ACORD 2 Instructions


Section Name Field Name Field and/or Section Description
TITLE ACORD 2 (2010/01) Automobile Loss Notice The title of the form. ACORD 2, Automobile Loss Notice, is used to report both commercial and personal lines automobile losses.
IDENTIFICATION SECTION Date Enter date: The month/day/year on which the form is completed. (MM/DD/YYYY)
IDENTIFICATION SECTION Agency Enter text: The full name of the producer/agency.
IDENTIFICATION SECTION Enter text: The mailing address line one of the producer/agency.
IDENTIFICATION SECTION Enter text: The mailing address line two of the producer/agency.
IDENTIFICATION SECTION Enter text: The mailing address city name of the producer/agency.
IDENTIFICATION SECTION Enter code: The mailing address state or province code of the producer/agency.
IDENTIFICATION SECTION Enter code: The mailing address postal code of the producer/agency.
IDENTIFICATION SECTION Contact Name Enter text: The name of the individual at the producer’s establishment that is the primary contact.
IDENTIFICATION SECTION Phone (A/C, No, Ext) Enter number: The producer’s contact person’s phone number. If applicable, include the area code and extension.
IDENTIFICATION SECTION FAX Enter number: The fax number of the producer/agency.
IDENTIFICATION SECTION E-Mail Address Enter text: The producer’s contact person e-mail address.
IDENTIFICATION SECTION Code Enter code: The identification code assigned to the producer (e.g. agency or brokerage firm) by the insurer.
IDENTIFICATION SECTION Subcode Enter code: The identification code assigned by the insurer to the sub-producer (e.g. person) within a producer’s office (e.g. agency or brokerage).
IDENTIFICATION SECTION Agency Customer ID Enter identifier: The customer’s identification number assigned by the producer (e.g. agency or brokerage).
IDENTIFICATION SECTION Insured Location Code Enter code: The code the policyholder defines that is used to allocate loss experience to cost centers. For example, if a grocery store chain is insured and the entire chain was under one policy, the grocery store chain might choose to allocate the losses for each store. To do this they would provide a store number or store code (something the insured defines) when they report a claim. The insured would include that store number in the “Insured Location Code” field so that the carrier can record the code in their claim system and then the right store is assessed the loss experience.
IDENTIFICATION SECTION Date of Loss Enter date: The date that the loss occurred.
IDENTIFICATION SECTION Time of Loss Enter time: The approximate time that the loss occurred.
IDENTIFICATION SECTION AM Check the box (if applicable): Indicates the loss occurred in the morning.
IDENTIFICATION SECTION PM Check the box (if applicable): Indicates the loss occurred in the afternoon or evening.
IDENTIFICATION SECTION Company Enter text: The insurer’s full legal company name(s) as found in the file copy of the policy. Use the actual name of the company within the group to which the policy has been issued. This is not the insurer’s group name or trade name.
IDENTIFICATION SECTION NAIC Code Enter code: The identification code assigned to the insurer by the NAIC.
IDENTIFICATION SECTION Policy Number Enter identifier: The identifier assigned by the insurer to the policy, or submission, being referenced exactly as it appears on the policy, including prefix and suffix symbols. If required for self-insurance, the self-insured license or contract number.
IDENTIFICATION SECTION Policy Type Enter text: The type of policy issued to the insured (e. g., personal auto, truckers, garage liability, commercial property, builders risk, etc.).
IDENTIFICATION SECTION Name of Insured Enter text: The named insured(s) as it/they will appear on the policy declarations page.
INSURED Date of Birth Enter date: The date of birth of the insured.
INSURED FEIN (if applicable) Enter identifier: The tax identifier of the named insured. As used here, this contains the Federal Employer Identification Number(FEIN), if applicable, for the insured.
IDENTIFICATION SECTION Marital Status Enter code: The insured’s marital status. The applicable codes are: * S Single * M Married * D Divorced * P Separated * W Widowed * C Domestic Partner (unmarried) * V Civil Union * U Unknown * O Other
IDENTIFICATION SECTION Primary Phone Enter number: The named insured’s primary phone number.
