ACORD Forms : How to Complete a Personal Inland Marine Application 81
The underwriting process for any personal lines policy begins with the submission of a completed application. This guide provides assistance in completing the ACORD Personal Inland Marine Application.
This form can be used as a stand-alone application. It can also be used as a supplement to the Homeowners Application (ACORD 80) if scheduled personal property is being submitted as part of a homeowners transaction.
The generic sections of each personal lines form are explained in the Personal Lines Generic Section at the beginning of the Personal Lines Sections of the Forms Instruction Guide. On the ACORD website (www.acord.org), this information appears under the title PERSONAL LINES GENERIC SECTIONS.
APPLICANT INFORMATION
Birth Date
First named applicant's date of birth (MM/DD/YYYY).
Marital Status
Marital status of the first named applicant. Examples:
S . . . . . . . . . . . . . . . . . . . . . . . . . . . . Single
M. . . . . . . . . . . . . . . . . . . . . . . . . . . . Married
D . . . . . . . . . . . . . . . . . . . . . . . . . . . . Divorced
SP . . . . . . . . . . . . . . . . . . . . . . . . . . .Separated
W. . . . . . . . . . . . . . . . . . . . . . . . . . . . Widowed
Occupation/Spouse's Occupation
A brief text description of the occupation of the applicant(s) named in the top identification section.
Terr Code
Location of the dwelling based on individual state bureau or company homeowner,s manual pages.
Protect Class
Dwelling,s four-character fire protection grade found in individual state homeowner,s manuals.
Fire District/Code Number
Dwelling's fire district name and corresponding five-character code number found in individual state homeowner,s manuals,
Location of Property
Indicate the physical address of the property to be insured only if it is different from the mailing address.
Dwelling Type(s)
Indicate each residence type. Possible options are:
Dwelling, up to four family building
Townhouse
Rowhouse
Apartment
Condominium
Co-operative.
Construction Type(s)
Primary type of building material used to construct the dwelling.
# Families
Number of families in each listed location.
Other
List any other information that may be required by or helpful to the company receiving this application.
COVERAGES
Enter the amounts of insurance, the rate (carried to three decimal places), and premium (rounded to the nearest whole dollar) for each applicable coverage.
If objects are stored at different locations, include information for each additional location.
Jewelry
Total amount for all jewelry.
Furs
Total amount for all furs. If more than one category of furs is to be covered, use the blank space provided (Nos. 10-14).
Fine Arts
Total amount for all fine arts. Include paintings, pictures, etchings, sculptures or other objects of art. Note general information question 2.
Cameras
Includes photographic equipment and supplies; note general information question 5.
Musical Instruments
Includes musical instruments, instrument cases, sound and amplifying equipment; note general information question 5.
Silverware
Includes flatware and other silverware and goldware.
Stamps and Coins
Stamps and coins may either be scheduled individually or blanket coverage may be provided. Check the box below No. 7 if unattended car coverage is to be included.
Golfer's Equipment
Total amount for golfer's equipment.
Personal Computers
Total amount for personal computers.
Unattended Car Coverage (Stamps and Coins)
Additional rating information may be required for this coverage. Check with your company.
Broad Form Pair and Set Coverage
Additional rating information may be required for this coverage. Check with your company.
Non-Mobile Organ Coverage
Additional rating information may be required for this coverage. Check with your company.
Safe Credit
Identify any property stored in a safe. If a bank vault is used, provide the name and address of the bank.
Breakage Coverage
Use an asterisk (*) to identify each item on the Schedule of Property that has breakage coverage.
ACV Loss Settlement/Replacement Cost Loss Settlement
Indicate if either of these options apply.
Blanket Coverage
If coverage is to be written blanket, check the box and attach a statement of values.
GENERAL INFORMATION
Use the Remarks section to provide additional information for any questions answered with a "Yes" response.
1. Any protective devices/systems in use?
Provide the details for the system; include the type of system, whether it is local, central, or directly connected to a central station, and whether it was professionally installed. For scheduled jewelry kept at home, a copy of the alarm specifications sheet must be submitted to qualify for a credit.
2. Will any property be exhibited?
This question refers to exhibition away from the insured's premises. Provide information regarding exhibition of the property. Include what type of property, the location where the property will be exhibited, type of exhibition, type of security, or security devices that may be used, and the duration of the exhibition.
