ACORD 21 (2009/12)

ACORD 21 (2009/12) rev. 03-23-2011
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Section Name
Field Name
Field and/or Section Description
TITLE
ACORD 21 (2009/12)
Certificate of Aircraft Insurance
ACORD 21, Certificate of Aircraft Insurance, is issued as a matter of
information only, and confers no rights upon the certificate holder. This certificate does
not amend, extend, or alter the coverage afforded by policies.
The above information is included in the opening statement of the form.
If the receiver of the form wants to verify that coverage exists on a policy and has no direct
interest in the policy, use the certificate of insurance. However, if the receiver of the form
does have a verifiable interest in the policy, such as an additional insured, the liability
policy must be amended by endorsement, to provide the appropriate coverage for the
interested party prior to issuing a certificate of insurance (since the certificate confers no
rights upon the holder and does not amend the policy).
TITLE
Purpose of the Certificate of Insurance
The purpose of the Certificate of Insurance has been the topic of frequent discussions
throughout the industry. Attention centers around the true purpose of a certificate and the
rights, if any, it conveys to a certificate holder.
In a 1974 court decision (United States Pipe & Foundry Co. v United States Fidelity &
Guar. Co, 505 F. 2d 88 (5th Cir. 1974), the court ruled that a certificate is not a contract
between the holder and the insurer. It only provides information to an interested third
party that insurance is in force at the time of issuance. The court also stated: The
provision regarding notification in the event of cancellation is a mere promise,
unsupported by any consideration. Although many companies provide notice of
cancellation to certificate holders, they are not obliged to do so, since the holder is not a
party to the contract.
ACORD 21 (2009/12) rev. 03-23-2011
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Section Name
Field Name
Field and/or Section Description
TITLE
The Certificate of Aircraft Insurance is used for most casualty situations in which the
insured has requested certification to a third party of issued casualty coverages.
The ACORD Certificate should be issued only in compliance with company instructions.
ACORD recommends that the Certificate NOT be used in the following situations:
* To waive rights
* To provide information to the owner of a leased motor vehicle or the lender about both
liability and physical damage coverages applying to the vehicle (ACORD 23, Automobile
Certificate of Insurance, should be used for this)
* To quote wording from a contract
* To attach to an endorsement
* To quote any wording that amends a policy unless the policy itself has been amended
IMPORTANT
Unlike ACORD 23, 24, 25, 27 and 28, certificates and evidence forms, ACORD 20 and 21
do not require filing since they deal exclusively with uncontrolled/unregulated inland
marine insurance. Nevertheless, virtually every state will not allow any change in a
certificate of insurance that would attempt to modify a policy unless the revised certificate
is filed and approved as a policy form. In these states, this form can only be changed to
reflect the terms and conditions of the policy on which it is reporting. Such change(s)
must be approved in advance by the insurance carrier that issued such policy.
IDENTIFICATION SECTION Date (MM/DD/YYYY)
Enter date: The month/day/year on which the form is completed. (MM/DD/YYYY)
IDENTIFICATION SECTION Producer
Enter text: The full name of the producer/agency.
IDENTIFICATION SECTION
Enter text: The mailing address line one of the producer/agency.
IDENTIFICATION SECTION
Enter text: The mailing address line two of the producer/agency.
IDENTIFICATION SECTION
Enter text: The mailing address city name of the producer/agency.
IDENTIFICATION SECTION
Enter code: The mailing address state or province code of the producer/agency.
ACORD 21 (2009/12) rev. 03-23-2011
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Section Name
Field Name
Field and/or Section Description
IDENTIFICATION SECTION
Enter code: The mailing address postal code of the producer/agency.
IDENTIFICATION SECTION Contact Name
Enter text: The name of the individual at the producer's establishment that is the primary
contact.
IDENTIFICATION SECTION Phone (A/C, No, Ext)
Enter number: The producer's contact person's phone number. If applicable, include the
area code and extension.
IDENTIFICATION SECTION Fax No. (A/C, No, Ext)
Enter number: The fax number of the producer/agency.
IDENTIFICATION SECTION E-Mail Address
Enter text: The producer's contact person e-mail address.
IDENTIFICATION SECTION Producer Customer ID
Enter identifier: The customer's identification number assigned by the producer (e.g.
agency or brokerage).
