| Section Name | Field Name | Field and/or Section Description |
| TITLE ACORD 74 (2009/09) | Residence Based Business Supplement to Residential Section | The title of the form. The ACORD 74, Residence Based Business is used as a supplement to any personal property insurance application, when there is a business located on the premises. Refer to your company for rules of use. |
| IDENTIFICATION SECTION | Agency Customer ID | Enter identifier: The customer’s identification number assigned by the producer (e.g. agency or brokerage). |
| IDENTIFICATION SECTION | Loc # | Enter number: The producer assigned number of the location. As used here, the location number of the risk’s location as it appears on ACORD 88, Personal Insurance Application, Applicant Information Section. |
| 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 | 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 | Effective Date | Enter date: The effective date of the policy. The date that the terms and conditions of the policy commence. |
| IDENTIFICATION SECTION | Carrier | Enter text: The insurer’s full legal company name(s) as found in thefile 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 | Named Insured(s) | Enter text: The named insured(s) as it/they will appear on the policy declarations page. |
| IDENTIFICATION SECTION | DBA: | Enter text: The name by which an organization is doing business. As used here, if the insured is an individual or partnership doing business under an assumed name, enter the name of the business. |
| APPLICANT INFORMATION | Individual (Checkbox) | Check the box (if applicable): Indicates the legal entity code for the named insured is “Individual”. |
| APPLICANT INFORMATION | Partnership (Checkbox) | Check the box (if applicable): Indicates the legal entity code for the named insured is “Partnership”. |
| APPLICANT INFORMATION | Corporation (Checkbox) | Check the box (if applicable): Indicates the legal entity code for the named insured is “Corporation”. |
| APPLICANT INFORMATION | Limited Corporation (Checkbox) | Check the box (if applicable): Indicates the legal entity code for the named insured is “Limited Liability Corporation”. |
| APPLICANT INFORMATION | Joint Venture (Checkbox) | Check the box (if applicable): Indicates the legal entity code for the named insured is “Joint Venture”. |
| APPLICANT INFORMATION | Other (Checkbox) | Check the box (if applicable): Indicates the legal entity code for the named insured is not listed on the form. |
| APPLICANT INFORMATION | Describe Other | Enter text: The description of the legal entity if not listed on the form. As used here, provide a description of “other”, such as Professional Association or a Limited Liability Company. If there is more than one Named Insured, provide the form of business organization for each. In the Remarks section list each Named Insured along with its form of organization (e.g., The Green Thumb Co., a corporation; John Jones and Bill Smith, a partnership or a joint venture composed of ABC Contracting Inc. and XYZ Contracting Inc.) |
| APPLICANT INFORMATION | GL Code | Enter code: The code identifying thegeneral liability nature of business for the insured. The source of this code list is the Insurance Services Office Commercial Lines Manual (CLM) or individual insurer rate manuals. |
| APPLICANT INFORMATION | NAICS Code | Enter code: The North American Industry Classification System (NAICS) 6-digit industry code assigned to the business activity (if known). |
| APPLICANT INFORMATION | Federal ID # | Enter identifier: The tax identifier of the named insured. |
| APPLICANT INFORMATION | Inspection Contact | Enter text: The name of the person to contact to arrange for a premises inspection. This should be an individual under the insured’semployment, not the insurance agent’s name and number. |
| APPLICANT INFORMATION | Phone (A/C, No., Ext.): | Enter number: The telephone number of the person to contact to arrange for a premises inspection. This should be an individual under the insured’s employment. |
| NATURE OF BUSINESS | Office (Checkbox) | Check the box (if applicable): Indicates the nature of business is an office. |
| NATURE OF BUSINESS | Service (Checkbox) | Check the box (if applicable): Indicates the nature of business is service. |
| NATURE OF BUSINESS | Retail (Checkbox) | Check the box (if applicable): Indicates the nature of business is retail. |
| NATURE OF BUSINESS | Wholesale (Checkbox) | Check the box (if applicable): Indicates the nature of business is wholesale. |
| NATURE OF BUSINESS | Crafts (Checkbox) | Check the box (if applicable): Indicates the nature of business is crafts. |
| NATURE OF BUSINESS | Other (Checkbox) | Check the box (if applicable): Indicates the nature of business is other than those listed. |
