ACORD Forms

ACORD Forms : How to Complete an Additional Interest 45

Additional Interest 45

The Additional Interest form is used in multiple situations to expand upon
the additional interest sections within line of business applications. This form may be used for both personal and commercial accounts. The form is used to secure information on additional interests and certificate holders.

IDENTIFICATION SECTION

Date (MM/DD/YYYY)
Month/day/year on which the form is completed.

Agency
Agency's name and address.

Phone (A / C, No, Ext)
Agency's telephone number.

Code
Identification code assigned to the agency or brokerage firm by the Insurance Company receiving this form.

Agency Customer ID
Customer's identification number assigned by the agency.

Applicant (First Named Insured)
First Named Insured as it appears on the line of business form to which this form will be attached.

Phone (A / C, No, Ext)
Applicants telephone number.

Effective Date
Month/day/year on which the terms and conditions of the policy will commence.

Expiration Date
Month/day/year on which the terms and conditions of the policy will terminate unless renewed.

Co/Plan
Name of the insurance company that will receive the application. Do not use group names, use the actual name of the company within the group in which you wish to have the policy issued. Also, if applicable, indicate the type of plan or policy program (Preferred) that you wish to use when issuing the policy. Use the specific plan name that is unique to that company.

Policy Number
Number assigned by the insurance company for the policy.

Account Number
Account number to be used for billing purposes. This is the Billing Number assigned by the billing entity. If agency bill, the agency assigns; if direct bill the company assigns.

ADDITIONAL INTERESTS/CERTIFICATE RECIPIENTS

Use this section for information on any additional interests, employees who should be listed as additional insureds, and others who require Certificates of Insurance.

Interest
Indicate all appropriate options for the individual named.

Rank
Primarily used for Mortgagees - indicate the ranking such as 1st, 2nd or 3rd mortgagee.

Name and Address
List the additional interests name and address.
If the additional interest is the owner of a motor vehicle, and the owner is different from the Named Insured, show the owner's name here.

Reference #
Indicate the additional interests reference number for this applicant such as the loan or mortgage number.

Certificate Required
If a Certificate of Insurance is required check this box.

Interest in Item Number
List the item number corresponding with the application for the item of interest for this additional insured.

Item Description
If needed, further clarify the item of interest in this field. For a vehicle list the make, model and VIN number. For a scheduled item list the description, such as 3 carat diamond in six point setting.

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posted by Wayne @ 11:06 AM