INSURED
Name & Mailing Address
Enter text: The named insured(s) as it/they will appear on the policy declarations page.
INSURED
Enter text: The named insured's mailing address line one.
INSURED
Enter text: The named insured's mailing address line two.
INSURED
Enter text: The named insured's mailing address city name.
INSURED
Enter code: The named insured's mailing address state or province code.
INSURED
Enter code: The named insured's mailing address postal code.
INSURER(S) AFFORDING
COVERAGE
Company A
Enter text: The insurer's full legal company name(s) as found in the file copy of the policy.
Use the actual name of the company within the group to which the policy has been issued.
This is not the insurer's group name or trade name.
INSURER(S) AFFORDING
COVERAGE
Company A %
Enter percentage: The percentage interest the insurer has in the policy.
INSURER(S) AFFORDING
COVERAGE
Company A NAIC #
Enter code: The identification code assigned to the insurer by the NAIC.
INSURER(S) AFFORDING
COVERAGE
Company B
Enter text: The insurer's full legal company name(s) as found in the file copy of the policy.
Use the actual name of the company within the group to which the policy has been issued.
This is not the insurer's group name or trade name.
INSURER(S) AFFORDING
COVERAGE
Company B %
Enter percentage: The percentage interest the insurer has in the policy.
INSURER(S) AFFORDING
COVERAGE
Company B NAIC #
Enter code: The identification code assigned to the insurer by the NAIC.
INSURER(S) AFFORDING
COVERAGE
Company C
Enter text: The insurer's full legal company name(s) as found in the file copy of the policy.
Use the actual name of the company within the group to which the policy has been issued.
This is not the insurer's group name or trade name.
ACORD 21 (2009/12) rev. 03-23-2011
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Section Name
Field Name
Field and/or Section Description
INSURER(S) AFFORDING
COVERAGE
Company C %
Enter percentage: The percentage interest the insurer has in the policy.
INSURER(S) AFFORDING
COVERAGE
Company C NAIC #
Enter code: The identification code assigned to the insurer by the NAIC.
INSURER(S) AFFORDING
COVERAGE
Company D
Enter text: The insurer's full legal company name(s) as found in the file copy of the policy.
Use the actual name of the company within the group to which the policy has been issued.
This is not the insurer's group name or trade name.
INSURER(S) AFFORDING
COVERAGE
Company D %
Enter percentage: The percentage interest the insurer has in the policy.
INSURER(S) AFFORDING
COVERAGE
Company D NAIC #
Enter code: The identification code assigned to the insurer by the NAIC.
INSURER(S) AFFORDING
COVERAGE
Company E
Enter text: The insurer's full legal company name(s) as found in the file copy of the policy.
Use the actual name of the company within the group to which the policy has been issued.
This is not the insurer's group name or trade name.
INSURER(S) AFFORDING
COVERAGE
Company E %
Enter percentage: The percentage interest the insurer has in the policy.
INSURER(S) AFFORDING
COVERAGE
Company E NAIC #
Enter code: The identification code assigned to the insurer by the NAIC.
INSURER(S) AFFORDING
COVERAGE
Company F
Enter text: The insurer's full legal company name(s) as found in the file copy of the policy.
Use the actual name of the company within the group to which the policy has been issued.
This is not the insurer's group name or trade name.
INSURER(S) AFFORDING
COVERAGE
Company F %
Enter percentage: The percentage interest the insurer has in the policy.
INSURER(S) AFFORDING
COVERAGE
Company F NAIC #
Enter code: The identification code assigned to the insurer by the NAIC.
POLICY INFORMATION
Certificate Number
Enter identifier: The producer assigned number for the certificate.
POLICY INFORMATION
Revision Number
Enter number: The producer assigned revision number for the certificate.
POLICY INFORMATION
Industrial Aid
Check the box (if applicable): Indicates the type of policy is aircraft - industrial aid.
POLICY INFORMATION
Pleasure & Business
Check the box (if applicable): Indicates the type of policy is aircraft - pleasure and
business.
POLICY INFORMATION
Commercial
Check the box (if applicable): Indicates the type of policy is aircraft - commercial.
POLICY INFORMATION
Non-Owned
Check the box (if applicable): Indicates the type of policy is aircraft - non-owned.
POLICY INFORMATION
Other Checkbox
Check the box (if applicable): Indicates the type of policy/perils insured is other than those
listed.