3. Will any special restriction/endorsements apply?
List the endorsements and/or describe the restrictions. If the endorsements/restrictions do not apply to all property classes or items, designate the classes or items to which they apply.
4. Will any type of deductible apply?
Provide the amount and type of deductible. Designate which classes or items should have the deductible applied.
5. Is any property used professionally/commercially?
List those items used in this capacity. Also, provide an explanation of how the property is used. Include cameras and musical instruments.
6. Any other insurance with this company?
Indicate whether other insurance is currently written for this applicant by the company. If a submission was mailed to another department recently, note it in the Remarks section along with any policy numbers available. If other insurance is in force, list types of insurance and provide policy numbers. Indicate whether insurance is commercial or personal.
7. Did any loss occur during the last 3 years?
Describe in detail all losses during the last three years; use the Remarks section. Include data on the applicant, the type of loss, the amount of the loss, the date and the disposition.
8. Any coverage declined/canceled/non renewed?
If this situation occurred, provide the circumstances under which it happened. This question may not be asked in Missouri.
Prior Insurance & Policy Number
Provide the prior insurance company's name and the complete policy number including any prefix or suffix.
SCHEDULE OF PROPERTY
List those items that are to be covered on the policy in this section. Designate which items should receive additional coverage or rating consideration. Since a total value for each property class must
be provided, group together all items of the same property class and with the same rating characteristics. When working with a long list of items, you may attach a list of the items rather than completing this section of the application. When listing items, provide a full description including serial numbers, if applicable. Appraisals or sales receipts must be included where required.
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ACORD Forms.
Labels: Personal Inland Marine Application 81
ACORD Forms : How to Complete a Homeowner Application 80
The underwriting process for any personal lines policy begins with submitting a completed application. This guide assists in completing the ACORD Homeowner Application. The ACORD Personal Inland Marine Application (ACORD 81) should be used for scheduling personal property which is being submitted as part of the Homeowner Application.
The Generic sections of each personal lines form are explained in the Personal Lines Generic Section at the beginning of the Personal Lines Section of the Forms Instruction Guide on the ACORD website (www.acord.org), this information appears under the title PERSONAL LINES GENERIC SECTIONS.
APPLICANT INFORMATION
Previous Address
Enter previous physical address of the first named insured if the applicant has been at the current address for less than three years. Also indicate the number of years at the previous address.
Location of Property if Different From Above
Enter the physical address of the property to be insured only if it is different from the mailing address listed above.
Applicant's/Co-Applicant's Occupation
Briefly describe the occupation for the applicant(s) named in the identification section. State the nature of the business if self employed.
Applicant's/Co-Applicant's Employer Name and Address
Name and address of the organization that employs the applicant(s) named in the identification section.
Yrs in Curr. Occ.
Number of years in current occupation or business.
Yrs w/Curr. Empl.
Number of years with the present employer. If less than 3 years, provide the number of years in career field or industry in the Remarks section.
Yrs w/Prior Empl.
Number of years with the prior employer.
Mar Stat
Marital status of each named applicant. Codes:
S . . . . . . . . . . . . . . . . . . . . . . . . . . . . Single
M. . . . . . . . . . . . . . . . . . . . . . . . . . . . Married
D . . . . . . . . . . . . . . . . . . . . . . . . . . . . Divorced
SP . . . . . . . . . . . . . . . . . . . . . . . . . . .Separated
W. . . . . . . . . . . . . . . . . . . . . . . . . . . . Widowed
Date of Birth
Birth date of each named applicant (MM/DD/YYYY). (E.g., March 7, 1944 should be 03/07/1944.)
Social Security #
Social security number for each named applicant.
Questions Relating to Knowledge of Applicant and Inspection of Property
Indicate how long the applicant is known to the agent, and the date of the last property inspection.
COVERAGES/LIMITS OF LIABILITY/ENDORSEMENTS/PAYMENT PLAN
Enter the anticipated dollar limit and premium charge for each applicable coverage. List any optional endorsement(s), corresponding limit(s) and any endorsement information that is to be included in this policy.
