ACORD 808 Instructions


ACORD 808 (2009/03) rev. 03-31-2009 1 of 6

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”.
ACORD 808 (2009/03) rev. 03-31-2009 2 of 6

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.
ACORD 808 (2009/03) rev. 03-31-2009 3 of 6

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.
ACORD 808 (2009/03) rev. 03-31-2009 4 of 6

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.
ACORD 808 (2009/03) rev. 03-31-2009 5 of 6

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).