Section Name
Field Name
Field and/or Section Description
TITLE
ACORD 74 (2009/09)
Residence Based Business
Supplement to Residential Section
The ACORD 74, Residence Based Business is used as a
supplement to any personal property insurance application, when there is a business
located on the premises. Refer to your company for rules of use.
IDENTIFICATION SECTION Agency Customer ID
Enter identifier: The customer's identification number assigned by the producer (e.g.
agency or brokerage).
IDENTIFICATION SECTION Loc #
Enter number: The producer assigned number of the location. As used here, the location
number of the risk's location as it appears on ACORD 88, Personal Insurance Application,
Applicant Information Section.
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 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.
IDENTIFICATION SECTION Named Insured(s)
Enter text: The named insured(s) as it/they will appear on the policy declarations page.
IDENTIFICATION SECTION DBA:
Enter text: The name by which an organization is doing business. As used here, if the
insured is an individual or partnership doing business under an assumed name, enter the
name of the business.
APPLICANT INFORMATION Individual (Checkbox)
Check the box (if applicable): Indicates the legal entity code for the named insured is
Individual.
APPLICANT INFORMATION Partnership (Checkbox)
Check the box (if applicable): Indicates the legal entity code for the named insured is
Partnership.
APPLICANT INFORMATION Corporation (Checkbox)
Check the box (if applicable): Indicates the legal entity code for the named insured is
Corporation.
APPLICANT INFORMATION Limited Corporation (Checkbox)
Check the box (if applicable): Indicates the legal entity code for the named insured is
Limited Liability Corporation.
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Section Name
Field Name
Field and/or Section Description
APPLICANT INFORMATION Joint Venture (Checkbox)
Check the box (if applicable): Indicates the legal entity code for the named insured is
Joint Venture.
APPLICANT INFORMATION Other (Checkbox)
Check the box (if applicable): Indicates the legal entity code for the named insured is not
listed on the form.
APPLICANT INFORMATION Describe Other
Enter text: The description of the legal entity if not listed on the form. As used here,
provide a description of other, such as Professional Association or a Limited Liability
Company. If there is more than one Named Insured, provide the form of business
organization for each. In the Remarks section list each Named Insured along with its form
of organization (e.g., The Green Thumb Co., a corporation; John Jones and Bill Smith, a
partnership or a joint venture composed of ABC Contracting Inc. and XYZ Contracting
Inc.)
APPLICANT INFORMATION GL Code
Enter code: The code identifying the general liability nature of business for the insured.
The source of this code list is the Insurance Services Office Commercial Lines Manual
(CLM) or individual insurer rate manuals.
APPLICANT INFORMATION NAICS Code
Enter code: The North American Industry Classification System (NAICS) 6-digit industry
code assigned to the business activity (if known).
APPLICANT INFORMATION Federal ID #
Enter identifier: The tax identifier of the named insured.
APPLICANT INFORMATION Inspection Contact
Enter text: The name of the person to contact to arrange for a premises inspection. This
should be an individual under the insured's employment, not the insurance agent's name
and number.
APPLICANT INFORMATION Phone (A/C, No., Ext.):
Enter number: The telephone number of the person to contact to arrange for a premises
inspection. This should be an individual under the insured's employment.
NATURE OF BUSINESS
Office (Checkbox)
Check the box (if applicable): Indicates the nature of business is an office.
NATURE OF BUSINESS
Service (Checkbox)
Check the box (if applicable): Indicates the nature of business is service.
NATURE OF BUSINESS
Retail (Checkbox)
Check the box (if applicable): Indicates the nature of business is retail.
NATURE OF BUSINESS
Wholesale (Checkbox)
Check the box (if applicable): Indicates the nature of business is wholesale.
NATURE OF BUSINESS
Crafts (Checkbox)
Check the box (if applicable): Indicates the nature of business is crafts.
NATURE OF BUSINESS
Other (Checkbox)
Check the box (if applicable): Indicates the nature of business is other than those listed.
NATURE OF BUSINESS
Other Description
Enter text: The description of the nature/type of business.
NATURE OF BUSINESS
Date Business Started
Enter date: The date the current owners purchased or started the business.