INSURED Home Check the box (if applicable): Indicates the primary phone number is for a home phone.
INSURED Business Check the box (if applicable): Indicates the primary phone number is for a business phone.
INSURED Cell Check the box (if applicable): Indicates the primary phone number is for a cell phone.
INSURED Secondary Phone Enter number: The named insured’s secondary phone number.
INSURED Home Check the box (if applicable): Indicates the secondary phone number is for a home phone.
INSURED Business Check the box (if applicable): Indicates the secondary phone number is for a business phone.
INSURED Cell Check the box (if applicable): Indicates the phone number is for a cell phone.
IDENTIFICATION SECTION Insured’s Mailing Address Enter text: The named insured’s mailing address line one. As used here, the mailing address as found on the declarations page of the policy.
IDENTIFICATION SECTION Enter text: The named insured’s mailing address line two.
IDENTIFICATION SECTION Enter text: The named insured’s mailing address city name.
IDENTIFICATION SECTION Enter code: The named insured’s mailing address state or province code.
IDENTIFICATION SECTION Enter code: The named insured’s mailing address postal code.
INSURED Primary E-Mail Address Enter text: The named insured’s primary e-mail address.
INSURED Secondary E-Mail Address Enter text: The named insured’s secondary e-mail address.
CONTACT Contact Insured Check the box (if applicable): Indicates If the individual to contact is the same as the insured, check this box and leave blank the areas for contact name, address and phone numbers.
CONTACT Contact Name Enter text: The full name (First, Middle, Last) of the individual to be contacted as a representative of the insured on all subsequent business relating to this incident. No entry is needed if the ‘Contact Insured’ option is checked.
CONTACT Primary Phone Enter number: The loss contact’s primary telephone number including area code.
CONTACT Home Check the box (if applicable): Indicates the primary phone number is for a home phone.
CONTACT Business Check the box (if applicable): Indicates the primary phone number is for a business phone.
CONTACT Cell Check the box (if applicable): Indicates the primary phone number is for a cell phone.
CONTACT Secondary Phone Enter number: The loss contact’s secondary telephone number including area code.
CONTACT Home Check the box (if applicable): Indicates the secondary phone number is for a home phone.
CONTACT Business Check the box (if applicable): Indicates the secondary phone number is for a business phone.
CONTACT Cell Check the box (if applicable): Indicates the secondary phone number is for a cell phone.
CONTACT When to Contact Enter text: The best time of the day to contact this individual (e.g., evenings, days, noon to 3:00 P.M.).
CONTACT Contact’s Mailing Address Enter text: The loss contact’s first address line.
CONTACT Enter text: The loss contact’s second address line.
CONTACT Enter text: The loss contact’s city.
CONTACT Enter code: The loss contact’s state.
CONTACT Enter code: The loss contact’s postal code.
CONTACT Primary E-Mail Address Enter text: The loss contact’s primary e-mail address.
CONTACT Secondary E-Mail Address Enter text: The loss contact’s secondary e-mail address.
LOSS Location of Loss Street Enter text: The loss location’s physical street address.
LOSS Location of Loss City, State, Zip Enter text: The loss location’s city.
LOSS Enter code: The loss location’s state or province code.
LOSS Enter code: The loss location’s postal code.
LOSS Location of Loss Country Enter code: The loss location’s country code.
LOSS Describe Location of Loss if not at Specific Street Address Enter text: The description of the location of loss if not at a specific street address.
LOSS Police or Fire Department Contacted Enter text: The name of the municipal, county or other police department, fire department or other authority to which the accident was reported, including any precinct or station number, if available.
LOSS Report # Enter identifier: The report number assigned by the authority contacted. For example, the number of the vehicle incident report filed by the police after an automobile accident.
