The Association for Cooperative Operations Research and Development (ACORD) forms are standardized documents used by the insurance industry.

This form is used in the USA to submit a notice of occurrence by insured customers.

This form can be machine printed or handwritten. If it is handwritten, TotalAgility must be configured to use full-page recognition using either Tungsten Clarity or Azure AI Document Intelligence.

This form starts on the first page and does not have any cover pages.

The variant of this form for California is not available.

Supported versions: 2019/09

Supported fields on this form:

• Producer_Agency

• ContactName

• Phone

• Fax

• EmailAddress

• Code

• Subcode

• AgencyCustomerID

• Date

• InsuredLocationCode

• DateOfLoss

• DateOfLossTime

• Carrier

• NAICCode

• PolicyNumber

• LineOfBusiness

• Insured_NameOfInsured

• Insured_DateOfBirth

• Insured_FEIN

• Insured_PrimaryPhone

• Insured_PrimaryPhoneType_Home - true or false.

• Insured_PrimaryPhoneType_Bus - true or false.

• Insured_PrimaryPhoneType_Cell - true or false.

• Insured_SecondaryPhone

• Insured_SecondaryPhoneType_Home - true or false.

• Insured_SecondaryPhoneType_Bus - true or false.

• Insured_SecondaryPhoneType_Cell - true or false.

• Insured_InsuredsMailingAddress

• Insured_PrimaryEmailAddress

• Insured_SecondaryEmailAddress

• Contact_ContactInsured

• Contact_NameOfContact

• Contact_PrimaryPhone

• Contact_PrimaryPhoneType_Home - true or false.

• Contact_PrimaryPhoneType_Bus - true or false.

• Contact_PrimaryPhoneType_Cell - true or false.

• Contact_SecondaryPhone

• Contact_SecondaryPhoneType_Home - true or false.

• Contact_SecondaryPhoneType_Bus - true or false.

• Contact_SecondaryPhoneType_Cell - true or false.

• Contact_WhenToContact

• Contact_ContactsMailingAddress

• Contact_PrimaryEmailAddress

• Contact_SecondaryEmailAddress

• Occurrence_LocationOfOccurrence_Street

• Occurrence_LocationOfOccurrence_CityStateZip

• Occurrence_LocationOfOccurrence_Country

• Occurrence_DescribeLocation

• Occurrence_PoliceOrFireDeptContacted

• Occurrence_ReportNumber

• Occurrence_DescriptionOfOccurrence

• TypeOfLiability_PremisesInsuredIsOwner - true or false.

• TypeOfLiability_PremisesInsuredIsTenant - true or false.

• TypeOfLiability_PremisesInsuredIsOtherCheckBox - true or false.

• TypeOfLiability_PremisesInsuredIsOther

• TypeOfLiability_OwnerNameAndAddress

• TypeOfLiability_TypeOfPremises

• TypeOfLiability_OwnersPrimaryPhone

• TypeOfLiability_OwnersPrimaryPhoneType_Home - true or false.

• TypeOfLiability_OwnersPrimaryPhoneType_Bus - true or false.

• TypeOfLiability_OwnersPrimaryPhoneType_Cell - true or false.

• TypeOfLiability_OwnersSecondaryPhone

• TypeOfLiability_OwnersSecondaryPhoneType_Home - true or false.

• TypeOfLiability_OwnersSecondaryPhoneType_Bus - true or false.

• TypeOfLiability_OwnersSecondaryPhoneType_Cell - true or false.

• TypeOfLiability_OwnersPrimaryEmailAddress

• TypeOfLiability_OwnersSecondaryEmailAddress

• TypeOfLiability_ProductsInsuredIsManufacturer - true or false.

• TypeOfLiability_ProductsInsuredIsVendor - true or false.

• TypeOfLiability_ProductsInsuredIsOtherCheckBox - true or false.

• TypeOfLiability_ProductsInsuredIsOther

• TypeOfLiability_ManufacturersNameAndAddress

• TypeOfLiability_TypeOfProduct

• TypeOfLiability_ManufacturersPrimaryPhone

• TypeOfLiability_ManufacturersPrimaryPhoneType_Home - true or false.

• TypeOfLiability_ManufacturersPrimaryPhoneType_Bus - true or false.

• TypeOfLiability_ManufacturersPrimaryPhoneType_Cell - true or false.

• TypeOfLiability_ManufacturersSecondaryPhone

• TypeOfLiability_ManufacturersSecondaryPhoneType_Home - true or false.

• TypeOfLiability_ManufacturersSecondaryPhoneType_Bus - true or false.

• TypeOfLiability_ManufacturersSecondaryPhoneType_Cell - true or false.

• TypeOfLiability_ManufacturersPrimaryEmailAddress

• TypeOfLiability_ManufacturersSecondaryEmailAddress

• TypeOfLiability_WhereCanProductBeSeen

• InjuredOrPropertyDamaged_NameAndAddress

• InjuredOrPropertyDamaged_PrimaryPhone

• InjuredOrPropertyDamaged_PrimaryPhoneType_Home - true or false.