NATURE OF BUSINESS
Class Code
Enter code: The industry code that identifies the exposure. This code is derived from
Insurance Services Office or a company code list.
NATURE OF BUSINESS
Sq. Ft. Used
Enter number: The area, in square feet, of the building that is used for business
purposes.
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Section Name
Field Name
Field and/or Section Description
NATURE OF BUSINESS
Annual Sales/Receipts $
Enter amount: The total annual gross sales or receipts.
NATURE OF BUSINESS
Total Payroll $
Enter amount: The total annual payroll of the business in whole dollars.
NATURE OF BUSINESS
List Names of Owners/Operators
Enter text: The additional interest's full name.
NATURE OF BUSINESS
# Visitors per Week
Enter number: The number of visitors the business normally receives per week.
NATURE OF BUSINESS
# Of Employees Full Time
Enter number: The number of full time employees.
NATURE OF BUSINESS
# Of Employees Part Time
Enter number: The number of part time employees.
NATURE OF BUSINESS
Business Opening Time
Enter time: The starting time for the normal business day.
NATURE OF BUSINESS
Business Closing Time
Enter time: The closing time for the normal business day.
NATURE OF BUSINESS
Description of Business
Enter text: The description of the operations of this risk. A restatement of the products
classification wording is often not sufficient (e.g., Metal Goods Manufacturing NOC could
include anything from paper clips to bridge girders). As used here, this section is designed
to tell the underwriter what business each applicant performs and the way it is conducted.
The section should be completed in enough detail to enable the underwriter to understand
and classify the business.
NATURE OF BUSINESS
# of Business Losses (Past 3
Years)
Enter number: The number of business losses that occurred for the past specified number
of years. As used here, enter the details of the losses on the ACORD 88 - Personal
Insurance Application Applicant Information Section.
PROPERTY COVERAGES
Business Related Structure - Limit
Enter limit: The limit amount for business related structure coverage.
PROPERTY COVERAGES
Business Related Structure -
Deductible
Enter deductible: The deductible amount for business related structure coverage.
PROPERTY COVERAGES
Business Related Structure -
Valuation
Enter code: Indicate the method which will be used to determine the amount paid on a
claim. Valuation methods are:
ACV . . . . . . . . . . . . . . . . . . . . . . . . . Actual Cash Value
RC. . . . . . . . . . . . . . . . . . . . . . . . . . .Replacement Cost
AA . . . . . . . . . . . . . . . . . . . . . . . . . . Agreed Amount
MV . . . . . . . . . . . . . . . . . . . . . . . . . . Market Value
PROPERTY COVERAGES
Business Related Structure - Form
Number
Enter identifier: The number used by the insurer for the business related structure form.
PROPERTY COVERAGES
Business Related Structure - Form
Date
Enter date: The edition date of the form used by the insurer for the business related
structure.
PROPERTY COVERAGES
Business Related Structure -
Premium
Enter amount: The premium amount for the business related structure coverage.
PROPERTY COVERAGES
Business Personal Property - Limit
Enter limit: The limit amount for business personal property coverage.
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Section Name
Field Name
Field and/or Section Description
PROPERTY COVERAGES
Business Personal Property -
Deductible
Enter deductible: The deductible amount for business personal property coverage.
PROPERTY COVERAGES
Business Personal Property -
Valuation
Enter code: Indicate the method which will be used to determine the amount paid on a
claim. Valuation methods are:
ACV . . . . . . . . . . . . . . . . . . . . . . . . . Actual Cash Value
RC. . . . . . . . . . . . . . . . . . . . . . . . . . .Replacement Cost
AA . . . . . . . . . . . . . . . . . . . . . . . . . . Agreed Amount
MV . . . . . . . . . . . . . . . . . . . . . . . . . . Market Value
PROPERTY COVERAGES
Business Personal Property -
Form Number
Enter identifier: The number used by the insurer for the business personal property form.
PROPERTY COVERAGES
Business Personal Property -
Form Date
Enter date: The edition date of the form used by the insurer for business related personal
property.
PROPERTY COVERAGES
Business Personal Property -
Premium
Enter amount: The premium amount for the business personal property coverage.
PROPERTY COVERAGES
Property Other
Enter text: The description of the coverage.
PROPERTY COVERAGES
Property Other - Limit
Enter limit: The limit amount for the coverage.