LOSS Description of Accident Enter text: An explanation of how the loss occurred. As used here, this is the description of the accident. Attach ACORD 101, Additional Remarks Schedule, if more space is required.
INSURED VEHICLE Veh. No. Enter number: The producer assigned vehicle number.
INSURED VEHICLE Year Enter year: The model year of the vehicle.
INSURED VEHICLE Make Enter text: The manufacturer of the vehicle (e.g. Ford, Chevy).
INSURED VEHICLE Model Enter text: The manufacturer’s model name for the vehicle.
INSURED VEHICLE Body Type Enter code: The body type of the vehicle.
INSURED VEHICLE V.I.N. Enter identifier: The vehicle identification number (VIN) or serial number assigned by the manufacturer.
INSURED VEHICLE Plate No. Enter number: The license plate number.
INSURED VEHICLE State Enter code: The state or province in which the vehicle is registered.
INSURED VEHICLE Owner is insured Check the box (if applicable): Indicates if the owner of the insured vehicle or aircraft is the same as the named insured.
INSURED VEHICLE Owner’s Name & Address Enter text: The full name of the individual or business that is the owner of the vehicle or property.
INSURED VEHICLE Enter text: The first address line of the owner of the vehicle or property.
INSURED VEHICLE Enter text: The city of the owner of the vehicle or property.
INSURED VEHICLE Enter code: The state or province code of the owner of the vehicle or property.
INSURED VEHICLE Enter code: The postal code of the owner of the vehicle or property.
INSURED VEHICLE Primary Phone Enter number: The primary phone number for the owner of the vehicle or property.
CONTACT Home Check the box (if applicable): Indicates the primary phone number for the owner is a home phone.
CONTACT Business Check the box (if applicable): Indicates the primary phone number for the owner is a business phone.
CONTACT Cell Check the box (if applicable): Indicates the primary phone number for the owner is a cell phone.
CONTACT Secondary Phone Enter number: The secondary phone number for the owner of the vehicle or property.
CONTACT Home Check the box (if applicable): Indicates the secondary phone number for the owner is a home phone.
CONTACT Business Check the box (if applicable): Indicates the secondary phone number for the owner is a business phone.
CONTACT Cell Check the box (if applicable): Indicates the secondary phone number for the owner is a cell phone.
CONTACT Primary E-Mail Address Enter text: The primary e-mail address of the owner of the vehicle or property.
CONTACT Secondary E-Mail Address Enter text: The secondary e-mail address of the owner of the vehicle or property.
INSURED VEHICLE Driver is owner Check the box (if applicable): Indicates if the driver of the insured vehicle is the same as the owner.
INSURED VEHICLE Driver’s Name & Address Enter text: The driver’s first name (given name).
INSURED VEHICLE Enter text: The driver’s middle name or initial (other given name).
INSURED VEHICLE Enter text: The driver’s last name (surname).
INSURED VEHICLE Enter text: The first address line of the driver.
INSURED VEHICLE Enter text: The city of the driver.
INSURED VEHICLE Enter code: The state or province of the driver.
INSURED VEHICLE Enter code: The postal code of the driver.
CONTACT Primary Phone Enter number: The primary phone number of the driver.
CONTACT Home Check the box (if applicable): Indicates the primary phone number for the driver is a home phone.
CONTACT Business Check the box (if applicable): Indicates the primary phone number for the driver is a business phone.
CONTACT Cell Check the box (if applicable): Indicates the primary phone number for the driver is a cell phone.
CONTACT Secondary Phone Enter number: The secondary phone number for the driver.
CONTACT Home Check the box (if applicable): Indicates the secondary phone number for the driver is a home phone.
CONTACT Business Check the box (if applicable): Indicates the secondary phone number for the driver is a business phone.
CONTACT Cell Check the box (if applicable): Indicates the secondary phone number for the driver is a cell phone.
CONTACT Primary E-Mail Address Enter text: The primary e-mail address for the driver.
CONTACT Secondary E-Mail Address Enter text: The secondary e-mail address of the owner of the vehicle or property.