POLICY INFORMATION
Other Description
Enter text: The description of the type of policy issued to the insured.
ACORD 21 (2009/12) rev. 03-23-2011
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Section Name
Field Name
Field and/or Section Description
POLICY INFORMATION
Airplane
Check the box (if applicable): Indicates Airplane is the line of business subcode that
further refines the line of business code.
POLICY INFORMATION
Helicopter
Check the box (if applicable): Indicates Helicopter is the line of business subcode that
further refines the line of business code.
POLICY INFORMATION
Mixed Fleet
Check the box (if applicable): Indicates Mixed Fleet is the line of business subcode that
further refines the line of business code.
POLICY INFORMATION
Excess
Check the box (if applicable): Indicates Excess is the line of business subcode that further
refines the line of business code.
POLICY INFORMATION
Quota Share
Check the box (if applicable): Indicates Quota Share is the line of business subcode that
further refines the line of business code.
POLICY INFORMATION
Liability Only
Check the box (if applicable): Indicates Liability Only is the line of business subcode that
further refines the line of business code.
POLICY INFORMATION
Hull & Liability
Check the box (if applicable): Indicates Hull & Liability is the line of business subcode that
further refines the line of business code.
POLICY INFORMATION
Hull Only
Check the box (if applicable): Indicates Hull Only is the line of business subcode that
further refines the line of business code.
POLICY INFORMATION
Other Checkbox
Check the box (if applicable): Indicates the line of business subcode that further refines
the line of business code is other than those listed.
POLICY INFORMATION
Other Description
Enter text: The line of business subcode that further refines the line of business code.
AIRCRAFT INFORMATION
ACORD 333, Aircraft Schedule
Attached
Check the box (if applicable): Indicates an ACORD 333, Aircraft Schedule, is attached to
the certificate.
AIRCRAFT INFORMATION
Year
Enter year: The year of the aircraft.
AIRCRAFT INFORMATION
Make
Enter text: The manufacturer of the aircraft.
AIRCRAFT INFORMATION
Model
Enter text: The model of the aircraft.
AIRCRAFT INFORMATION
Serial Number
Enter identifier: The serial number of the aircraft.
AIRCRAFT INFORMATION
Registration Number
Enter identifier: The registration number of the aircraft (a.k.a. tail number).
AIRCRAFT INFORMATION
Territory
Enter text: The description of the rating territory for the aircraft.
AIRCRAFT COVERAGES
Insurer Letter
Enter code: The company letter of the insurer, as identified in the Insurer(s) Affording
Coverage form section, associated with the Aircraft Policy.
AIRCRAFT COVERAGES
Policy Number
Enter identifier: The identifier assigned by the insurer to the policy, or submission, being
referenced exactly as it appears on the policy, including prefix and suffix symbols. If
required for self-insurance, the self-insured license or contract number. As used here, the
Aircraft policy number.
AIRCRAFT COVERAGES
Effective Date
Enter date: The effective date of the policy. The date that the terms and conditions of the
policy commence. As used here, the Aircraft policy effective date.
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Section Name
Field Name
Field and/or Section Description
AIRCRAFT COVERAGES
Expiration Date
Enter date: The date on which the terms and conditions of the policy will expire. As used
here, the Aircraft policy expiration date.
AIRCRAFT COVERAGES
Additional Insured? (Y / N)
Enter Y for a Yes response. Input N for No response. Indicates if the certificate holder
has been named as an additional insured for any of the Aircraft policy coverages
described in the certificate.
AIRCRAFT COVERAGES
Subrogation Waived?
Enter Y for a Yes response. Input N for No response. Indicates subrogation has been
waived on the policy.
AIRCRAFT COVERAGES
Aircraft Hull Option Checkbox
Check the box (if applicable): Indicates a coverage option applies to the coverage.
AIRCRAFT COVERAGES
Aircraft Hull Option Description
Enter text: The description of the option being requested. Examples: All Risk Ground and
Flight, Ground and Taxi, Ground Not in Flight, Ground Not in Motion, Ground Only, In
Motion Excluding Flight, Excluding in Flight, Aircraft Storage in Hangar.
AIRCRAFT COVERAGES
Aircraft Hull Option Checkbox
Check the box (if applicable): Indicates a coverage option applies to the coverage.