PROPERTY COVERAGES
Property Other - Deductible
Enter deductible: The deductible amount for the coverage.
PROPERTY COVERAGES
Property Other - Valuation
Enter code: Indicate the method which will be used to determine the amount paid on a
claim. Valuation methods are:
ACV . . . . . . . . . . . . . . . . . . . . . . . . . Actual Cash Value
RC. . . . . . . . . . . . . . . . . . . . . . . . . . .Replacement Cost
AA . . . . . . . . . . . . . . . . . . . . . . . . . . Agreed Amount
MV . . . . . . . . . . . . . . . . . . . . . . . . . . Market Value
PROPERTY COVERAGES
Property Other - Form Number
Enter identifier: The number used by the insurer for the form associated with the
coverage.
PROPERTY COVERAGES
Property Other - Form Date
Enter date: The edition date of the form used by the insurer for the coverage.
PROPERTY COVERAGES
Property Other - Premium
Enter amount: The premium amount associated with the coverage.
PROPERTY COVERAGES
Property Other
Enter text: The description of the coverage.
PROPERTY COVERAGES
Property Other - Limit
Enter limit: The limit amount for the coverage.
PROPERTY COVERAGES
Property Other - Deductible
Enter deductible: The deductible amount for the coverage.
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Section Name
Field Name
Field and/or Section Description
PROPERTY COVERAGES
Property Other - Valuation
Enter code: Indicate the method which will be used to determine the amount paid on a
claim. Valuation methods are:
ACV . . . . . . . . . . . . . . . . . . . . . . . . . Actual Cash Value
RC. . . . . . . . . . . . . . . . . . . . . . . . . . .Replacement Cost
AA . . . . . . . . . . . . . . . . . . . . . . . . . . Agreed Amount
MV . . . . . . . . . . . . . . . . . . . . . . . . . . Market Value
PROPERTY COVERAGES
Property Other - Form Number
Enter identifier: The number used by the insurer for the form associated with the
coverage.
PROPERTY COVERAGES
Property Other - Form Date
Enter date: The edition date of the form used by the insurer for the coverage.
PROPERTY COVERAGES
Property Other - Premium
Enter amount: The premium amount associated with the coverage.
LIABILITY COVERAGES
Combined Single Limit
Enter limit: The limit amount for combined single limit coverage. As used here, list all limits
as they will appear in the policy. Show limits in whole dollars. Several formats are included
here for the collection of liability limits. Complete only those items that match the format of
the program you are using to write the policy.
LIABILITY COVERAGES
Combined Single Limit - Form
Number
Enter identifier: The number used by the insurer for the form associated with combined
single limit coverage.
LIABILITY COVERAGES
Combined Single Limit - Form
Date
Enter date: The edition date of the form used by the insurer for combined single limit
coverage.
LIABILITY COVERAGES
Combined Single Limit - Premium
Enter amount: The premium amount for combined single limit coverage.
LIABILITY COVERAGES
Bodily Injury Occurrence - Limit
Enter limit: The each occurrence limit amount for bodily injury coverage. As used here, list
all limits as they will appear in the policy. Show limits in whole dollars. Several formats are
included here for the collection of liability limits. Complete only those items that match the
format of the program you are using to write the policy.
LIABILITY COVERAGES
Bodily Injury Aggregate - Limit
Enter limit: The limit amount for bodily injury coverage.
LIABILITY COVERAGES
Bodily Injury - Form Number
Enter identifier: The number used by the insurer for the form associated with bodily injury
coverage.
LIABILITY COVERAGES
Bodily Injury - Form Date
Enter date: The edition date of the form used by the insurer for bodily injury coverage.
LIABILITY COVERAGES
Bodily Injury - Premium
Enter amount: The premium amount for bodily injury coverage.
LIABILITY COVERAGES
Property Damage - Limit
Enter limit: The limit amount for the property damage coverage. As used here, list all limits
as they will appear in the policy. Show limits in whole dollars. Several formats are included
here for the collection of liability limits. Complete only those items that match the format of
the program you are using to write the policy.
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Section Name
Field Name
Field and/or Section Description
LIABILITY COVERAGES
Property Damage - Form Number
Enter identifier: The number used by the insurer for the form associated with property
damage coverage.