INSURED VEHICLE Relation to Insured Enter code: The relationship of the driver to the named insured. Examples are: I -Insured; S – Spouse; C – Child; SIB – Brother or Sister; P – Parent; E – Employee.
INSURED VEHICLE Date of Birth Enter date: The birth date of the driver.
INSURED VEHICLE Driver’s License Number Enter identifier: The driver’s license number.
INSURED VEHICLE State Enter code: The state the driver is licensed in.
INSURED VEHICLE Purpose of Use Enter text: A short description of the purpose of the trip during which the accident occurred (e.g., trip to store or commuting to work).
INSURED VEHICLE Used With Permission? Enter code: Indicates if the driver had permission to use the vehicle.
INSURED VEHICLE Describe Damage Enter text: Describe any damage to the vehicle, aircraft or property (e.g., right front fender crushed).
INSURED VEHICLE Was a standard child passenger restraint system (child seat) installed in the vehicle at the time of the accident? Enter Y for a “Yes” response. Input N for “No” response. Indicates the response to the question, “Was a standard child passenger restraint system (child seat) installed in the vehicle at the time of the accident?”.
INSURED VEHICLE Was the child passenger restraint system (child seat) in use by a child during the time of the accident? Enter Y for a “Yes” response. Input N for “No” response. Indicates the response to the question, “Was the child passenger restraint system (child seat) in use by a child during the time of the accident?”.
INSURED VEHICLE Did the child passenger restraint system (child seat) sustain a loss at the time of the accident? Enter Y for a “Yes” response. Input N for “No” response. Indicates the response to the question, “Did the child passenger restraint system (child seat) sustain a loss at the time of the accident?”.
INSURED VEHICLE Estimate Amount Enter amount: An estimate for the cost of repairing the vehicle, aircraft or property.
INSURED VEHICLE Where Can Vehicle Be Seen? Enter text: The location where the adjuster can inspect the vehicle, aircraft or property. If other than at the insured’s address, include the address.
INSURED VEHICLE When Can Vehicle Be Seen? Enter text: The time period the vehicle, aircraft or property is available for inspection.
INSURED VEHICLE Other Insurance On Vehicle-Carrier Enter text: The insurer name on any other applicable insurance. As used here, enter “N/A” if none.
INSURED VEHICLE Other Insurance On Vehicle-Policy Number Enter identifier: The policy number on any other applicable insurance. As used here, enter “N/A” if none.
IDENTIFICATION SECTION Agency Customer ID Enter identifier: The customer’s identification number assigned by the producer (e.g. agency or brokerage).
PROPERTY DAMAGED Non-Vehicle ? Check the box (if applicable): Indicates the damage is not to a vehicle.
PROPERTY DAMAGED Veh # Enter number: The producer assigned vehicle number.
PROPERTY DAMAGED Year Enter year: The model year of the vehicle.
PROPERTY DAMAGED Make Enter text: The manufacturer of the vehicle (e.g. Ford, Chevy).
PROPERTY DAMAGED Model Enter text: The manufacturer’s model name for the vehicle.
PROPERTY DAMAGED Body Type Enter code: The body type of the vehicle.
PROPERTY DAMAGED V.I.N. Enter identifier: The vehicle identification number (VIN) or serial number assigned by the manufacturer.
PROPERTY DAMAGED Plate Number Enter number: The license plate number.
PROPERTY DAMAGED State Enter code: The state or province in which the vehicle is registered.
PROPERTY DAMAGED Describe Property Enter text: A brief description of the type of property damaged, such as home or fence.
PROPERTY DAMAGED Other Veh./Prop. Ins? Enter code: Indicates if the damaged property, vehicle or aircraft is insured or not.
PROPERTY DAMAGED Company or Agency Name Enter text: The insurer name on any other applicable insurance.
IDENTIFICATION SECTION NAIC Code Enter code: The NAIC code of the insurance company that issued the policy.