| NATURE OF BUSINESS | Other Description | Enter text: The description of the nature/type of business. |
| NATURE OF BUSINESS | Date Business Started | Enter date: The date the current owners purchased or started the business. |
| NATURE OF BUSINESS | Class Code | Enter code: The industry code that identifies the exposure. This code is derived from Insurance Services Office or a company code list. |
| NATURE OF BUSINESS | Sq. Ft. Used | Enter number: The area, in square feet, of the building that is used for business purposes. |
| NATURE OF BUSINESS | Annual Sales/Receipts $ | Enter amount: The total annual gross sales or receipts. |
| NATURE OF BUSINESS | Total Payroll $ | Enter amount: The total annual payroll of the business in whole dollars. |
| NATURE OF BUSINESS | List Names of Owners/Operators | Enter text: The additional interest’s full name. |
| NATURE OF BUSINESS | # Visitors per Week | Enter number: The number of visitors the business normally receives per week. |
| NATURE OF BUSINESS | # Of Employees Full Time | Enter number: The number of full time employees. |
| NATURE OF BUSINESS | # Of Employees Part Time | Enter number: The number of part time employees. |
| NATURE OF BUSINESS | Business Opening Time | Enter time: The starting time for the normal business day. |
| NATURE OF BUSINESS | Business Closing Time | Enter time: The closing time for the normal business day. |
| NATURE OF BUSINESS | Description of Business | Enter text: The description of the operations of this risk. A restatement of the products classification wording is often not sufficient (e.g., “Metal Goods Manufacturing NOC” could include anything from paper clips to bridge girders). As used here, this section is designed to tell the underwriter what business each applicant performs and the way it is conducted. The section should be completed in enough detail to enable the underwriter to understand and classify the business. |
| NATURE OF BUSINESS | # of Business Losses (Past 3 Years) | Enter number: The number of business losses that occurred for the past specified number of years. As used here, enter the details of the losses on the ACORD 88 – Personal Insurance Application Applicant Information Section. |
| PROPERTY COVERAGES | Business Related Structure – Limit | Enter limit: The limit amount for business related structure coverage. |
| PROPERTY COVERAGES | Business Related Structure -Deductible | Enter deductible: The deductible amount for business related structure coverage. |
| PROPERTY COVERAGES | Business Related Structure -Valuation | Enter code: Indicate the method which will be used to determine the amount paid on a claim. Valuation methods are: ACV . . . . . . . . . . . . . . . . . . . . . . . . . Actual Cash Value RC. . . . . . . . . . . . . . . . . . . . . . . . . . .Replacement Cost AA . . . . . . . . . . . . . . . . . . . . . . . . . . Agreed Amount MV . . . . . . . . . . . . . . . . . . . . . . . . . . Market Value |
| PROPERTY COVERAGES | Business Related Structure – Form Number | Enter identifier: The number used by the insurer for the business related structure form. |
| PROPERTY COVERAGES | Business Related Structure – Form Date | Enter date: The edition date of the form used by the insurer for the business related structure. |
| PROPERTY COVERAGES | Business Related Structure -Premium | Enter amount: The premium amount for the business related structure coverage. |
| PROPERTY COVERAGES | Business Personal Property – Limit | Enter limit: The limit amount for business personal property coverage. |
| PROPERTY COVERAGES | Business Personal Property -Deductible | Enter deductible: The deductible amount for business personal property coverage. |
| PROPERTY COVERAGES | Business Personal Property -Valuation | Enter code: Indicate the method which will be used to determine the amount paid on a claim. Valuation methods are: ACV . . . . . . . . . . . . . . . . . . . . . . . . . Actual Cash Value RC. . . . . . . . . . . . . . . . . . . . . . . . . . .Replacement Cost AA . . . . . . . . . . . . . . . . . . . . . . . . . . Agreed Amount MV . . . . . . . . . . . . . . . . . . . . . . . . . . Market Value |
| PROPERTY COVERAGES | Business Personal Property -Form Number | Enter identifier: The number used by the insurer for the business personal property form. |
| PROPERTY COVERAGES | Business Personal Property -Form Date | Enter date: The edition date of the form used by the insurer for business related personal property. |
| PROPERTY COVERAGES | Business Personal Property -Premium | Enter amount: The premium amount for the business personal property coverage. |
| PROPERTY COVERAGES | Property Other | Enter text: The description of the coverage. |
| PROPERTY COVERAGES | Property Other – Limit | Enter limit: The limit amount for the coverage. |