LIABILITY COVERAGES
Property Damage - Form Date
Enter date: The edition date of the form used by the insurer for property damage
coverage.
LIABILITY COVERAGES
Property Damage - Premium
Enter amount: The premium amount for property damage coverage.
LIABILITY COVERAGES
Products/Compl. Operations
Occurrence - Limit
Enter limit: The each occurrence limit amount for products and completed operations
coverage. As used here, list all limits as they will appear in the policy. Show limits in whole
dollars. Several formats are included here for the collection of liability limits. Complete only
those items that match the format of the program you are using to write the policy.
LIABILITY COVERAGES
Products/Compl. Operations -
Aggregate Limit
Enter limit: The limit amount for products and completed operations coverage.
LIABILITY COVERAGES
Products/Compl. Operations -
Form Number
Enter identifier: The number used by the insurer for the form associated with products and
completed operations coverage.
LIABILITY COVERAGES
Products/Compl. Operations -
Form Date
Enter date: The edition date of the form used by the insurer for products and completed
operations coverage.
LIABILITY COVERAGES
Products/Compl. Operations -
Premium
Enter amount: The premium amount for products and completed operations coverage.
LIABILITY COVERAGES
Damage to Rented Premises -
Limit
Enter limit: The limit amount for fire damage to rented premises coverage. As used here,
list all limits as they will appear in the policy. Show limits in whole dollars. Several formats
are included here for the collection of liability limits. Complete only those items that match
the format of the program you are using to write the policy.
LIABILITY COVERAGES
Damage to Rented Premises -
Form Number
Enter identifier: The number used by the insurer for the form associated with fire damage
to rented premises coverage.
LIABILITY COVERAGES
Damage to Rented Premises -
Form Date
Enter date: The edition date of the form used by the insurer for fire damage to rented
premises coverage.
LIABILITY COVERAGES
Damage to Rented Premises -
Premium
Enter amount: The premium amount for fire damage to rented premises coverage.
LIABILITY COVERAGES
Medical Expense Per Person -
Limit
Enter limit: The limit amount for medical expense coverage. As used here, list all limits as
they will appear in the policy. Show limits in whole dollars. Several formats are included
here for the collection of liability limits. Complete only those items that match the format of
the program you are using to write the policy.
LIABILITY COVERAGES
Medical Expense Per Person -
Form Number
Enter identifier: The number used by the insurer for the form associated with medical
expense coverage.
LIABILITY COVERAGES
Medical Expense Per Person -
Form Date
Enter date: The edition date of the form used by the insurer for medical expense
coverage.
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Section Name
Field Name
Field and/or Section Description
LIABILITY COVERAGES
Medical Expense Per Person -
Premium
Enter amount: The premium amount for medical expense coverage.
LIABILITY COVERAGES
Hired Auto - Limit
Enter limit: The limit amount for hired auto coverage. As used here, list all limits as they
will appear in the policy. Show limits in whole dollars. Several formats are included here
for the collection of liability limits. Complete only those items that match the format of the
program you are using to write the policy.
LIABILITY COVERAGES
Hired Auto - Form Number
Enter identifier: The number used by the insurer for the form associated with hired auto
coverage.
LIABILITY COVERAGES
Hired Auto - Form Date
Enter date: The edition date of the form used by the insurer for hired auto coverage.
LIABILITY COVERAGES
Hired Auto - Premium
Enter amount: The premium amount for hired auto coverage.
LIABILITY COVERAGES
Non-owned Auto - Limit
Enter limit: The limit amount for non-owned auto coverage. As used here, list all limits as
they will appear in the policy. Show limits in whole dollars. Several formats are included
here for the collection of liability limits. Complete only those items that match the format of
the program you are using to write the policy.
LIABILITY COVERAGES
Non-owned Auto - Form Number
Enter identifier: The number used by the insurer for the form associated with non-owned
auto coverage.
LIABILITY COVERAGES
Non-owned Auto - Form Date
Enter date: The edition date of the form used by the insurer for non-owned auto coverage.
LIABILITY COVERAGES
Non-owned Auto - Premium
Enter amount: The premium amount for non-owned auto coverage.