PROPERTY DAMAGED Policy # Enter identifier: The policy number on any other applicable insurance. As used here, the policy number for this property (or vehicle) or any other applicable insurance.
PROPERTY DAMAGED Owners’ Name and address Enter text: The full name of the individual or business that is the owner of the vehicle or property.
PROPERTY DAMAGED Enter text: The first address line of the owner of the vehicle or property.
PROPERTY DAMAGED Enter text: The city of the owner of the vehicle or property.
PROPERTY DAMAGED Enter code: The state or province code of the owner of the vehicle or property.
PROPERTY DAMAGED Enter code: The postal code of the owner of the vehicle or property.
CONTACT Primary Phone Enter number: The primary phone number for the owner of the vehicle or property.
CONTACT Home Check the box (if applicable): Indicates the primary phone number for the owner is a home phone.
CONTACT Business Check the box (if applicable): Indicates the primary phone number for the owner is a business phone.
CONTACT Cell Check the box (if applicable): Indicates the primary phone number for the owner is a cell phone.
CONTACT Secondary Phone Enter number: The secondary phone number for the owner of the vehicle or property.
CONTACT Home Check the box (if applicable): Indicates the secondary phone number for the owner is a home phone.
CONTACT Business Check the box (if applicable): Indicates the secondary phone number for the owner is a business phone.
CONTACT Cell Check the box (if applicable): Indicates the secondary phone number for the owner is a cell phone.
CONTACT Primary E-Mail Address Enter text: The primary e-mail address of the owner of the vehicle or property.
CONTACT Secondary E-Mail Address Enter text: The secondary e-mail address of the owner of the vehicle or property.
CONTACT Driver address same as owner Check the box (if applicable): Indicates if the driver of the insured vehicle is the same as the owner.
PROPERTY DAMAGED Driver’s Name & Address Enter text: The driver’s first name (given name).
PROPERTY DAMAGED Enter text: The driver’s middle name or initial (other given name).
PROPERTY DAMAGED Enter text: The driver’s last name (surname).
PROPERTY DAMAGED Enter text: The first address line of the driver.
PROPERTY DAMAGED Enter text: The city of the driver.
PROPERTY DAMAGED Enter code: The state or province of the driver.
PROPERTY DAMAGED Enter code: The postal code of the driver.
CONTACT Primary Phone Enter number: The primary phone number of the driver.
CONTACT Home Check the box (if applicable): Indicates the primary phone number for the driver is a home phone.
CONTACT Business Check the box (if applicable): Indicates the primary phone number for the driver is a business phone.
CONTACT Cell Check the box (if applicable): Indicates the primary phone number for the driver is a cell phone.
CONTACT Secondary Phone Enter number: The secondary phone number for the driver.
CONTACT Home Check the box (if applicable): Indicates the secondary phone number for the driver is a home phone.
CONTACT Business Check the box (if applicable): Indicates the secondary phone number for the driver is a business phone.
CONTACT Cell Check the box (if applicable): Indicates the secondary phone number for the driver is a cell phone.
CONTACT Primary E-Mail Address Enter text: The primary e-mail address for the driver.
CONTACT Secondary E-Mail Address Enter text: The secondary e-mail address of the owner of the vehicle or property.
PROPERTY DAMAGED Describe Damage Enter text: Describe any damage to the vehicle, aircraft or property (e.g., right front fender crushed).
PROPERTY DAMAGED Estimate Amount Enter amount: An estimate for the cost of repairing the vehicle, aircraft or property.
PROPERTY DAMAGED Where Can Damage Be Seen? Enter text: The location where the adjuster can inspect the vehicle, aircraft or property. If other than at the insured’s address, include the address.
INJURED Name & Address Enter text: The name of a person that was injured in the incident or accident.
INJURED Enter text: The first address line of the injured party.
INJURED Enter text: The second address line of the injured party.
INJURED Enter text: The city of the injured party.
INJURED Enter code: The state or province of the injured party.