AIRCRAFT COVERAGES
Aircraft Hull Option Description
Enter text: The description of the option being requested. Examples: All Risk Ground and
Flight, Ground and Taxi, Ground Not in Flight, Ground Not in Motion, Ground Only, In
Motion Excluding Flight, Excluding in Flight, Aircraft Storage in Hangar.
AIRCRAFT COVERAGES
Aircraft Hull Option Checkbox
Check the box (if applicable): Indicates a coverage option applies to the coverage.
AIRCRAFT COVERAGES
Aircraft Hull Option Description
Enter text: The description of the option being requested. Examples: All Risk Ground and
Flight, Ground and Taxi, Ground Not in Flight, Ground Not in Motion, Ground Only, In
Motion Excluding Flight, Excluding in Flight, Aircraft Storage in Hangar.
AIRCRAFT COVERAGES
Aircraft Hull Option Checkbox
Check the box (if applicable): Indicates a coverage option applies to the coverage.
AIRCRAFT COVERAGES
Aircraft Hull Option Description
Enter text: The description of the option being requested. Examples: All Risk Ground and
Flight, Ground and Taxi, Ground Not in Flight, Ground Not in Motion, Ground Only, In
Motion Excluding Flight, Excluding in Flight, Aircraft Storage in Hangar.
AIRCRAFT COVERAGES
Aircraft Hull Limit
Enter limit: The limit amount for aircraft hull coverage.
AIRCRAFT COVERAGES
Aircraft Hull Limit Applies To
Enter code: The code identifying what the limit applies to. Examples: Total Aircraft,
Aircraft while on Floats, Aircraft while on Skis, Floats, Skis.
AIRCRAFT COVERAGES
Aircraft Hull Limit
Enter limit: The limit amount for aircraft hull coverage.
AIRCRAFT COVERAGES
Aircraft Hull Limit Applies To
Enter code: The code identifying what the limit applies to. Examples: Total Aircraft,
Aircraft while on Floats, Aircraft while on Skis, Floats, Skis.
AIRCRAFT COVERAGES
Aircraft Hull Limit
Enter limit: The limit amount for aircraft hull coverage.
AIRCRAFT COVERAGES
Aircraft Hull Limit Applies To
Enter code: The code identifying what the limit applies to. Examples: Total Aircraft,
Aircraft while on Floats, Aircraft while on Skis, Floats, Skis.
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Section Name
Field Name
Field and/or Section Description
AIRCRAFT COVERAGES
Aircraft Liability Option Checkbox
Check the box (if applicable): Indicates a coverage option applies to the coverage.
AIRCRAFT COVERAGES
Aircraft Liability Option
Description
Enter text: The description of the option being requested. Examples: Adjacent
Fields/CBT, BI Only, Chemical BI, Chemical BI and PD, Chemical PD, CSL BI and PD,
CSL BI and PD Excluding Passengers, CSL BI and PD Including Passengers, Excluding
Chemicals, PD Only, Total Limit.
AIRCRAFT COVERAGES
Aircraft Liability Option Checkbox
Check the box (if applicable): Indicates a coverage option applies to the coverage.
AIRCRAFT COVERAGES
Aircraft Liability Option
Description
Enter text: The description of the option being requested. Examples: Adjacent
Fields/CBT, BI Only, Chemical BI, Chemical BI and PD, Chemical PD, CSL BI and PD,
CSL BI and PD Excluding Passengers, CSL BI and PD Including Passengers, Excluding
Chemicals, PD Only, Total Limit.
AIRCRAFT COVERAGES
Aircraft Liability Option Checkbox
Check the box (if applicable): Indicates a coverage option applies to the coverage.
AIRCRAFT COVERAGES
Aircraft Liability Option
Description
Enter text: The description of the option being requested. Examples: Adjacent
Fields/CBT, BI Only, Chemical BI, Chemical BI and PD, Chemical PD, CSL BI and PD,
CSL BI and PD Excluding Passengers, CSL BI and PD Including Passengers, Excluding
Chemicals, PD Only, Total Limit.
AIRCRAFT COVERAGES
Aircraft Liability Option Checkbox
Check the box (if applicable): Indicates a coverage option applies to the coverage.
