ACORD 853MN Instructions


Section Name Field Name Field and/or Section Description
TITLE ACORD 853 MN (2010/01) Minnesota Home OwnersPersonal PropertySupplement The title of the form. ACORD 853 MN, Minnesota Home Owners Personal Property Supplement, is used to comply with Minnesota law that requires notification to all applicants for homeowners insurance of the insurers right to cancel coverage at any time during the first 60 days following issuance of the coverage for any reason which is not specifically prohibited by statute. This notice must be provided at the time the application is submitted.
IDENTIFICATION SECTION Agency Customer ID Enter identifier: The customer’s identification number assigned by the producer (e.g. agency or brokerage).
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 Named Insured(s) Enter text: The named insured(s) as it/they will appear on the policy declarations page.
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.
SIGNATURE Applicant’s Signature Sign here: Accommodates the signature of the applicant or named insured.
SIGNATURE Date Enter date: The date the form was signed by the named insured.
Edition Date The edition identifier of the form including the form number and edition (the date is typically formatted YYYY/MM).