LIABILITY COVERAGES
Employee Benefits - Limit
Enter limit: The limit amount for employee benefits coverage. As used here, list all limits
as they will appear in the policy. Show limits in whole dollars. Several formats are included
here for the collection of liability limits. Complete only those items that match the format of
the program you are using to write the policy.
LIABILITY COVERAGES
Employee Benefits - Form Number
Enter identifier: The number used by the insurer for the form associated with employee
benefits coverage.
LIABILITY COVERAGES
Employee Benefits - Form Date
Enter date: The edition date of the form used by the insurer for employee benefits
coverage.
LIABILITY COVERAGES
Employee Benefits - Premium
Enter amount: The premium amount for employee benefits coverage.
LIABILITY COVERAGES
Liability Other Coverage
Enter text: The description of the coverage.
LIABILITY COVERAGES
Liability Other Limit
Enter limit: The limit amount for the coverage. As used here, list all limits as they will
appear in the policy. Show limits in whole dollars. Several formats are included here for
the collection of liability limits. Complete only those items that match the format of the
program you are using to write the policy.
LIABILITY COVERAGES
Liability Other Form Number
Enter identifier: The number used by the insurer for the form associated with the
coverage.
LIABILITY COVERAGES
Liability Other Form Date
Enter date: The edition date of the form used by the insurer for the coverage.
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Section Name
Field Name
Field and/or Section Description
LIABILITY COVERAGES
Liability Other Premium
Enter amount: The premium amount associated with the coverage.
LIABILITY COVERAGES
Liability Other Coverage
Enter text: The description of the coverage.
LIABILITY COVERAGES
Liability Other Limit
Enter limit: The limit amount for the coverage. As used here, list all limits as they will
appear in the policy. Show limits in whole dollars. Several formats are included here for
the collection of liability limits. Complete only those items that match the format of the
program you are using to write the policy.
LIABILITY COVERAGES
Liability Other Form Number
Enter identifier: The number used by the insurer for the form associated with the
coverage.
LIABILITY COVERAGES
Liability Other Form Date
Enter date: The edition date of the form used by the insurer for the coverage.
LIABILITY COVERAGES
Liability Other Premium
Enter amount: The premium amount associated with the coverage.
LIABILITY COVERAGES
Liability Other Coverage
Enter text: The description of the coverage.
LIABILITY COVERAGES
Liability Other Limit
Enter limit: The limit amount for the coverage. As used here, list all limits as they will
appear in the policy. Show limits in whole dollars. Several formats are included here for
the collection of liability limits. Complete only those items that match the format of the
program you are using to write the policy.
LIABILITY COVERAGES
Liability Other Form Number
Enter identifier: The number used by the insurer for the form associated with the
coverage.
LIABILITY COVERAGES
Liability Other Form Date
Enter date: The edition date of the form used by the insurer for the coverage.
LIABILITY COVERAGES
Liability Other Premium
Enter amount: The premium amount associated with the coverage.
DEDUCTIBLES
Deductible Basis Per Claim
Check the box (if applicable): Indicates that a per claim deductible applies to individual
claims even if the claims are all related to the same occurrence or event.
DEDUCTIBLES
Deductible Basis Per Occurrence
Check the box (if applicable): Indicates that a per occurrence deductible applies once to
each occurrence no matter how many individual claims result from the occurrence or
event.
DEDUCTIBLES
Property Damage
Enter amount: The deductible amount for the property damage coverage.
DEDUCTIBLES
Bodily Injury
Enter amount: The deductible amount for the bodily injury coverage.
DEDUCTIBLES
Other Deductible
Enter text: The description of the coverage.
DEDUCTIBLES
Other Deductible Amount
Enter deductible: The deductible amount for the coverage.
GENERAL INFORMATION
1. Any business conducted at any
other location?
Enter Y for a Yes response. Input N for No response. Indicates the response to the
question, Any business conducted at any other location?.
GENERAL INFORMATION
Remarks
Enter text: An explanation of a response to a general information or underwriting question.
Normally, Yes responses require an explanation.
GENERAL INFORMATION
2. Do you lease to or from other
employers?
Enter Y for a Yes response. Input N for No response. Indicates the response to the
question, Do you lease employees to or from other employers?.