| PROPERTY COVERAGES | Property Other – Deductible | Enter deductible: The deductible amount for the coverage. |
| PROPERTY COVERAGES | Property Other – Valuation | Enter code: Indicate the method which will be used to determine the amount paid on a claim. Valuation methods are: ACV . . . . . . . . . . . . . . . . . . . . . . . . . Actual Cash Value RC. . . . . . . . . . . . . . . . . . . . . . . . . . .Replacement Cost AA . . . . . . . . . . . . . . . . . . . . . . . . . . Agreed Amount MV . . . . . . . . . . . . . . . . . . . . . . . . . . Market Value |
| PROPERTY COVERAGES | Property Other – Form Number | Enter identifier: The number used by the insurer for the form associated with the coverage. |
| PROPERTY COVERAGES | Property Other – Form Date | Enter date: The edition date of the form used by the insurer for the coverage. |
| PROPERTY COVERAGES | Property Other – Premium | Enter amount: The premium amount associated with the coverage. |
| PROPERTY COVERAGES | Property Other | Enter text: The description of the coverage. |
| PROPERTY COVERAGES | Property Other – Limit | Enter limit: The limit amount for the coverage. |
| PROPERTY COVERAGES | Property Other – Deductible | Enter deductible: The deductible amount for the coverage. |
| PROPERTY COVERAGES | Property Other – Valuation | Enter code: Indicate the method which will be used to determine the amount paid on a claim. Valuation methods are: ACV . . . . . . . . . . . . . . . . . . . . . . . . . Actual Cash Value RC. . . . . . . . . . . . . . . . . . . . . . . . . . .Replacement Cost AA . . . . . . . . . . . . . . . . . . . . . . . . . . Agreed Amount MV . . . . . . . . . . . . . . . . . . . . . . . . . . Market Value |
| PROPERTY COVERAGES | Property Other – Form Number | Enter identifier: The number used by the insurer for the form associated with the coverage. |
| PROPERTY COVERAGES | Property Other – Form Date | Enter date: The edition date of the form used by the insurer for the coverage. |
| PROPERTY COVERAGES | Property Other – Premium | Enter amount: The premium amount associated with the coverage. |
| LIABILITY COVERAGES | Combined Single Limit | Enter limit: The limit amount for combined single limit coverage. As used here, list all limits as they will appear in the policy. Show limits in whole dollars. Several formats are included here for the collection of liability limits. Complete only those items that match the format of the program you are using to write the policy. |
| LIABILITY COVERAGES | Combined Single Limit – Form Number | Enter identifier: The number used by the insurer for the form associated with combined single limit coverage. |
| LIABILITY COVERAGES | Combined Single Limit – Form Date | Enter date: The edition date of the form used by the insurer for combined single limit coverage. |
| LIABILITY COVERAGES | Combined Single Limit – Premium | Enter amount: The premium amount for combined single limit coverage. |
| LIABILITY COVERAGES | Bodily Injury Occurrence – Limit | Enter limit: The each occurrence limit amount for bodily injury coverage. As used here, list all limits as they will appear in the policy. Show limits in whole dollars. Several formats are included here for the collection of liability limits. Complete only those items that match the format of the program you are using to write the policy. |
| LIABILITY COVERAGES | Bodily Injury Aggregate – Limit | Enter limit: The limit amount for bodily injury coverage. |
| LIABILITY COVERAGES | Bodily Injury – Form Number | Enter identifier: The number used by the insurer for the form associated with bodily injury coverage. |
| LIABILITY COVERAGES | Bodily Injury – Form Date | Enter date: The edition date of the form used by the insurer for bodily injury coverage. |
| LIABILITY COVERAGES | Bodily Injury – Premium | Enter amount: The premium amount for bodily injury coverage. |
| LIABILITY COVERAGES | Property Damage – Limit | Enter limit: The limit amount for the property damage coverage. As used here, list all limits as they will appear in the policy. Show limits in whole dollars. Several formats are included here for the collection of liability limits. Complete only those items that match the format of the program you are using to write the policy. |
| LIABILITY COVERAGES | Property Damage – Form Number | Enter identifier: The number used by the insurer for the form associated with property damage coverage. |
| LIABILITY COVERAGES | Property Damage – Form Date | Enter date: The edition date of the form used by the insurer for property damage coverage. |
| LIABILITY COVERAGES | Property Damage – Premium | Enter amount: The premium amount for property damage coverage. |
