Monday, March 26, 2007

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 (, this information appears under the title PERSONAL LINES GENERIC SECTIONS.


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

Construction Type(s)
Primary type of building material used to construct the dwelling.

# Families
Number of families in each listed location.

List any other information that may be required by or helpful to the company receiving this application.


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.

Total amount for all jewelry.

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.

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.

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.


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.


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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