was a witness to the incident.
ACORD 6 (2009/05)
10 of 15
Section Name
Field Name
Field and/or Section Description
WITNESSES OR
PASSENGERS
Enter code: The state or province code of a person that was a witness to the incident.
WITNESSES OR
PASSENGERS
Enter code: The postal code of a person that was a witness to the incident.
WITNESSES OR
PASSENGERS
Home Phone
Enter number: The primary phone number of a person that was a witness to the incident.
As used here, this is the home phone number.
WITNESSES OR
PASSENGERS
Business Phone
Enter number: The secondary phone number of the witness. As used here, this is the
business phone number.
WITNESSES OR
PASSENGERS
Cell Phone
Enter number: The third phone number of the witness. As used here, this is the cell phone
number.
WITNESSES OR
PASSENGERS
Insured Aircraft
Check the box (if applicable): Indicates if the witness was in the insured's aircraft at the
time of the incident or accident.
WITNESSES OR
PASSENGERS
Other Aircraft
Check the box (if applicable): Indicates if the witness was in an aircraft other than the
insured's aircraft at the time of the incident or accident.
WITNESSES OR
PASSENGERS
Other Checkbox
Enter text: Indicates the witness was in a location other than those listed. As used here, if
other, enter the location in Other Location Details.
WITNESSES OR
PASSENGERS
Other Location Details
Enter text: A description of the location of the witness if the witness was not in the
insured's vehicle or aircraft or other involved vehicle or aircraft at the time of the incident.
WITNESSES OR
PASSENGERS
#
Enter number: The producer assigned number for the witness.
WITNESSES OR
PASSENGERS
Name & Address
Enter text: The name of a person that was a witness to the incident or an uninjured
passenger.
WITNESSES OR
PASSENGERS
Enter text: The first address line of a person that was a witness to the incident.
WITNESSES OR
PASSENGERS
Enter text: The second address line of a person that was a witness to the incident.
WITNESSES OR
PASSENGERS
Enter text: The city of a person that was a witness to the incident.
WITNESSES OR
PASSENGERS
Enter code: The state or province code of a person that was a witness to the incident.
WITNESSES OR
PASSENGERS
Enter code: The postal code of a person that was a witness to the incident.
WITNESSES OR
PASSENGERS
Home Phone
Enter number: The primary phone number of a person that was a witness to the incident.
As used here, this is the home phone number.
ACORD 6 (2009/05)
11 of 15
Section Name
Field Name
Field and/or Section Description
WITNESSES OR
PASSENGERS
Business Phone
Enter number: The secondary phone number of the witness. As used here, this is the
business phone number.
WITNESSES OR
PASSENGERS
Cell Phone
Enter number: The third phone number of the witness. As used here, this is the cell phone
number.
WITNESSES OR
PASSENGERS
Insured Aircraft
Check the box (if applicable): Indicates if the witness was in the insured's aircraft at the
time of the incident or accident.
WITNESSES OR
PASSENGERS
Other Aircraft
Check the box (if applicable): Indicates if the witness was in an aircraft other than the
insured's aircraft at the time of the incident or accident.
WITNESSES OR
PASSENGERS
Other Checkbox
Enter text: Indicates the witness was in a location other than those listed. As used here, if
other, enter the location in Other Location Details.
WITNESSES OR
PASSENGERS
Other Location Details
Enter text: A description of the location of the witness if the witness was not in the
insured's vehicle or aircraft or other involved vehicle or aircraft at the time of the incident.
WITNESSES OR
PASSENGERS
#
Enter number: The producer assigned number for the witness.
WITNESSES OR
PASSENGERS
Name & Address
Enter text: The name of a person that was a witness to the incident or an uninjured
passenger.
WITNESSES OR
PASSENGERS
Enter text: The first address line of a person that was a witness to the incident.
WITNESSES OR
PASSENGERS
Enter text: The second address line of a person that was a witness to the incident.
WITNESSES OR
PASSENGERS
Enter text: The city of a person that was a witness to the incident.
WITNESSES OR
PASSENGERS
Enter code: The state or province code of a person that was a witness to the incident.
WITNESSES OR
PASSENGERS
Enter code: The postal code of a person that was a witness to the incident.
WITNESSES OR
PASSENGERS
Home Phone
Enter number: The primary phone number of a person that was a witness to the incident.
As used here, this is the home phone number.
WITNESSES OR
PASSENGERS
Business Phone
Enter number: The secondary phone number of the witness. As used here, this is the
business phone number.
WITNESSES OR
PASSENGERS
Cell Phone
Enter number: The third phone number of the witness. As used here, this is the cell phone
number.
WITNESSES OR
PASSENGERS
Insured Aircraft
Check the box (if applicable): Indicates if the witness was in the insured's aircraft at the
time of the incident or accident.
ACORD 6 (2009/05)
12 of 15
Section Name
Field Name
Field and/or Section Description
WITNESSES OR
PASSENGERS
Other Aircraft
Check the box (if applicable): Indicates if the witness was in an aircraft other than the
insured's aircraft at the time of the incident or accident.
WITNESSES OR
PASSENGERS
Other Checkbox
Enter text: Indicates the witness was in a location other than those listed. As used here, if
other, enter the location in Other Location Details.
WITNESSES OR
PASSENGERS
Other Location Details
Enter text: A description of the location of the witness if the witness was not in the
insured's vehicle or aircraft or other involved vehicle or aircraft at the time of the incident.
WITNESSES OR
PASSENGERS
#
Enter number: The producer assigned number for the witness.
WITNESSES OR
PASSENGERS
Name & Address
Enter text: The name of a person that was a witness to the incident or an uninjured
passenger.