HO Form
Policy form number or company form designation for the type of policy/coverage desired. Some ISO form types are:
1. . . . . . . . . . . . . . . . . . . . . . . . . . . . . Basic
2. . . . . . . . . . . . . . . . . . . . . . . . . . . . . Broad
3. . . . . . . . . . . . . . . . . . . . . . . . . . . . . Special
4. . . . . . . . . . . . . . . . . . . . . . . . . . . . . Tenants Contents
4A . . . . . . . . . . . . . . . . . . . . . . . . . . . All Risk Tenants
5. . . . . . . . . . . . . . . . . . . . . . . . . . . . . Comprehensive
6. . . . . . . . . . . . . . . . . . . . . . . . . . . . . Condominium
6A . . . . . . . . . . . . . . . . . . . . . . . . . . . All Risk Condominium.
Deductibles
Several deductible fields are shown. One or more may be selected, depending on the company, the jurisdiction for the policy and the property coverage. Enter the appropriate deductible amount in each field. (Note: Deductibles may be the same amount or they may differ by coverage.)
Premium
Enter the estimated total premium calculated by the insurance agency, as well as the applicant's deposit.
Payment Plan
Indicate whether the agency or the company (direct) will bill the insured or other payee for the policy. If direct bill, also indicate who is to be billed, and the plan to be used for payment.
RATING/UNDERWRITING
Provide the information below for each dwelling.
Construction Type
Check the primary type of building material used to construct the dwelling. Also indicate the siding type.
Examples of siding types not shown on the form include stucco, log, asbestos, and synthetic stucco/ EIFS (Exterior Insulation Finishing System).
Synthetic stucco is an artificial stucco used for exterior insulation and finishing systems (EIFS). It is created by affixing a styrofoam panel to the wall sheathing. The styrofoam is covered with reinforcing mesh, followed by a base coat and a finish coat. Both the base coat and the finish coats include an acrylic resin. The resin is water soluble in its liquid form, but once applied and dried, it becomes waterproof. Typically, this type of surface is less than a half-inch thick. It is relatively light, and sounds hollow when tapped. Real stucco is relatively heavy and feels and sounds solid when tapped. It is a much harder material than synthetic stucco, and is more resistant to injury by a blow or impact.
NOTE: you must advise the insurer if synthetic stucco (EIFS) siding is present.
Yr Built
Year the dwelling was built. Use four digits (e.g., 1952). If significant alterations were made, indicate the year and describe the alternations in the Remarks section. Also complete the Renovation Update section.
Sq Ft
Dwelling's total square footage of living area.
# Rooms
Total number of rooms in a residence, including full and half rooms (bath).
# Apts
Complete only for tenant or condominium policies. Enter the number of apartments (residences) in the building.
Market Value
Estimated total dollar amount for which the dwelling could be sold under current market conditions.
Replacement Cost
Estimated total dollar amount required to rebuild the dwelling without depreciation.
Structure Type
Indicate the residence type. The full meaning of each abbreviation is:
DWELLING Dwelling, intended to be a free standing, up to 4 family building.
APART Apartment.
CONDO Condominium.
TOWNHOUSE Townhouse
ROWHOUSE Rowhouse
CO-OP Co-operative.
Usage Type
Applicant's use for the dwelling within the guidelines listed. ("COC" refers to dwellings in the "course of construction.")
# Families
Number of separate family units in the dwelling. Not required for HO-4 or HO-6.
# Hsehold Res
Number of residents in the household.
Purchase Date/Price
Year the applicant acquired the dwelling and the purchase price. The year should be expressed in YYYY format.
# of Fire Div/ # of Units in Fire Div
Complete only for apartments, townhouses, rowhouses and condominiums. Enter the number of residences that are in the same fire division with the insured residence (including the insured's residence). A fire division is the number of units within the building or within approved firewalls.
Terr Code
Dwelling location based on individual state bureau or company homeowners manual pages.
Prem Group
Premium group codes are found in individual state homeowner manuals. Some companies may require this data, others will generate it. Premium Group is a combination of Protection Class, Territory Code and Construction Type Code used to determine the applicable rate
based upon the dwelling's location, construction and fire protection code.
Protect Class
Dwelling's four-character fire protection grade found in individual state homeowners manuals.
Distance to Hydrant
Distance in feet from the nearest hydrant to support the protection class used.
Distance to Fire Station
Distance in miles from the nearest fire station to support the protection class used.
Fire/EC Rate
Complete if residence is specifically rated. Refer to thecompany rate manual.
Fire District/Code Number
Residence's fire district name and correspoding code number, which can be found in the idividual state manual pages.