• InjuredOrPropertyDamaged_PrimaryPhoneType_Bus - true or false.

• InjuredOrPropertyDamaged_PrimaryPhoneType_Cell - true or false.

• InjuredOrPropertyDamaged_SecondaryPhone

• InjuredOrPropertyDamaged_SecondaryPhoneType_Home - true or false.

• InjuredOrPropertyDamaged_SecondaryPhoneType_Bus - true or false.

• InjuredOrPropertyDamaged_SecondaryPhoneType_Cell - true or false.

• InjuredOrPropertyDamaged_PrimaryEmailAddress

• InjuredOrPropertyDamaged_SecondaryEmailAddress

• InjuredOrPropertyDamaged_EmployersNameAndAddress

• InjuredOrPropertyDamaged_EmployersPrimaryPhoneNumber

• InjuredOrPropertyDamaged_EmployersPrimaryPhoneNumberType_Home - true or false.

• InjuredOrPropertyDamaged_EmployersPrimaryPhoneNumberType_Bus - true or false.

• InjuredOrPropertyDamaged_EmployersPrimaryPhoneNumberType_Cell - true or false.

• InjuredOrPropertyDamaged_EmployersSecondaryphone

• InjuredOrPropertyDamaged_EmployersSecondaryphoneType_Home - true or false.

• InjuredOrPropertyDamaged_EmployersSecondaryphoneType_Bus - true or false.

• InjuredOrPropertyDamaged_EmployersSecondaryphoneType_Cell - true or false.

• InjuredOrPropertyDamaged_EmployersPrimaryEmailAddress

• InjuredOrPropertyDamaged_EmployersSecondaryEmailAddress

• InjuredOrPropertyDamaged_Age

• InjuredOrPropertyDamaged_Sex

• InjuredOrPropertyDamaged_Occupation

• InjuredOrPropertyDamaged_DescribeInjury

• InjuredOrPropertyDamaged_WhereTaken

• InjuredOrPropertyDamaged_WhatWasInjuredDoing

• InjuredOrPropertyDamaged_DescribeProperty

• InjuredOrPropertyDamaged_EstimateAmount

• InjuredOrPropertyDamaged_WhereCanPropertyBeSeen

• Witnesses_NameAndAddress1

• Witnesses_NameAndAddress1PrimaryPhone

• Witnesses_NameAndAddress1PrimaryPhoneType_Home - true or false.

• Witnesses_NameAndAddress1PrimaryPhoneType_Bus - true or false.

• Witnesses_NameAndAddress1PrimaryPhoneType_Cell - true or false.

• Witnesses_NameAndAddress1SecondaryPhone

• Witnesses_NameAndAddress1SecondaryPhoneType_Home - true or false.

• Witnesses_NameAndAddress1SecondaryPhoneType_Bus - true or false.

• Witnesses_NameAndAddress1SecondaryPhoneType_Cell - true or false.

• Witnesses_NameAndAddress1PrimaryEmailAddress

• Witnesses_NameAndAddress1SecondaryEmailAddress

• Witnesses_NameAndAddress2

• Witnesses_NameAndAddress2PrimaryPhone

• Witnesses_NameAndAddress2PrimaryPhoneType_Home - true or false.

• Witnesses_NameAndAddress2PrimaryPhoneType_Bus - true or false.

• Witnesses_NameAndAddress2PrimaryPhoneType_Cell - true or false.

• Witnesses_NameAndAddress2SecondaryPhone

• Witnesses_NameAndAddress2SecondaryPhoneType_Home - true or false.

• Witnesses_NameAndAddress2SecondaryPhoneType_Bus - true or false.

• Witnesses_NameAndAddress2SecondaryPhoneType_Cell - true or false.

• Witnesses_NameAndAddress2PrimaryEmailAddress

• Witnesses_NameAndAddress2SecondaryEmailAddress

• Witnesses_NameAndAddress3

• Witnesses_NameAndAddress3PrimaryPhone

• Witnesses_NameAndAddress3PrimaryPhoneType_Home - true or false.

• Witnesses_NameAndAddress3PrimaryPhoneType_Bus - true or false.

• Witnesses_NameAndAddress3PrimaryPhoneType_Cell - true or false.

• Witnesses_NameAndAddress3SecondaryPhone

• Witnesses_NameAndAddress3SecondaryPhoneType_Home - true or false.

• Witnesses_NameAndAddress3SecondaryPhoneType_Bus - true or false.

• Witnesses_NameAndAddress3SecondaryPhoneType_Cell - true or false.

• Witnesses_NameAndAddress3PrimaryEmailAddress

• Witnesses_NameAndAddress3SecondaryEmailAddress

• Remarks

• Remarks_ReportedBy

• Remarks_ReportedTo