| LIABILITY COVERAGES | Products/Compl. Operations Occurrence – Limit | Enter limit: The each occurrence limit amount for products and completed operations coverage. As used here, list all limits as they will appear in the policy. Show limits in whole dollars. Several formats are included here for the collection of liability limits. Complete only those items that match the format of the program you are using to write the policy. |
| LIABILITY COVERAGES | Products/Compl. Operations -Aggregate Limit | Enter limit: The limit amount for products and completed operations coverage. |
| LIABILITY COVERAGES | Products/Compl. Operations -Form Number | Enter identifier: The number used by the insurer for the form associated with products and completed operations coverage. |
| LIABILITY COVERAGES | Products/Compl. Operations -Form Date | Enter date: The edition date of the form used by the insurer for products and completed operations coverage. |
| LIABILITY COVERAGES | Products/Compl. Operations -Premium | Enter amount: The premium amount for products and completed operations coverage. |
| LIABILITY COVERAGES | Damage to Rented Premises -Limit | Enter limit: The limit amount for fire damage to rented premises coverage. As used here, list all limits as they will appear in the policy. Show limits in whole dollars. Several formats are included here for the collection of liability limits. Complete only those items that match the format of the program you are using to write the policy. |
| LIABILITY COVERAGES | Damage to Rented Premises -Form Number | Enter identifier: The number used by the insurer for the form associated with fire damage to rented premises coverage. |
| LIABILITY COVERAGES | Damage to Rented Premises -Form Date | Enter date: The edition date of the form used by the insurer for fire damage to rented premises coverage. |
| LIABILITY COVERAGES | Damage to Rented Premises -Premium | Enter amount: The premium amount for fire damage to rented premises coverage. |
| LIABILITY COVERAGES | Medical Expense Per Person -Limit | Enter limit: The limit amount for medical expense coverage. As used here, list all limits as they will appear in the policy. Show limits in whole dollars. Several formats are included here for the collection of liability limits. Complete only those items that match the format of the program you are using to write the policy. |
| LIABILITY COVERAGES | Medical Expense Per Person -Form Number | Enter identifier: The number used by the insurer for the form associated with medical expense coverage. |
| LIABILITY COVERAGES | Medical Expense Per Person -Form Date | Enter date: The edition date of the form used by the insurer for medical expense coverage. |
| LIABILITY COVERAGES | Medical Expense Per Person -Premium | Enter amount: The premium amount for medical expense coverage. |
| LIABILITY COVERAGES | Hired Auto – Limit | Enter limit: The limit amount for hired auto coverage. As used here, list all limits as they will appear in the policy. Show limits in whole dollars. Several formats are included here for the collection of liability limits. Complete only those items that match the format of the program you are using to write the policy. |
| LIABILITY COVERAGES | Hired Auto – Form Number | Enter identifier: The number used by the insurer for the form associated with hired auto coverage. |
| LIABILITY COVERAGES | Hired Auto – Form Date | Enter date: The edition date of the form used by the insurer for hired auto coverage. |
| LIABILITY COVERAGES | Hired Auto – Premium | Enter amount: The premium amount for hired auto coverage. |
| LIABILITY COVERAGES | Non-owned Auto – Limit | Enter limit: The limit amount for non-owned auto coverage. As used here, list all limits as they will appear in the policy. Show limits in whole dollars. Several formats are included here for the collection of liability limits. Complete only those items that match the format of the program you are using to write the policy. |
| LIABILITY COVERAGES | Non-owned Auto – Form Number | Enter identifier: The number used by the insurer for the form associated with non-owned auto coverage. |
| LIABILITY COVERAGES | Non-owned Auto – Form Date | Enter date: The edition date of the form used by the insurer for non-owned auto coverage. |
| LIABILITY COVERAGES | Non-owned Auto – Premium | Enter amount: The premium amount for non-owned auto coverage. |
| LIABILITY COVERAGES | Employee Benefits – Limit | Enter limit: The limit amount for employee benefits coverage. As used here, list all limits as they will appear in the policy. Show limits in whole dollars. Several formats are included here for the collection of liability limits. Complete only those items that match the format of the program you are using to write the policy. |