Protection Device Type
For temperature, smoke and burglar alarms to qualify for credit, a copy of the manufacturer's specification sheet must be submitted with the application. The combination of dead bolt, smoke detector and fire extinguisher qualifies for a separate credit with some companies.
Heat Type
Type of heating device for the residence. If there is more than one type, indicate the primary and secondary types. Use the Remarks section if necessary. Some possible types are:
Electric - Permanent/Portable
Liquid Propane - Permanent/Portable
Natural Gas
Kerosene - Permanent/Portable
Coal -Professionally/Non-Professionally Installed
Oil
Wood
Solar
Other - Explain the heating system in Remarks
Housekeeping Condition
Enter the evaluation of the interior upkeep of the dwelling.
Renovation Type
If wiring, plumbing, heating or roofing have been partially or completely replaced, provide the year updated. If the exterior has been repainted, provide the year.
Date Heating System Last Serviced
Indicate the date (mm/dd/yyyy) heating system was last serviced.
Num of Amps (Elec. Syst)
Indicate the number of amps in the electrical system.
Circuit Breakers
Check the applicable box.
Fuses
Check the applicable box.
Knob & Tube or Aluminum Wiring
Check the appropriate box.
Plumbing System Condition
Indicate condition of the plumbing system.
Plumbing System - Any Known Leaks
Indicate if there are any known leaks in the plumbing system.
Foundation
Check the applicable box.
Dwelling Location
Location of the dwelling within the guidelines listed. Complete only if applicable.
Occupancy
Indicate if the dwelling is occupied by the owner or a tenant, unoccupied or vacant.
Deadbolt
If all entry (exterior) doors are fitted with deadbolt locks, check the box.
Fire Extinguisher
If the dwelling is equipped with fire extinguisher(s), check the box. Indicate the number of fire extinguishers and their locations in the blank space.
Visible to Neighbors
If the residence is visible from a road, or from another residence usually occupied by an adult during the day, check the box.
Oil Storage Tank Location
If the fuel type is oil, provide the location of the fuel oil storage tank. Options are:
Indoors above ground on masonry floor
Indoors above ground not on a masonry floor
Outdoors above ground
Outdoors below ground
Also show the distance from the dwelling, if the storage tank is outdoors.
Swimming Pool
If a swimming pool is on the residence property, check the appropriate boxes to indicate the existence of the pool, whether the pool is above ground, in ground, has a diving board, slide or approved fence.
Storm Shutters
Check the applicable boxes.
Hurricane Resistant Glass
Check the applicable box.
Bldg Code Grade
Enter the ISO Building Code Grade, if applicable. Also check the appropriate box to indicate whether or not the building was inspected.
Tax Code
Enter the city, county or state tax code, if required.
Rating
Check the applicable box.
Occupied Daily
Check the applicable box.
# Weeks Rented
Number of weeks the dwelling is rented by the insured to others.
Wind Class
Check the applicable box.
Roof Material
Enter the material used to construct the roof. Examples:
Composition (fiberglass, asphalt, etc.)
Metal
Poured
Slate
Tile
Wood Shake/Shingle
Other If used, explain in Remarks
Condition of Roof
Indicate the condition of the roof.
If Replacement Cost coverage applies, check the appropriate box if an ACORD replacement cost worksheet has been used (i. e., ACORD 40, 41, or 42.)
Basement
Indicate the number of square feet in the basement. Leave this field blank if there is no basement.
Garage
Indicate the number of square feet in the garage. Leave this field blank if there is no garage.
Breezeway
Indicate the number of square feet in the breezeway. Leave this field blank if there is no breezeway.
Rating Credits
Check the applicable box(es) if any rating credits apply.
Sprinkler
If the dwelling is equipped with a fire sprinkler system, indicate whether it is full or partial. Leave this field blank if there is no sprinkler system.
Fireplaces
Enter the number in the applicable box(es) to describe the fireplace(s.)
GENERAL INFORMATION
Use the Remarks section to provide additional information for any questions answered with a "Yes" response (Except questions 15, 16 and 17.)
1. Any farming or other business conducted on premises?
Describe the business, where business is conducted on the premises, and if applicable, whether corporal punishment or day care coverage is to be provided.
2. Any residence employees?
Use the Remarks section to provide information regarding the number of employees, the nature of their employment, hours worked per week, and whether employed inside (inservants) or outside (outservants).
