| Section Name | Field Name | Field and/or Section Description |
| TITLE ACORD 808 (2009/03) | P & C Agency Appointment Form | The title of the form. ACORD 808, P & C Agency Appointment Form, is a standard Agency Appointment Form designed for P & C / Surety appointments and accepted by multiple insurers. In this case, the agency is an organization. This form is to be completed by a Producer and then sent to the insurer. ACORD 808 is comprised of the data content needed for new PCS agency appointments. |
| IDENTIFICATION SECTION | Date | Enter date: The month/day/year on which the form is completed. (MM/DD/YYYY) |
| IDENTIFICATION SECTION | Carrier Name | 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. |
| AGENCY INFORMATION | Agency Full Legal Name | Enter text: The full name of the producer/agency. As used here, this is the full name of the agency at which the producer (person) is employed with regards to this appointment request. |
| AGENCY INFORMATION | Agency Address | Enter text: The mailing address line one of the producer/agency. |
| AGENCY INFORMATION | Enter text: The mailing address line two of the producer/agency. | |
| AGENCY INFORMATION | City | Enter text: The mailing address city name of the producer/agency. |
| AGENCY INFORMATION | State | Enter code: The mailing address state or province code of the producer/agency. |
| AGENCY INFORMATION | Zip | Enter code: The mailing address postal code of the producer/agency. |
| AGENCY INFORMATION | Agency DBA | Enter text: The name by which an organization is doing business. |
| AGENCY INFORMATION | FEIN | Enter identifier: The producer’s tax identification number. This may be the federal employer identification number or social security number. As used here, this is the FEIN for the agency. |
| AGENCY INFORMATION | Licensing Contact | Enter text: The name of the individual at the producer’s establishment that is the primary contact. As used here, this is the name of the licensing contact person within the agency. Contact this person if there are any questions about the appointment form. |
| AGENCY INFORMATION | Contact Phone | Enter number: The producer’s contact person’s phone number. If applicable, include the area code and extension. |
| AGENCY INFORMATION | Contact Fax | Enter number: The producer’s contact person’s fax number. |
| AGENCY INFORMATION | Contact Email | Enter text: The producer’s contact person e-mail address. |
| AGENCY INFORMATION | Agency Website | Enter text: The website address for the producer / agency. |
| AGENCY INFORMATION | Legal Entity Type– Sole Proprietor | Check the box (if applicable): Indicates the legal entity code for the producer is “Sole Proprietor”. |
| Section Name | Field Name | Field and/or Section Description |
| AGENCY INFORMATION | Legal Entity Type – Corporation | Check the box (if applicable): Indicates the legal entity code for the producer is “Corporation”. |
| AGENCY INFORMATION | Legal Entity Type – Partnership | Check the box (if applicable): Indicates the legal entity code for the producer is “Partnership”. |
| AGENCY INFORMATION | Legal Entity Type –Limited Liability Company(LLC) | Check the box (if applicable): Indicates the legal entity code for the producer is “Limited Liability Company”. |
| AGENCY INFORMATION | Legal Entity Type –Limited Liability Partnership(LLP) | Check the box (if applicable): Indicates the legal entity code for the producer is “Limited Liability Partnership”. |
| MAILING ADDRESS | Street Address | Enter text: The mailing address line one of the producer/agency. |
| MAILING ADDRESS | City | Enter text: The mailing address city name of the producer/agency. |
| MAILING ADDRESS | State | Enter code: The mailing address state or province code of the producer/agency. |
| MAILING ADDRESS | Zip | Enter code: The mailing address postal code of the producer/agency. |
| STATES AND US TERRITORIES | All States | Check the box (if applicable): Indicate the appointment ortermination applies in the state or territory. As used here, indicates that the appointment or termination applies to all states. |
| STATES AND US TERRITORIES | AK – Alaska | Check the box (if applicable): Indicate the appointment or termination applies in the state or territory. |
| STATES AND US TERRITORIES | AL – Alabama | Check the box (if applicable): Indicate the appointment or termination applies in the state or territory. |
| STATES AND US TERRITORIES | AR – Arkansas | Check the box (if applicable): Indicate the appointment or termination applies in the state or territory. |
| STATES AND US TERRITORIES | AZ – Arizona | Check the box (if applicable): Indicate the appointment or termination applies in the state or territory. |
| STATES AND US TERRITORIES | CA – California | Check the box (if applicable): Indicate the appointment or termination applies in the state or territory. |
| STATES AND US TERRITORIES | CO – Colorado | Check the box (if applicable): Indicate the appointment or termination applies in the state or territory. |
