At the top hand corner of the signature section of the ACORD 130 workers compensation application is a check box you need to check to state that you have given this insured a copy of the Notice of Information Practices form.
This is the ACORD 38 form for most states. The following states have their own form as of this writing...
ACORD 38AR - Arkansas
ACORD 38AZ - Arizona
ACORD 38CA - California
ACORD 38CT - Connecticut
ACORD 38DE - Delaware
ACORD 38GA - Georgia
ACORD 38IL - Illinois
ACORD 38MT - Montana
ACORD 38NH - New Hampshire
ACORD 38NJ - New Jersey
ACORD 38NV - Nevada
ACORD 38OR - Oregon
ACORD 38RI - Rhode Island
ACORD 38VA - Virginia
ACORD 38WA - Washington
Not all states require a notice. Check with an experienced agent at your agency or with your underwriter.
In the bottom left hand corner of the first section of the Signature section there is a place to get your insured to initial. Don't forget this.
At the very bottom of the 4th page is a place for the Applicant's Signature and next to it a space to have the insured date their signature.
Next to that is a spot for your - the agent's - signature.
Finally there is a box for your National Producer Number if your agency has one.
If you are using our Cap Dat ACORD services we have an electronic, or e-signature, feature available to you. You can add this to the signature box and email a link to the form to your insured. They can then review and sign the form on a tablet, smart phone or most current browsers. This gives you an extra level of legal documentation on the time and date of the signature. It can also save time.
I hope this group of posts have been helpful in your learning more about how to complete the ACORD 130 workers compensation application.
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