ACORD 101 Instructions

Section Name Field Name Field and/or Section Description
TITLE ACORD 101 (2008/01) Additional Remarks Schedule Use ACORD 101, Additional Remarks Schedule, as an attachment to any ACORD form when more space is required for additional remarks or comments.
IDENTIFICATION SECTION Agency Customer ID Customer’s identification number assigned by the agency or brokerage.
IDENTIFICATION SECTION Loc # Enter the location number (if applicable).
IDENTIFICATION SECTION Page _ Enter the page number of this schedule.
IDENTIFICATION SECTION Of _ Enter the total number of pages if multiple pages of this schedule are attached (e.g., Page 1 of 4). If only one page, indicate Page 1 of 1.
IDENTIFICATION SECTION Agency Producer’s name.
IDENTIFICATION SECTION Policy Number The number assigned by the insurance company for the policy. In general, policy numbers will not appear on new business applications since they are not known at that point in time.
IDENTIFICATION SECTION Carrier Name of the insurance company (or residual market plan) that will receive theapplication. Do not use group names, use the actual name of the company within the group in which you wish to have the policy issued
IDENTIFICATION SECTION NAIC Code The identification code assigned to the company by the NAIC.
IDENTIFICATION SECTION Named Insured Full name of the applicant as it should appear on the policy. The First Named Insured is given certain rights and responsibilities by the policy contract language. If more than one insured is named, be sure the one intended to receive these rights and responsibilities is named first and any additional insureds identified as such. If joint ownership, the name used may include both names (e.g., John and Mary Smith).
IDENTIFICATION SECTION Effective Date Date (MM/DD/YYYY) on which the terms and conditions of the policy will commence.
ADDITIONAL REMARKS Form Number: Enter the form number of the ACORD form to which this section is attached.
ADDITIONAL REMARKS Form Title: Enter the title of the ACORD form to which this section is attached.
ADDITIONAL REMARKS Additional Remarks Use this space for any additional remarks or comments.