| STATES AND US TERRITORIES | CT – Connecticut | Check the box (if applicable): Indicate the appointment or termination applies in the state or territory. |
| STATES AND US TERRITORIES | DC – District of Columbia | Check the box (if applicable): Indicate the appointment or termination applies in the state or territory. |
| STATES AND US TERRITORIES | DE – Delaware | Check the box (if applicable): Indicate the appointment or termination applies in the state or territory. |
| STATES AND US TERRITORIES | FL – Florida | Check the box (if applicable): Indicate the appointment or termination applies in the state or territory. |
| Section Name | Field Name | Field and/or Section Description |
|---|---|---|
| STATES AND US TERRITORIES | GA – Georgia | Check the box (if applicable): Indicate the appointment or termination applies in the state or territory. |
| STATES AND US TERRITORIES | HI – Hawaii | Check the box (if applicable): Indicate the appointment or termination applies in the state or territory. |
| STATES AND US TERRITORIES | IA – Iowa | Check the box (if applicable): Indicate the appointment or termination applies in the state or territory. |
| STATES AND US TERRITORIES | ID – Idaho | Check the box (if applicable): Indicate the appointment or termination applies in the state or territory. |
| STATES AND US TERRITORIES | IL – Illinois | Check the box (if applicable): Indicate the appointment or termination applies in the state or territory. |
| STATES AND US TERRITORIES | IN – Indiana | Check the box (if applicable): Indicate the appointment or termination applies in the state or territory. |
| STATES AND US TERRITORIES | KS – Kansas | Check the box (if applicable): Indicate the appointment or termination applies in the state or territory. |
| STATES AND US TERRITORIES | KY – Kentucky | Check the box (if applicable): Indicate the appointment or termination applies in the state or territory. |
| STATES AND US TERRITORIES | LA – Louisiana | Check the box (if applicable): Indicate the appointment or termination applies in the state or territory. |
| STATES AND US TERRITORIES | MA – Massachusetts | Check the box (if applicable): Indicate the appointment or termination applies in the state or territory. |
| STATES AND US TERRITORIES | MD – Maryland | Check the box (if applicable): Indicate the appointment or termination applies in the state or territory. |
| STATES AND US TERRITORIES | ME – Maine | Check the box (if applicable): Indicate the appointment or termination applies in the state or territory. |
| STATES AND US TERRITORIES | MI – Michigan | Check the box (if applicable): Indicate the appointment or termination applies in the state or territory. |
| STATES AND US TERRITORIES | MN – Minnesota | Check the box (if applicable): Indicate the appointment or termination applies in the state or territory. |
| STATES AND US TERRITORIES | MO – Missouri | Check the box (if applicable): Indicate the appointment or termination applies in the state or territory. |
| STATES AND US TERRITORIES | MS – Mississippi | Check the box (if applicable): Indicate the appointment or termination applies in the state or territory. |
| STATES AND US TERRITORIES | MT – Montana | Check the box (if applicable): Indicate the appointment or termination applies in the state or territory. |
| STATES AND US TERRITORIES | NC – North Carolina | Check the box (if applicable): Indicate the appointment or termination applies in the state or territory. |
| Section Name | Field Name | Field and/or Section Description |
|---|---|---|
| STATES AND US TERRITORIES | ND – North Dakota | Check the box (if applicable): Indicate the appointment or termination applies in the state or territory. |
| STATES AND US TERRITORIES | NE – Nebraska | Check the box (if applicable): Indicate the appointment or termination applies in the state or territory. |
| STATES AND US TERRITORIES | NH – New Hampshire | Check the box (if applicable): Indicate the appointment or termination applies in the state or territory. |
| STATES AND US TERRITORIES | NJ – New Jersey | Check the box (if applicable): Indicate the appointment or termination applies in the state or territory. |
| STATES AND US TERRITORIES | NM – New Mexico | Check the box (if applicable): Indicate the appointment or termination applies in the state or territory. |
| STATES AND US TERRITORIES | NV – Nevada | Check the box (if applicable): Indicate the appointment or termination applies in the state or territory. |
| STATES AND US TERRITORIES | NY – New York | Check the box (if applicable): Indicate the appointment or termination applies in the state or territory. |
| STATES AND US TERRITORIES | OH – Ohio | Check the box (if applicable): Indicate the appointment or termination applies in the state or territory. |
| STATES AND US TERRITORIES | OK – Oklahoma | Check the box (if applicable): Indicate the appointment or termination applies in the state or territory. |
| STATES AND US TERRITORIES | OR – Oregon | Check the box (if applicable): Indicate the appointment or termination applies in the state or territory. |