3. Any flooding/brush, forest fire hazard/landslide, etc.?
Use the Remarks section to describe the type of hazard and the distance between the residence and the hazard. Some companies may require a photograph.
4. Any other residence owned, occupied or rented?
Use the Remarks section to detail the occupancy or use of the other residence. If no liability coverage is requested for this residence, detail where the coverage is provided if liability coverage is to be included in the policy for any property.
5. Any other insurance with this company?
Indicate whether other insurance is currently written for this applicant by the company. If a submission was mailed to another department recently, note it in the Remarks section along with any policy numbers available. If other insurance is in force, list types of insurance and provide policy numbers. Indicate whether insurance is commercial or personal.
6. Has insurance been transferred within agency?
Indicate why this insurance has been moved from the last company.
7. Any coverage declined, cancelled, or non-renewed?
Explain the circumstances surrounding this situation, including the reason for the cancellation. This question cannot be asked in Missouri.
8. Has applicant had a foreclosure, repossession, bankruptcy, judgement or lien during the past five years?
Use the Remarks section to provide information regarding any real estate foreclosure, personal property repossession, or bankruptcy filing, judgement or lien during the specified time period.
9. Are there any animals or exotic pets kept on the premises?
Use the Remarks section to give the age, breed, or other information about livestock or pets that may be vicious or dangerous to human beings. Also give any history of biting or causing injury to others or to other animals.
10. Is property located within two miles of tidal water?
Use the Remarks section to describe the coastal hazard, if applicable. Indicate actual distance.
11. Is property situated on more than five acres?
Use the Remarks section to indicate if any part of the property is farmed, or used to grow crops or animals for sale, or used for any other non-residential purpose.
12. Does applicant own any recreational vehicles (snowmobiles, dune buggys, ATVs, mini-bikes, etc.)?
Use the Remarks section to describe the recreational vehicle. Include the year, type, make, model, and any other information necessary to provide a complete description.
13. Is building retrofitted for earthquake?
Answer this question only in those earthquake zones where existing buildings may be retrofitted to comply with the latest "earthquake resistant" technology and building codes.
14. During the last ten years, has any applicant been convicted of any degree of the crime of arson? (In Rhode Island, failure to disclose the existence of an arson conviction is a misdemeanor punishable by a sentence of up to one year of imprisonment.)
Rhode Island law requires that all applicants for property insurance must answer this question.
15-17. Renters and Condos Only.
Indicate if:
15. There is a manager on the premises.
16. A security attendant.
17. The building entrance is locked.
18. Any uncorrected code violations?
Describe any violations of applicable building codes that have not been corrected.
19. Is building undergoing renovation or reconstruction?
Describe the type and scope of renovation or reconstruction of any part of the building.
20. Is the house for sale?
Provide the length of time the house has been for sale, and the expected sale date if known.
21. Is property within 300 ft. of a commercial or non-residential property?
Describe the occupancy of any commercial or non-residential property.
22. Is there a trampoline on the premises?
Describe the device.
23. Was structure originally built & converted for other than private residence?
Indicate what the structure was originally built for.
24. Any lead paint hazard?
Describe the location and the extent of the hazard.
25. If a fuel tank is on premises, has other insurance been obtained for the tank?
Give the First Party and the applicable limit, and the Third Party and the applicable limit.
26. If building is under construction, is the applicant the general contractor?
LOSS HISTORY
This section shows the losses this applicant has had in the past. List losses for the time period required by the company.
CAT# refers to a Catastrophe Number that is assigned by the Insurance Services Office Property Claims Service in cases of multiple losses due to floods, hurricanes, earthquakes, and similar major loss events.
Provision is made for the applicant to initial this section.
PRIOR COVERAGE
Prior Carrier
Provide the prior insurance company's name.
Prior Policy Number/Expiration Date
List the complete policy number including prefix and suffix, and the policy's expiration date.
ADDITIONAL INTEREST
Provide the following information for each entity having an interest in the dwelling(s) to be insured: the interest number or rank (1st, 2nd), whether the additional interest is the mortgage holder (e.g., bank in which the mortgage is held) or other interest, the name and address of the
interest (e.g., Loans Are Us Bank, 123 Main St, Anytown, NY 10010) and loan number.
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ACORD Forms.
Labels: Homeowner Application 80