GENERAL INFORMATION
Enter text: An explanation of a response to a general information or underwriting question.
Normally, Yes responses require an explanation.
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Section Name
Field Name
Field and/or Section Description
GENERAL INFORMATION
3. Any workers compensation
carried?
Enter Y for a Yes response. Input N for No response. Indicates the response to the
question, Any Workers Compensation carried?.
GENERAL INFORMATION
NAIC Code
Enter code: The NAIC code of the insurance company that issued the policy.
GENERAL INFORMATION
Carrier
Enter text: The insurer name on any other applicable insurance.
GENERAL INFORMATION
Policy Number
Enter identifier: The policy number on any other applicable insurance.
GENERAL INFORMATION
4. Do you rent or loan equipment
to others?
Enter Y for a Yes response. Input N for No response. Indicates the response to the
question, Do you rent or loan equipment to others?.
GENERAL INFORMATION
Enter text: An explanation of a response to a general information or underwriting question.
Normally, Yes responses require an explanation.
IDENTIFICATION SECTION Agency Customer ID
Enter identifier: The customer's identification number assigned by the producer (e.g.
agency or brokerage).
IDENTIFICATION SECTION Loc #
Enter number: The producer assigned number of the location. As used here, the location
number of the risk's location as it appears on ACORD 88, Personal Insurance Application,
Applicant Information Section.
GENERAL INFORMATION
(continued)
5. Is the applicant a subsidiary of
another entity or does the
applicant have any subsidiaries?
Enter Y for a Yes response. Input N for No response. Indicates the response to the
question, Is the applicant a subsidiary or another entity or does the applicant have
subsidiaries?.
GENERAL INFORMATION
(continued)
Parent Company Name
Enter text: The name of the parent organization.
GENERAL INFORMATION
(continued)
Enter text: The description of what business the parent organization performs and the way
it is conducted.
GENERAL INFORMATION
(continued)
6. Does the applicant have any
subsidiaries?
Enter Y for a Yes response. Input N for No response. Indicates the response to the
question, Does the applicant have subsidiaries?.
GENERAL INFORMATION
(continued)
Subsidiary Company Name
Enter text: The name of the subsidiary of the company. This may also contain owned
foundations or charitable trusts.
GENERAL INFORMATION
(continued)
Description of Operations
Enter text: The description of what business the subsidiary organization performs and the
way it is conducted.
GENERAL INFORMATION
(continued)
6. Does the business involve the
use or storage of petroleum-based
products, paint, fertilizer,
pesticides or other hazardous
material or pollutants?
Enter Y for a Yes response. Input N for No response. Indicates the response to the
question, Does the business involve the use or storage of petroleum-based products,
paint, fertilizer, pesticides or other hazardous material or pollutants?.
GENERAL INFORMATION
(continued)
Enter text: An explanation of a response to a general information or underwriting question.
Normally, Yes responses require an explanation.
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Section Name
Field Name
Field and/or Section Description
GENERAL INFORMATION
(continued)
7. Has any applicant filed for
bankruptcy (Business or Personal)
in the last five (5) years?
Enter Y for a Yes response. Input N for No response. Indicates the response to the
question, Has the applicant filed for bankruptcy (business or personal) in the last
specified number of years?.
GENERAL INFORMATION
(continued)
Enter text: An explanation of a response to a general information or underwriting question.
Normally, Yes responses require an explanation.
GENERAL INFORMATION
(continued)
8. Any products directly imported
or exported outside the U.S.,
Puerto Rico or Canada?
Enter Y for a Yes response. Input N for No response. Indicates the response to the
question, Any products directly imported or exported outside the U.S., Puerto Rico or
Canada?.
GENERAL INFORMATION
(continued)
Enter text: An explanation of a response to a general information or underwriting question.
Normally, Yes responses require an explanation.
GENERAL INFORMATION
(continued)
9. Any products repackaged,
modified or mixed?
Enter Y for a Yes response. Input N for No response. Indicates the response to the
question, Any products repackaged, modified, or mixed?.
GENERAL INFORMATION
(continued)
Enter text: An explanation of a response to a general information or underwriting question.
Normally, Yes responses require an explanation.
GENERAL INFORMATION
(continued)
10. Any used items sold?
Enter Y for a Yes response. Input N for No response. Indicates the response to the
question, Any used items sold?.