| STATES AND US TERRITORIES | PA – Pennsylvania | Check the box (if applicable): Indicate the appointment or termination applies in the state or territory. |
| STATES AND US TERRITORIES | RI – Rhode Island | Check the box (if applicable): Indicate the appointment or termination applies in the state or territory. |
| STATES AND US TERRITORIES | SC – South Carolina | Check the box (if applicable): Indicate the appointment or termination applies in the state or territory. |
| STATES AND US TERRITORIES | SD – South Dakota | Check the box (if applicable): Indicate the appointment or termination applies in the state or territory. |
| STATES AND US TERRITORIES | TN – Tennessee | Check the box (if applicable): Indicate the appointment or termination applies in the state or territory. |
| STATES AND US TERRITORIES | TX – Texas | Check the box (if applicable): Indicate the appointment or termination applies in the state or territory. |
| STATES AND US TERRITORIES | UT – Utah | Check the box (if applicable): Indicate the appointment or termination applies in the state or territory. |
| STATES AND US TERRITORIES | VA – Virginia | Check the box (if applicable): Indicate the appointment or termination applies in the state or territory. |
| Section Name | Field Name | Field and/or Section Description |
| STATES AND US TERRITORIES | VT – Vermont | Check the box (if applicable): Indicate the appointment or termination applies in the state or territory. |
| STATES AND US TERRITORIES | WA – Washington | Check the box (if applicable): Indicate the appointment or termination applies in the state or territory. |
| STATES AND US TERRITORIES | WI – Wisconsin | Check the box (if applicable): Indicate the appointment or termination applies in the state or territory. |
| STATES AND US TERRITORIES | WV – West Virginia | Check the box (if applicable): Indicate the appointment or termination applies in the state or territory. |
| STATES AND US TERRITORIES | WY – Wyoming | Check the box (if applicable): Indicate the appointment or termination applies in the state or territory. |
| STATES AND US TERRITORIES | All Territories | Check the box (if applicable): Indicate the appointment or termination applies in the state or territory. As used here, indicates that the appointment or termination applies to all territories. |
| STATES AND US TERRITORIES | AS – American Samoa | Check the box (if applicable): Indicate the appointment or termination applies in the state or territory. |
| STATES AND US TERRITORIES | GU – Guam | Check the box (if applicable): Indicate the appointment or termination applies in the state or territory. |
| STATES AND US TERRITORIES | PR – Puerto Rico | Check the box (if applicable): Indicate the appointment or termination applies in the state or territory. |
| STATES AND US TERRITORIES | VI – Virgin Islands | Check the box (if applicable): Indicate the appointment or termination applies in the state or territory. |
| STATES AND US TERRITORIES | Other Information Does your agency operate under another license and / or name in any other state? | Enter Y for a “Yes” response. Input N for “No” response. Indicates the response to the question, “Does your agency operate under another license and / or name in any other state?”. |
| STATES AND US TERRITORIES | Name | Enter text: The full name of the agency. |
| STATES AND US TERRITORIES | State | Enter code: The state or province code in which the agency is located. |
| STATES AND US TERRITORIES | Name | Enter text: The full name of the agency. |
| STATES AND US TERRITORIES | State | Enter code: The state or province code in which the agency is located. |
| STATES AND US TERRITORIES | Name | Enter text: The full name of the agency. |
| Section Name | Field Name | Field and/or Section Description |
| STATES AND US TERRITORIES | State | Enter code: The state or province code in which the agency is located. |
| STATES AND US TERRITORIES | Name | Enter text: The full name of the agency. |
| STATES AND US TERRITORIES | State | Enter code: The state or province code in which the agency is located. |
| CARRIER ADDRESS | Street Address | Enter text: The first line of the insurer’s mailing address. |
| CARRIER ADDRESS | City | Enter text: The city of the insurer’s mailing address. |
| CARRIER ADDRESS | State | Enter code: The state or province of the insurer’s mailing address. |
| CARRIER ADDRESS | Zip | Enter code: The postal code of the insurer’s mailing address. |
| SIGNATURES | Company Representative Name | Enter text: The name of the individual at the insurance company that is the primary contact. |
| SIGNATURES | Signature | Sign here: Accommodates the signature of the authorized representative of the insurer. |
| SIGNATURES | Date | Enter date: The date the form was signed by the authorized representative of the insurer. |
| Edition | Date | The edition identifier of the form including the form number and edition (the date is typically formatted YYYY/MM). |