ACORD 125 Form | Commercial Insurance Application (PDF)

This is the front section of most commercial insurance applications, the part that describes the business itself. ACORD, the organization that publishes it, is a standards group and not an insurance company, so every carrier reads the same layout. The form collects the basics: who the applicant is, where the business operates, what it does, what insurance it has had, and what claims it has had.

What it leaves out is the line-by-line coverage detail. That goes on companion forms, one for each type of insurance. It is also an application, not proof of insurance. If someone asks for proof, they want ACORD 25 or ACORD 27 instead. In most cases an insurance agent fills it in using details from the business owner, who then reviews it and signs.

1. 1

   Page 1: Who Is Applying and for What

   The busiest page. It names the agency and carrier, says what kind of request this is, lists the coverage being asked for, and identifies the business.

   Status of Transaction

   Six boxes: Quote, Issue Policy, Renew, Bound, Change, and Cancel. “Bound” asks for a date or a copy, since coverage is already in place.

   Lines of Business

   Check each type of insurance being requested, with a premium amount next to it. Workers’ compensation is not on the list.

   Attachments

   A checklist of the extra schedules and supplements that come with the application.

   Policy Information

   Proposed effective and expiration dates, billing plan, payment plan, method of payment, audit, deposit, and premium.

   Applicant Information

   Legal name and mailing address, FEIN or Social Security number, industry codes (SIC and NAICS), phone, website, and the business type, such as corporation, LLC, or partnership. There is room for two more named insureds.

2. 2

   Page 2: Where and How the Business Operates

   Details about each location and what happens there.

   Premises

   For each location: address, whether it is inside city limits, owner or tenant, employee counts, annual revenues, square footage, and any area leased to others. ACORD 823 covers extra locations.

   Nature of Business

   Boxes for the type of business (retail, contractor, restaurant, office, and others), the date it started, and a written description of its main operations.

   Contact Information

   Who the underwriter should contact, with phone and email.

   Additional Interest

   Anyone with a financial stake, such as a mortgagee, lienholder, or loss payee. ACORD 45 covers extra additional interests.

3. 3

   Page 3: Background Questions and Prior Insurance

   Fifteen yes/no questions (covered below), a remarks area, and a record of earlier insurance.

   Remarks

   Free text for processing instructions. ACORD 101 is available if more space is needed.

   Prior Carrier Information

   Earlier insurers listed by type of coverage, with policy numbers, dates, and premiums.

4. 4

   Page 4: Loss History and Signatures

   A record of past claims, then the signature block.

   Loss History

   Every claim or loss goes here, “regardless of fault and whether or not insured.” Each entry shows the date, type, amounts paid and reserved, and whether the claim is still open. There is a box to check if there are none.

   Fraud Warnings

   State-specific warnings about giving false information. They are printed on the form, and the wording varies by state.

   Signatures

   The producer and the applicant both sign and date. The producer’s license number is required, and a national producer number is required in Florida.

This is the part people worry about most. Any “yes” answer needs an explanation, and the form says so directly: “Explain all yes responses.” The questions fall into five groups:

Business structure

Whether the applicant is a subsidiary or has subsidiaries, whether the business is held in a trust, whether there are other business ventures not being insured, and whether there are foreign operations or foreign sales.

Safety and hazards

Whether there is a formal safety program, any exposure to flammables, explosives, or chemicals, any uncorrected fire or safety code violations, and whether the applicant owns, leases, or operates drones, or hires others to operate them.

Insurance history

Whether the applicant has other insurance with the same company, and whether any policy or coverage was declined, cancelled, or non-renewed in the last three years. Missouri applicants skip that last one.

Legal and financial history

Any foreclosure, repossession, or bankruptcy in the last five years, any judgment or lien in the last five years, and any indictment or conviction for fraud, bribery, or arson-related crimes in the last five years (ten in Rhode Island).

Claims involving conduct

Past losses or claims tied to sexual abuse or molestation allegations, discrimination, or negligent hiring.

This form describes the business. Coverage details go on companion forms, and the form itself points to several of them. Workers’ compensation is the exception, since it is not a line of business here and uses its own application.