WITNESSES OR
PASSENGERS
Enter text: The first address line of a person that was a witness to the incident.
WITNESSES OR
PASSENGERS
Enter text: The second address line of a person that was a witness to the incident.
WITNESSES OR
PASSENGERS
Enter text: The city of a person that was a witness to the incident.
WITNESSES OR
PASSENGERS
Enter code: The state or province code of a person that was a witness to the incident.
WITNESSES OR
PASSENGERS
Enter code: The postal code of a person that was a witness to the incident.
WITNESSES OR
PASSENGERS
Home Phone
Enter number: The primary phone number of a person that was a witness to the incident.
As used here, this is the home phone number.
WITNESSES OR
PASSENGERS
Business Phone
Enter number: The secondary phone number of the witness. As used here, this is the
business phone number.
WITNESSES OR
PASSENGERS
Cell Phone
Enter number: The third phone number of the witness. As used here, this is the cell phone
number.
WITNESSES OR
PASSENGERS
Insured Aircraft
Check the box (if applicable): Indicates if the witness was in the insured's aircraft at the
time of the incident or accident.
WITNESSES OR
PASSENGERS
Other Aircraft
Check the box (if applicable): Indicates if the witness was in an aircraft other than the
insured's aircraft at the time of the incident or accident.
WITNESSES OR
PASSENGERS
Other Checkbox
Enter text: Indicates the witness was in a location other than those listed. As used here, if
other, enter the location in Other Location Details.
WITNESSES OR
PASSENGERS
Other Location Details
Enter text: A description of the location of the witness if the witness was not in the
insured's vehicle or aircraft or other involved vehicle or aircraft at the time of the incident.
ACORD 6 (2009/05)
13 of 15
Section Name
Field Name
Field and/or Section Description
WITNESSES OR
PASSENGERS
#
Enter number: The producer assigned number for the witness.
WITNESSES OR
PASSENGERS
Name & Address
Enter text: The name of a person that was a witness to the incident or an uninjured
passenger.
WITNESSES OR
PASSENGERS
Enter text: The first address line of a person that was a witness to the incident.
WITNESSES OR
PASSENGERS
Enter text: The second address line of a person that was a witness to the incident.
WITNESSES OR
PASSENGERS
Enter text: The city of a person that was a witness to the incident.
WITNESSES OR
PASSENGERS
Enter code: The state or province code of a person that was a witness to the incident.
WITNESSES OR
PASSENGERS
Enter code: The postal code of a person that was a witness to the incident.
WITNESSES OR
PASSENGERS
Home Phone
Enter number: The primary phone number of a person that was a witness to the incident.
As used here, this is the home phone number.
WITNESSES OR
PASSENGERS
Business Phone
Enter number: The secondary phone number of the witness. As used here, this is the
business phone number.
WITNESSES OR
PASSENGERS
Cell Phone
Enter number: The third phone number of the witness. As used here, this is the cell phone
number.
WITNESSES OR
PASSENGERS
Insured Aircraft
Check the box (if applicable): Indicates if the witness was in the insured's aircraft at the
time of the incident or accident.
WITNESSES OR
PASSENGERS
Other Aircraft
Check the box (if applicable): Indicates if the witness was in an aircraft other than the
insured's aircraft at the time of the incident or accident.
WITNESSES OR
PASSENGERS
Other Checkbox
Enter text: Indicates the witness was in a location other than those listed. As used here, if
other, enter the location in Other Location Details.
WITNESSES OR
PASSENGERS
Other Location Details
Enter text: A description of the location of the witness if the witness was not in the
insured's vehicle or aircraft or other involved vehicle or aircraft at the time of the incident.
WITNESSES OR
PASSENGERS
#
Enter number: The producer assigned number for the witness.
WITNESSES OR
PASSENGERS
Name & Address
Enter text: The name of a person that was a witness to the incident or an uninjured
passenger.
WITNESSES OR
PASSENGERS
Enter text: The first address line of a person that was a witness to the incident.
ACORD 6 (2009/05)
14 of 15
Section Name
Field Name
Field and/or Section Description
WITNESSES OR
PASSENGERS
Enter text: The second address line of a person that was a witness to the incident.
WITNESSES OR
PASSENGERS
Enter text: The city of a person that was a witness to the incident.
WITNESSES OR
PASSENGERS
Enter code: The state or province code of a person that was a witness to the incident.
WITNESSES OR
PASSENGERS
Enter code: The postal code of a person that was a witness to the incident.
WITNESSES OR
PASSENGERS
Home Phone
Enter number: The primary phone number of a person that was a witness to the incident.
As used here, this is the home phone number.
WITNESSES OR
PASSENGERS
Business Phone
Enter number: The secondary phone number of the witness. As used here, this is the
business phone number.
WITNESSES OR
PASSENGERS
Cell Phone
Enter number: The third phone number of the witness. As used here, this is the cell phone
number.
WITNESSES OR
PASSENGERS
Insured Aircraft
Check the box (if applicable): Indicates if the witness was in the insured's aircraft at the
time of the incident or accident.
WITNESSES OR
PASSENGERS
Other Aircraft
Check the box (if applicable): Indicates if the witness was in an aircraft other than the
insured's aircraft at the time of the incident or accident.
WITNESSES OR
PASSENGERS
Other Checkbox
Enter text: Indicates the witness was in a location other than those listed. As used here, if
other, enter the location in Other Location Details.
WITNESSES OR
PASSENGERS
Other Location Details
Enter text: A description of the location of the witness if the witness was not in the
insured's vehicle or aircraft or other involved vehicle or aircraft at the time of the incident.
Edition
Date
The edition identifier of the form including the form number and edition (the date is
typically formatted YYYY/MM).
ACORD 6 (2009/05)
15 of 15