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ACORD Insurance Form

Last updated: May 13, 2025
ACORD Insurance Form

ACORD forms are standardized insurance documents used by insurers and agencies to capture, update, and communicate policy-related data. They include applicant, policy, coverage, and loss information in a consistent format recognized across the insurance industry.

Fields

Field Description Example
form_number The specific ACORD form number (e.g., ACORD 125, ACORD 130). ACORD 125
form_name Short title for the ACORD form. Commercial Insurance Application
policy_number Unique identifier assigned by the insurer to this policy. POL-123456
insurance_company_name Name of the underwriting insurance company. ABC Insurance Company
named_insured Primary entity or individual listed as the insured on the policy. XYZ Enterprises LLC
applicant_name Name of the applicant if different from the named insured. John Doe
insured_address Physical or mailing address of the insured. 123 Main St, Cityville, ST 12345
policy_effective_date Date the policy coverage begins. 2023-01-01
policy_expiration_date Date the policy coverage ends. 2024-01-01
producer_name Name of the agent or agency that produced the policy. Smith Insurance Agency
producer_address Address of the producing agent/agency. 456 Agency Ln, InsuranceTown, ST 98765
producer_phone Contact phone number for the agent/agency. (555) 123-4567
policy_type Type of policy or line of business (e.g., CGL, Commercial Auto). Commercial General Liability
coverage_details A list or summary of coverages and coverage parts included. Bodily Injury, Property Damage, etc.
coverage_limits Specified coverage limits for each coverage part. Each occurrence: $1,000,000; Aggregate: $2,000,000
premium_amount Total or annual premium for the coverage. 1200.00
deductible Deductible amount the insured is responsible for per claim. 500
claim_number Number assigned to a specific claim under this policy, if applicable. CLAIM-987654
loss_date Date of a reported loss/incident if relevant to the form. 2023-07-15
loss_description Summary of the reported incident or cause of loss. Water damage due to burst pipe in office building.
location_of_loss Where the loss occurred, if different from insured address. Warehouse #3, 789 Industrial Rd, Cityville, ST 12345
policyholder_signature Signature of the insured or policyholder verifying the information. John Doe
agent_broker_signature Signature of the agent or broker representing the policy. Jane Agent
additional_insureds List of extra parties who are named as insured under the policy. Lender: Big Bank, Landlord: Real Estate Holdings
lienholder_mortgagee_name Entity holding a financial interest in the insured property/vehicle. ABC Bank, Loan #12345
vehicle_information Vehicle details if the ACORD form pertains to auto coverage. 2019 Ford F-150, VIN #1FTEX1EPXKKF00000
property_information Property details for commercial/residential lines of business. Commercial Building, 10,000 sq ft, Built 2005
risk_classifications Risk classification codes or descriptions used by underwriters. Class Code 5192, Mercantile
endorsements List or short summary of endorsements included with the policy. Additional named insured endorsement, Blanket Waiver of Subrogation
policy_status Indicates whether the policy is active, canceled, pending, etc. Active