| LIABILITY COVERAGES | Employee Benefits – Form Number | Enter identifier: The number used by the insurer for the form associated with employee benefits coverage. |
| LIABILITY COVERAGES | Employee Benefits – Form Date | Enter date: The edition date of the form used by the insurer for employee benefits coverage. |
| LIABILITY COVERAGES | Employee Benefits – Premium | Enter amount: The premium amount for employee benefits coverage. |
| LIABILITY COVERAGES | Liability Other Coverage | Enter text: The description of the coverage. |
| LIABILITY COVERAGES | Liability Other Limit | Enter limit: The limit amount for the coverage. As used here, list all limits as they will appear in the policy. Show limits in whole dollars. Several formats are included here for the collection of liability limits. Complete only those items that match the format of the program you are using to write the policy. |
| LIABILITY COVERAGES | Liability Other Form Number | Enter identifier: The number used by the insurer for the form associated with the coverage. |
| LIABILITY COVERAGES | Liability Other Form Date | Enter date: The edition date of the form used by the insurer for the coverage. |
| LIABILITY COVERAGES | Liability Other Premium | Enter amount: The premium amount associated with the coverage. |
| LIABILITY COVERAGES | Liability Other Coverage | Enter text: The description of the coverage. |
| LIABILITY COVERAGES | Liability Other Limit | Enter limit: The limit amount for the coverage. As used here, list all limits as they will appear in the policy. Show limits in whole dollars. Several formats are included here for the collection of liability limits. Complete only those items that match the format of the program you are using to write the policy. |
| LIABILITY COVERAGES | Liability Other Form Number | Enter identifier: The number used by the insurer for the form associated with the coverage. |
| LIABILITY COVERAGES | Liability Other Form Date | Enter date: The edition date of the form used by the insurer for the coverage. |
| LIABILITY COVERAGES | Liability Other Premium | Enter amount: The premium amount associated with the coverage. |
| LIABILITY COVERAGES | Liability Other Coverage | Enter text: The description of the coverage. |
| LIABILITY COVERAGES | Liability Other Limit | Enter limit: The limit amount for the coverage. As used here, list all limits as they will appear in the policy. Show limits in whole dollars. Several formats are included here for the collection of liability limits. Complete only those items that match the format of the program you are using to write the policy. |
| LIABILITY COVERAGES | Liability Other Form Number | Enter identifier: The number used by the insurer for the form associated with the coverage. |
| LIABILITY COVERAGES | Liability Other Form Date | Enter date: The edition date of the form used by the insurer for the coverage. |
| LIABILITY COVERAGES | Liability Other Premium | Enter amount: The premium amount associated with the coverage. |
| DEDUCTIBLES | Deductible Basis Per Claim | Check the box (if applicable): Indicates that a per claim deductible applies to individual claims even if the claims are all related to the same occurrence or event. |
| DEDUCTIBLES | Deductible Basis Per Occurrence | Check the box (if applicable): Indicates that a per occurrence deductible applies once to each occurrence no matter how many individual claims result from the occurrence or event. |
| DEDUCTIBLES | Property Damage | Enter amount: The deductible amount for the property damage coverage. |
| DEDUCTIBLES | Bodily Injury | Enter amount: The deductible amount for the bodily injury coverage. |
| DEDUCTIBLES | Other Deductible | Enter text: The description of the coverage. |
| DEDUCTIBLES | Other Deductible Amount | Enter deductible: The deductible amount for the coverage. |
| GENERAL INFORMATION | 1. Any business conducted at any other location? | Enter Y for a “Yes” response. Input N for “No” response. Indicates the response to the question, “Any business conducted at any other location?”. |
| GENERAL INFORMATION | Remarks | Enter text: An explanation of a response to a general information or underwriting question. Normally, “Yes” responses require an explanation. |
| GENERAL INFORMATION | 2. Do you lease to or from other employers? | Enter Y for a “Yes” response. Input N for “No” response. Indicates the response to the question, “Do you lease employees to or from other employers?”. |
| GENERAL INFORMATION | Enter text: An explanation of a response to a general information or underwriting question. Normally, “Yes” responses require an explanation. | |
| GENERAL INFORMATION | 3. Any workers compensation carried? | Enter Y for a “Yes” response. Input N for “No” response. Indicates the response to the question, “Any Workers Compensation carried?”. |
