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

This is a standardized insurance form that certifies an insured does not have any losses or claims from a period of lapse in cover.

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.

Supported versions: 2008/01

Supported fields on this form:

• Form_version

• Agency

• Named_Insured

• Contact_Name

• Carrier

• Phone_ACNo

• Naic_Code

• FAX_ACNo

• Policy_Number

• Email_Address

• Code

• Subcode

• Approved_By

• Agency_Customer_Id

• From

• Date_And_Time_Signed

• Cancellation_Date

• Applicants_Signature

• Amount

• Amount_Received_By

• Witness

• Witness_Date_And_Time