AIRCRAFT COVERAGES
Aircraft Liability Option
Description
Enter text: The description of the option being requested. Examples: Adjacent
Fields/CBT, BI Only, Chemical BI, Chemical BI and PD, Chemical PD, CSL BI and PD,
CSL BI and PD Excluding Passengers, CSL BI and PD Including Passengers, Excluding
Chemicals, PD Only, Total Limit.
AIRCRAFT COVERAGES
Aircraft Liability Ea Occ
Enter limit: The each occurrence limit amount for aircraft liability coverage.
AIRCRAFT COVERAGES
Aircraft Liability Ea Pass
Enter limit: The each passenger limit amount for aircraft liability coverage.
AIRCRAFT COVERAGES
Aircraft Liability Ea Per
Enter limit: The each person limit amount for aircraft liability coverage.
AIRCRAFT COVERAGES
Aircraft Liability Aggr
Enter limit: The aggregate limit amount for aircraft liability coverage.
AIRCRAFT COVERAGES
Medical Payments Including Crew
Check the box (if applicable): Indicates the crew is included in the medical payments
coverage.
AIRCRAFT COVERAGES
Medical Payments Excluding Crew
Check the box (if applicable): Indicates the crew is excluded from the medical payments
coverage.
AIRCRAFT COVERAGES
Medical Payments Ea Per
Enter limit: The each person limit amount for medical payments coverage.
AIRCRAFT COVERAGES
Coverage Code
Enter code: The code for the coverage.
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Section Name
Field Name
Field and/or Section Description
AIRCRAFT COVERAGES
Coverage Description
Enter text: The description of other coverage (not the limit) on the policy. Any questions
about appropriate limits or applicable policy coverage(s) should be answered by the
issuing insurer(s)
AIRCRAFT COVERAGES
Option Checkbox
Check the box (if applicable): Indicates a coverage option applies to the coverage.
AIRCRAFT COVERAGES
Option Description
Enter text: The description of the option being requested.
AIRCRAFT COVERAGES
Option Checkbox
Check the box (if applicable): Indicates a coverage option applies to the coverage.
AIRCRAFT COVERAGES
Option Description
Enter text: The description of the option being requested.
AIRCRAFT COVERAGES
Option Checkbox
Check the box (if applicable): Indicates a coverage option applies to the coverage.
AIRCRAFT COVERAGES
Option Description
Enter text: The description of the option being requested.
AIRCRAFT COVERAGES
Option Checkbox
Check the box (if applicable): Indicates a coverage option applies to the coverage.
AIRCRAFT COVERAGES
Option Description
Enter text: The description of the option being requested.
AIRCRAFT COVERAGES
Limit
Enter limit: The limit amount for the coverage.
AIRCRAFT COVERAGES
Applies To
Enter code: The code identifying what the limit applies to (i.e. per occurrence).
AIRCRAFT COVERAGES
Limit
Enter limit: The limit amount for the coverage.
AIRCRAFT COVERAGES
Applies To
Enter code: The code identifying what the limit applies to (i.e. per occurrence).
AIRCRAFT COVERAGES
Limit
Enter limit: The limit amount for the coverage.
AIRCRAFT COVERAGES
Applies To
Enter code: The code identifying what the limit applies to (i.e. per occurrence).
AIRCRAFT COVERAGES
Limit
Enter limit: The limit amount for the coverage.
AIRCRAFT COVERAGES
Applies To
Enter code: The code identifying what the limit applies to (i.e. per occurrence).
AIRCRAFT COVERAGES
Coverage Code
Enter code: The code for the coverage.
AIRCRAFT COVERAGES
Coverage Description
Enter text: The description of other coverage (not the limit) on the policy. Any questions
about appropriate limits or applicable policy coverage(s) should be answered by the
issuing insurer(s)
AIRCRAFT COVERAGES
Option Checkbox
Check the box (if applicable): Indicates a coverage option applies to the coverage.
AIRCRAFT COVERAGES
Option Description
Enter text: The description of the option being requested.
AIRCRAFT COVERAGES
Option Checkbox
Check the box (if applicable): Indicates a coverage option applies to the coverage.
AIRCRAFT COVERAGES
Option Description
Enter text: The description of the option being requested.
AIRCRAFT COVERAGES
Option Checkbox
Check the box (if applicable): Indicates a coverage option applies to the coverage.
AIRCRAFT COVERAGES
Option Description
Enter text: The description of the option being requested.