INJURED Enter code: The postal code of the injured party.
INJURED Phone Enter number: The primary phone number of the injured party.
INJURED PED Check the box (if applicable): Indicates if the injured party was a pedestrian.
INJURED Ins. Veh. Check the box (if applicable): Indicates if the injured party was in the insured’s vehicle.
INJURED Other Veh. Check the box (if applicable): Indicates if the injured party was in a vehicle other than the insured’s vehicle.
INJURED Age Enter number: The age, at the time of the incident, of the injured party.
INJURED Extent of Injury Enter text: A brief description of the injury sustained by the injured party (e.g. broken left leg).
INJURED Name & Address Enter text: The name of a person that was injured in the incident or accident.
INJURED Enter text: The first address line of the injured party.
INJURED Enter text: The second address line of the injured party.
INJURED Enter text: The city of the injured party.
INJURED Enter code: The state or province of the injured party.
INJURED Enter code: The postal code of the injured party.
INJURED Phone Enter number: The primary phone number of the injured party.
INJURED PED Check the box (if applicable): Indicates if the injured party was a pedestrian.
INJURED Ins. Veh. Check the box (if applicable): Indicates if the injured party was in the insured’s vehicle.
INJURED Other Veh. Check the box (if applicable): Indicates if the injured party was in a vehicle other than the insured’s vehicle.
INJURED Age Enter number: The age, at the time of the incident, of the injured party.
INJURED Extent of Injury Enter text: A brief description of the injury sustained by the injured party (e.g. broken left leg).
INJURED Name & Address Enter text: The name of a person that was injured in the incident or accident.
INJURED Enter text: The first address line of the injured party.
INJURED Enter text: The second address line of the injured party.
INJURED Enter text: The city of the injured party.
INJURED Enter code: The state or province of the injured party.
INJURED Enter code: The postal code of the injured party.
INJURED Phone Enter number: The primary phone number of the injured party.
INJURED PED Check the box (if applicable): Indicates if the injured party was a pedestrian.
INJURED Ins. Veh. Check the box (if applicable): Indicates if the injured party was in the insured’s vehicle.
INJURED Other Veh. Check the box (if applicable): Indicates if the injured party was in a vehicle other than the insured’s vehicle.
INJURED Age Enter number: The age, at the time of the incident, of the injured party.
INJURED Extent of Injury Enter text: A brief description of the injury sustained by the injured party (e.g. broken left leg).
INJURED Name & Address Enter text: The name of a person that was injured in the incident or accident.
INJURED Enter text: The first address line of the injured party.
INJURED Enter text: The second address line of the injured party.
INJURED Enter text: The city of the injured party.
INJURED Enter code: The state or province of the injured party.
INJURED Enter code: The postal code of the injured party.
INJURED Phone Enter number: The primary phone number of the injured party.
INJURED PED Check the box (if applicable): Indicates if the injured party was a pedestrian.
INJURED Ins. Veh. Check the box (if applicable): Indicates if the injured party was in the insured’s vehicle.
INJURED Other Veh. Check the box (if applicable): Indicates if the injured party was in a vehicle other than the insured’s vehicle.
INJURED Age Enter number: The age, at the time of the incident, of the injured party.
INJURED Extent of Injury Enter text: A brief description of the injury sustained by the injured party (e.g. broken left leg).
WITNESSES OR PASSENGERS Name & Address Enter text: The name of a person that was a witness to the incident or an uninjured passenger.
WITNESSES OR PASSENGERS Enter text: The first address line of a person that was a witness to the incident.
WITNESSES OR PASSENGERS Enter text: The second address line of a person that was a witness to the incident.
WITNESSES OR PASSENGERS Enter text: The city of a person that was a witness to the incident.
WITNESSES OR PASSENGERS Enter code: The state or province code of a person that was a witness to the incident.
WITNESSES OR PASSENGERS Enter code: The postal code of a person that was a witness to the incident.