| GENERAL INFORMATION | NAIC Code | Enter code: The NAIC code of the insurance company that issued the policy. |
| GENERAL INFORMATION | Carrier | Enter text: The insurer name on any other applicable insurance. |
| GENERAL INFORMATION | Policy Number | Enter identifier: The policy number on any other applicable insurance. |
| GENERAL INFORMATION | 4. Do you rent or loan equipment to others? | Enter Y for a “Yes” response. Input N for “No” response. Indicates the response to the question, “Do you rent or loan equipment to others?”. |
| GENERAL INFORMATION | Enter text: An explanation of a response to a general information or underwriting question. Normally, “Yes” responses require an explanation. | |
| IDENTIFICATION SECTION | Agency Customer ID | Enter identifier: The customer’s identification number assigned by the producer (e.g. agency or brokerage). |
| IDENTIFICATION SECTION | Loc # | Enter number: The producer assigned number of the location. As used here, the location number of the risk’s location as it appears on ACORD 88, Personal Insurance Application, Applicant Information Section. |
| GENERAL INFORMATION (continued) | 5. Is the applicant a subsidiary of another entity or does the applicant have any subsidiaries? | Enter Y for a “Yes” response. Input N for “No” response. Indicates the response to the question, “Is the applicant a subsidiary or another entity or does the applicant have subsidiaries?”. |
| GENERAL INFORMATION (continued) | Parent Company Name | Enter text: The name of the parent organization. |
| GENERAL INFORMATION (continued) | Enter text: The description of what business the parent organization performs and the way it is conducted. | |
| GENERAL INFORMATION (continued) | 6. Does the applicant have any subsidiaries? | Enter Y for a “Yes” response. Input N for “No” response. Indicates the response to the question, “Does the applicant have subsidiaries?”. |
| GENERAL INFORMATION (continued) | Subsidiary Company Name | Enter text: The name of the subsidiary of the company. This may also contain owned foundations or charitable trusts. |
| GENERAL INFORMATION (continued) | Description of Operations | Enter text: The description of what business the subsidiary organization performs and the way it is conducted. |
| GENERAL INFORMATION (continued) | 6. Does the business involve the use or storage of petroleum-based products, paint, fertilizer, pesticides or other hazardous material or pollutants? | Enter Y for a “Yes” response. Input N for “No” response. Indicates the response to the question, “Does the business involve the use or storage of petroleum-based products, paint, fertilizer, pesticides or other hazardous material or pollutants?”. |
| GENERAL INFORMATION (continued) | Enter text: An explanation of a response to a general information or underwriting question. Normally, “Yes” responses require an explanation. | |
| 7. Has any applicant filed for | Enter Y for a “Yes” response. Input N for “No” response. Indicates the response to the | |
| GENERAL INFORMATION | bankruptcy (Business or Personal) | question, “Has the applicant filed for bankruptcy (business or personal) in the last |
| (continued) | in the last five (5) years? | specified number of years?”. |
| GENERAL INFORMATION (continued) | Enter text: An explanation of a response to a general information or underwriting question. Normally, “Yes” responses require an explanation. | |
| 8. Any products directly imported | Enter Y for a “Yes” response. Input N for “No” response. Indicates the response to the | |
| GENERAL INFORMATION | or exported outside the U.S., | question, “Any products directly imported or exported outside the U.S., Puerto Rico or |
| (continued) | Puerto Rico or Canada? | Canada?”. |
| GENERAL INFORMATION (continued) | Enter text: An explanation of a response to a general information or underwriting question. Normally, “Yes” responses require an explanation. | |
| GENERAL INFORMATION (continued) | 9. Any products repackaged, modified or mixed? | Enter Y for a “Yes” response. Input N for “No” response. Indicates the response to the question, “Any products repackaged, modified, or mixed?”. |
| GENERAL INFORMATION (continued) | Enter text: An explanation of a response to a general information or underwriting question. Normally, “Yes” responses require an explanation. | |
| GENERAL INFORMATION (continued) | 10. Any used items sold? | Enter Y for a “Yes” response. Input N for “No” response. Indicates the response to the question, “Any used items sold?”. |
| GENERAL INFORMATION (continued) | Enter text: An explanation of a response to a general information or underwriting question. Normally, “Yes” responses require an explanation. | |
| 11. Do you distribute your | ||
| GENERAL INFORMATION | products or services by means of | Enter Y for a “Yes” response. Input N for “No” response. Indicates the response to the |