AIRCRAFT COVERAGES
Option Checkbox
Check the box (if applicable): Indicates a coverage option applies to the coverage.
AIRCRAFT COVERAGES
Option Description
Enter text: The description of the option being requested.
AIRCRAFT COVERAGES
Limit
Enter limit: The limit amount for the coverage.
AIRCRAFT COVERAGES
Applies To
Enter code: The code identifying what the limit applies to (i.e. per occurrence).
AIRCRAFT COVERAGES
Limit
Enter limit: The limit amount for the coverage.
AIRCRAFT COVERAGES
Applies To
Enter code: The code identifying what the limit applies to (i.e. per occurrence).
AIRCRAFT COVERAGES
Limit
Enter limit: The limit amount for the coverage.
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Section Name
Field Name
Field and/or Section Description
AIRCRAFT COVERAGES
Applies To
Enter code: The code identifying what the limit applies to (i.e. per occurrence).
AIRCRAFT COVERAGES
Limit
Enter limit: The limit amount for the coverage.
AIRCRAFT COVERAGES
Applies To
Enter code: The code identifying what the limit applies to (i.e. per occurrence).
AIRCRAFT COVERAGES
Coverage Code
Enter code: The code for the coverage.
AIRCRAFT COVERAGES
Coverage Description
Enter text: The description of other coverage (not the limit) on the policy. Any questions
about appropriate limits or applicable policy coverage(s) should be answered by the
issuing insurer(s)
AIRCRAFT COVERAGES
Option Checkbox
Check the box (if applicable): Indicates a coverage option applies to the coverage.
AIRCRAFT COVERAGES
Option Description
Enter text: The description of the option being requested.
AIRCRAFT COVERAGES
Option Checkbox
Check the box (if applicable): Indicates a coverage option applies to the coverage.
AIRCRAFT COVERAGES
Option Description
Enter text: The description of the option being requested.
AIRCRAFT COVERAGES
Option Checkbox
Check the box (if applicable): Indicates a coverage option applies to the coverage.
AIRCRAFT COVERAGES
Option Description
Enter text: The description of the option being requested.
AIRCRAFT COVERAGES
Option Checkbox
Check the box (if applicable): Indicates a coverage option applies to the coverage.
AIRCRAFT COVERAGES
Option Description
Enter text: The description of the option being requested.
AIRCRAFT COVERAGES
Limit
Enter limit: The limit amount for the coverage.
AIRCRAFT COVERAGES
Applies To
Enter code: The code identifying what the limit applies to (i.e. per occurrence).
AIRCRAFT COVERAGES
Limit
Enter limit: The limit amount for the coverage.
AIRCRAFT COVERAGES
Applies To
Enter code: The code identifying what the limit applies to (i.e. per occurrence).
AIRCRAFT COVERAGES
Limit
Enter limit: The limit amount for the coverage.
AIRCRAFT COVERAGES
Applies To
Enter code: The code identifying what the limit applies to (i.e. per occurrence).
AIRCRAFT COVERAGES
Limit
Enter limit: The limit amount for the coverage.
AIRCRAFT COVERAGES
Applies To
Enter code: The code identifying what the limit applies to (i.e. per occurrence).
AIRCRAFT COVERAGES
Description of Operations /
Remarks
Enter text: The Certificate Of Aircraft Insurance general remarks including the description
of operations. ACORD 101, Additional Remarks Schedule, may be attached if more
space is required.
CERTIFICATE HOLDER
Certificate Holder Name & Address
Enter text: The certificate holder's full name.
CERTIFICATE HOLDER
Enter text: The certificate holder's mailing address line one.
CERTIFICATE HOLDER
Enter text: The certificate holder's mailing address line two.
CERTIFICATE HOLDER
Enter text: The certificate holder's mailing address city name.
CERTIFICATE HOLDER
Enter code: The certificate holder's mailing address state or province code.
CERTIFICATE HOLDER
Enter code: The certificate holder's mailing address postal code.
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Section Name
Field Name
Field and/or Section Description
CANCELLATION
Authorized Representative
Sign here: Accommodates the signature of the authorized representative (e.g. producer,
agent, broker, etc.) by all companies to issue Certificates. This is required in most states.
As used here, the authorized representative by all companies to issue Certificates.
Edition
Date
The edition identifier of the form including the form number and edition (the date is
typically formatted YYYY/MM).