WITNESSES OR PASSENGERS Phone Enter number: The primary phone number of a person that was a witness to the incident.
WITNESSES OR PASSENGERS Ins. Veh. Check the box (if applicable): Indicates if the witness was in the insured’s vehicle at the time of the incident.
WITNESSES OR PASSENGERS Other Veh. Check the box (if applicable): Indicates if the witness was in a vehicle other than the insured’s at the time of the incident.
WITNESSES OR PASSENGERS Other Enter text: A description of the location of the witness if the witness was not in the insured’s vehicle or aircraft or other involved vehicle or aircraft at the time of the incident.
WITNESSES OR PASSENGERS Name & Address Enter text: The name of a person that was a witness to the incident or an uninjured passenger.
WITNESSES OR PASSENGERS Enter text: The first address line of a person that was a witness to the incident.
WITNESSES OR PASSENGERS Enter text: The second address line of a person that was a witness to the incident.
WITNESSES OR PASSENGERS Enter text: The city of a person that was a witness to the incident.
WITNESSES OR PASSENGERS Enter code: The state or province code of a person that was a witness to the incident.
WITNESSES OR PASSENGERS Enter code: The postal code of a person that was a witness to the incident.
WITNESSES OR PASSENGERS Phone Enter number: The primary phone number of a person that was a witness to the incident.
WITNESSES OR PASSENGERS Ins. Veh. Check the box (if applicable): Indicates if the witness was in the insured’s vehicle at the time of the incident.
WITNESSES OR PASSENGERS Other Veh. Check the box (if applicable): Indicates if the witness was in a vehicle other than the insured’s at the time of the incident.
WITNESSES OR PASSENGERS Other Enter text: A description of the location of the witness if the witness was not in the insured’s vehicle or aircraft or other involved vehicle or aircraft at the time of the incident.
WITNESSES OR PASSENGERS Name & Address Enter text: The name of a person that was a witness to the incident or an uninjured passenger.
WITNESSES OR PASSENGERS Enter text: The first address line of a person that was a witness to the incident.
WITNESSES OR PASSENGERS Enter text: The second address line of a person that was a witness to the incident.
WITNESSES OR PASSENGERS Enter text: The city of a person that was a witness to the incident.
WITNESSES OR PASSENGERS Enter code: The state or province code of a person that was a witness to the incident.
WITNESSES OR PASSENGERS Enter code: The postal code of a person that was a witness to the incident.
WITNESSES OR PASSENGERS Phone Enter number: The primary phone number of a person that was a witness to the incident.
WITNESSES OR PASSENGERS Ins. Veh. Check the box (if applicable): Indicates if the witness was in the insured’s vehicle at the time of the incident.
WITNESSES OR PASSENGERS Other Veh. Check the box (if applicable): Indicates if the witness was in a vehicle other than the insured’s at the time of the incident.
WITNESSES OR PASSENGERS Other Enter text: A description of the location of the witness if the witness was not in the insured’s vehicle or aircraft or other involved vehicle or aircraft at the time of the incident.
WITNESSES OR PASSENGERS Reported By Enter text: The name of the individual that reported the loss.
WITNESSES OR PASSENGERS Reported To Enter text: The name of the individual within the agency or company to whom this loss was reported.
WITNESSES OR PASSENGERS Remarks (Attach ACORD 101, Additional Remarks Schedule, if more space is required) Enter text: The automobile loss notice general remarks. Describe any other additional information that will assist in properly reporting and settling this claim. Include the adjuster’s name if known. Attach ACORD 101, Additional Remarks Schedule, if more space is required.
IDENTIFICATION SECTION Agency Customer ID Enter identifier: The customer’s identification number assigned by the producer (e.g. agency or brokerage).
IDENTIFICATION SECTION Agency Customer ID Enter identifier: The customer’s identification number assigned by the producer (e.g. agency or brokerage).
Edition Date The edition identifier of the form including the form number and edition (the date is typically formatted YYYY/MM).