| (continued) | the internet? | question, “Do you distribute your products or services by means of the internet?”. |
| GENERAL INFORMATION (continued) | Enter text: An explanation of a response to a general information or underwriting question. Normally, “Yes” responses require an explanation. | |
| GENERAL INFORMATION | 12. Does your company maintain | Enter Y for a “Yes” response. Input N for “No” response. Indicates the response to the |
| (continued) | or support an internet website? | question, “Does your company maintain an internet website?”. |
| GENERAL INFORMATION (continued) | Enter text: An explanation of a response to a general information or underwriting question. Normally, “Yes” responses require an explanation. | |
| GENERAL INFORMATION (continued) | 13. Does the business involve demonstration of any products? | Enter Y for a “Yes” response. Input N for “No” response. Indicates the response to the question, “Does the business involve demonstration of any products?”. |
| GENERAL INFORMATION (continued) | Enter text: An explanation of a response to a general information or underwriting question. Normally, “Yes” responses require an explanation. | |
| 14. Is the business run from a | ||
| distinctly separate area in the | Enter Y for a “Yes” response. Input N for “No” response. Indicates the response to the | |
| GENERAL INFORMATION | residence from household | question, “Is the business run from a distinctly separate are in the residence from |
| (continued) | activities? | household activities?”. |
| GENERAL INFORMATION (continued) | Enter text: An explanation of a response to a general information or underwriting question. Normally, “Yes” responses require an explanation. | |
| 15. Are you or any resident a | ||
| professional entertainer, athlete, | ||
| media personality, state or federal | Enter Y for a “Yes” response. Input N for “No” response. Indicates the response to the | |
| GENERAL INFORMATION | political figure? (Not applicable in | question, “Are you or any resident a professional entertainer, athlete, media personality, |
| (continued) | NC) | state or federal political figure? (Not applicable in North Carolina)”. |
| GENERAL INFORMATION (continued) | Enter text: An explanation of a response to a general information or underwriting question. Normally, “Yes” responses require an explanation. | |
| 16. Other than computer systems | ||
| or office equipment, do you install | Enter Y for a “Yes” response. Input N for “No” response. Indicates the response to the | |
| GENERAL INFORMATION | or service any products off | question, “Other than computer systems or office equipment, do you install or service any |
| (continued) | premises? | products off premises?”. |
| GENERAL INFORMATION (continued) | Enter text: An explanation of a response to a general information or underwriting question. Normally, “Yes” responses require an explanation. | |
| 17. Are all exterior doors equipped | Enter Y for a “Yes” response. Input N for “No” response. Indicates the response to the | |
| GENERAL INFORMATION | with deadbolt locks or comparable | question, “Are all exterior doors equipped with deadbolt locks or comparable slider |
| (continued) | slider locks? | locks?”. |
| GENERAL INFORMATION (continued) | Enter text: An explanation of a response to a general information or underwriting question. Normally, “Yes” responses require an explanation. | |
| 18. If a financial planner or | ||
| consultant, do you have | ||
| discretionary trading authority | Enter Y for a “Yes” response. Input N for “No” response. Indicates the response to the | |
| GENERAL INFORMATION | and/or access to customers data | question, “If a financial planner or consultant, do you have discretionary trading authority |
| (continued) | and/or funds? | and/or access to customer’s data and/or funds?”. |
| GENERAL INFORMATION (continued) | Enter text: An explanation of a response to a general information or underwriting question. Normally, “Yes” responses require an explanation. | |
| GENERAL INFORMATION | 19. If involved in real estate, do | Enter Y for a “Yes” response. Input N for “No” response. Indicates the response to the |
| (continued) | you manage property for others? | question, “If involved in real estate, do you manage property for others?”. |
| GENERAL INFORMATION (continued) | Enter text: An explanation of a response to a general information or underwriting question. Normally, “Yes” responses require an explanation. | |
| REMARKS | Remarks | Enter text: The remarks associated with the residence based business. |
| Edition | Date | The edition identifier of the form including the form number and edition (the date is typically formatted YYYY/MM). |