GENERAL INFORMATION
(continued)
Enter text: An explanation of a response to a general information or underwriting question.
Normally, Yes responses require an explanation.
GENERAL INFORMATION
(continued)
11. Do you distribute your
products or services by means of
the internet?
Enter Y for a Yes response. Input N for No response. Indicates the response to the
question, Do you distribute your products or services by means of the internet?.
GENERAL INFORMATION
(continued)
Enter text: An explanation of a response to a general information or underwriting question.
Normally, Yes responses require an explanation.
GENERAL INFORMATION
(continued)
12. Does your company maintain
or support an internet website?
Enter Y for a Yes response. Input N for No response. Indicates the response to the
question, Does your company maintain an internet website?.
GENERAL INFORMATION
(continued)
Enter text: An explanation of a response to a general information or underwriting question.
Normally, Yes responses require an explanation.
GENERAL INFORMATION
(continued)
13. Does the business involve
demonstration of any products?
Enter Y for a Yes response. Input N for No response. Indicates the response to the
question, Does the business involve demonstration of any products?.
GENERAL INFORMATION
(continued)
Enter text: An explanation of a response to a general information or underwriting question.
Normally, Yes responses require an explanation.
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Section Name
Field Name
Field and/or Section Description
GENERAL INFORMATION
(continued)
14. Is the business run from a
distinctly separate area in the
residence from household
activities?
Enter Y for a Yes response. Input N for No response. Indicates the response to the
question, Is the business run from a distinctly separate are in the residence from
household activities?.
GENERAL INFORMATION
(continued)
Enter text: An explanation of a response to a general information or underwriting question.
Normally, Yes responses require an explanation.
GENERAL INFORMATION
(continued)
15. Are you or any resident a
professional entertainer, athlete,
media personality, state or federal
political figure? (Not applicable in
NC)
Enter Y for a Yes response. Input N for No response. Indicates the response to the
question, Are you or any resident a professional entertainer, athlete, media personality,
state or federal political figure? (Not applicable in North Carolina).
GENERAL INFORMATION
(continued)
Enter text: An explanation of a response to a general information or underwriting question.
Normally, Yes responses require an explanation.
GENERAL INFORMATION
(continued)
16. Other than computer systems
or office equipment, do you install
or service any products off
premises?
Enter Y for a Yes response. Input N for No response. Indicates the response to the
question, Other than computer systems or office equipment, do you install or service any
products off premises?.
GENERAL INFORMATION
(continued)
Enter text: An explanation of a response to a general information or underwriting question.
Normally, Yes responses require an explanation.
GENERAL INFORMATION
(continued)
17. Are all exterior doors equipped
with deadbolt locks or comparable
slider locks?
Enter Y for a Yes response. Input N for No response. Indicates the response to the
question, Are all exterior doors equipped with deadbolt locks or comparable slider
locks?.
GENERAL INFORMATION
(continued)
Enter text: An explanation of a response to a general information or underwriting question.
Normally, Yes responses require an explanation.
GENERAL INFORMATION
(continued)
18. If a financial planner or
consultant, do you have
discretionary trading authority
and/or access to customers data
and/or funds?
Enter Y for a Yes response. Input N for No response. Indicates the response to the
question, If a financial planner or consultant, do you have discretionary trading authority
and/or access to customer's data and/or funds?.
GENERAL INFORMATION
(continued)
Enter text: An explanation of a response to a general information or underwriting question.
Normally, Yes responses require an explanation.
GENERAL INFORMATION
(continued)
19. If involved in real estate, do
you manage property for others?
Enter Y for a Yes response. Input N for No response. Indicates the response to the
question, If involved in real estate, do you manage property for others?.
GENERAL INFORMATION
(continued)
Enter text: An explanation of a response to a general information or underwriting question.
Normally, Yes responses require an explanation.
ACORD 74 (2009/09) rev. 11-25-2009
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Section Name
Field Name
Field and/or Section Description
REMARKS
Remarks
Enter text: The remarks associated with the residence based business.
Edition
Date
The edition identifier of the form including the form number and edition (the date is
typically formatted YYYY/MM).
ACORD 74 (2009/09) rev. 11-25-2009
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