How to Complete the ACORD 81 Loss History, Payment Plan and Additional Interest Sections
LOSS HISTORY
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| Instructions for ACORD 81 Loss History Section |
ANY LOSSES, WHETHER OR NOT PAID BY INSURANCE, DURING THE LAST _ YEARS, AT THIS OR ANY LOCATION
Enter the number of years in the blank space.
To the right of the text is a check box. Enter "Y" for YES or "N" for NO in this box to answer the question.
If the answer if YES, then you will need to explain more detail by completing the information in the remainder of this section.
If the answer is NO, you will not have anything to add to this section.
APPLICANT'S INITIALS
Have you customer initial here to confirm the correctness of this information.
There are four rows, all with the same columns. The same actions should be taken for each row in which you have entered a loss date. If you need more room you can use the ACORD 101 Additional Remarks form.
LOSS DATE - enter the date of the occurrence, accident or incident occurred which created this loss.
LOSS TYPE - Enter the type of coverage this loss was filed under as a claim.
DESCRIPTION OF LOSS - enter a concise description of the loss event. Brevity is saintly here.
CAT # - This stands for Catastrophe Number. Sometimes ISO - Insurance Services Office - will assign a Catastrophe Number to major events such as a hurricanes, floods, earthquakes or other major events. You may not know this number.
AMOUNT PAID - Enter the amount actually paid. This does not include reserved amounts.
ENTERED BY (A)GENT (C)OMPANY - If this loss is being entered by the agent enter A, if it is being added to this form by the insurance company enter C.
IN DISPUTE (Y/N) - "Y" for YES, "N" for NO. Is this claim being disputed by the insurance company?
PAYMENT PLAN
Attach ACORD 610 Premium Payment Supplement if additional information is required.
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| ACORD 81 Instructions for Premium Payment Section |
BILLING ACCOUNT #
Enter this customer's billing account number.
DEPOSIT AMOUNT
Enter the amount of the insured's deposit.
EST TOTAL PREMIUM
Enter your estimated annual premium for this account
BILLING - Three Options
DIRECT BILL - POLICY - Check if this specific policy is being billed directly by the insurance company.
DIRECT BILL - ACCOUNT - Check if this entire account - more than one policy - is being billed directly by the insurance company
AGENCY BILL - Check this box if this policy or account is billed by the agency.
PAYMENT PLAN
FULL PAY - check this box if the payment for the policy or account will be paid in full at the time of the policy issuance.
ANNUAL - Check if this will be billed once a year.
SEMI-ANNUAL - billed once every six months
QUARTERLY - billed once every three months
BI-MONTHLY - billed every other month
MONTHLY - billed each month
BLANK - enter any other plan. An example might be billed monthly for three months in a row.
PAYMENT METHOD
Check the check box next to the method of payment the insured will be using.
CASH
CHECK
CREDIT CARD - include debit cards
EFT - Electronic Funds Transfer. This is a pre-authorized form of drafting a bank account.
PAYROLL DEDUCTION
PRE-AUTHORIZED DRAFT / CHECK (PAC) - this would normally be an ACH pre-authorized billing. Normally ACH is for a set amount or an amount within a limited range. EFT has more flexibility.
MAIL POLICY TO:
AGENT - the agent would mail or deliver copy to the insured
INSURED
OTHER - sometimes this would be a lienholder, etc.
PAYOR
Check the box for who will be paying this bill.
INSURED
MORTGAGEE
ADDITIONAL INTEREST (Attach ACORD 45, Additional Interest Schedule if additional information is required)
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| Instructions ACORD 81 Additional Interest |
INTEREST
Check the box which applies for this specific business entity.
ADDITIONAL INSURED - Good Definition HERE
LIENHOLDER - a person who retains legal possession of a piece of property until the person to whom he/she has advanced money for use of the property has satisfactorily repaid the debt.
LOSS PAYEE - Good Definition HERE
MORTGAGEE - Good Discussion HERE
TRUSTEE - a person or institution which manages property for the insured
OTHER - List your own here
NAME ADDRESS
Enter the full name and address as they need to be shown on a certificate of insurance.
RANK
Additional Interest can have a priority of rights. A rank of 1 would indicate this Additional Interest would receive protection from the policy prior to payments being made on behalf of lower ranked Additional Interests.
EVIDENCE
Check if this entity wants an Evidence of Insurance form.
CERTIFICATE
Check if this entity wants a certificate of insurance form.
SEND BILL
Check if this is to whom the bill should be sent.
REFERENCE / LOAN #
Enter the loan number.
INTEREST IN ITEM NUMBER
SCHD#: - Schedule number
This is the number from the schedule on the third page of this form for the item this additional interest has an interest in.
ITEM#:
This is the number from the schedule on the third page of this form for the item this additional interest has an interest
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