Section Name
Field Name
Field and/or Section Description
TITLE
ACORD 808 (2010/08)
P & C Agency Appointment Form
ACORD 808, P & C Agency Appointment Form, is a standard Agency
Appointment Form designed for P & C / Surety appointments and accepted by multiple
insurers. In this case, the agency is an organization. This form is to be completed by a
Producer and then sent to the insurer. ACORD 808 is comprised of the data content
needed for new PCS agency appointments.
IDENTIFICATION SECTION Date
Enter date: The month/day/year on which the form is completed. (MM/DD/YYYY)
IDENTIFICATION SECTION Carrier Name
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.
IDENTIFICATION SECTION NAIC Code
Enter code: The identification code assigned to the insurer by the NAIC.
AGENCY INFORMATION
Agency Full Legal Name
Enter text: The full name of the producer/agency. As used here, this is the full name of the
agency at which the producer (person) is employed with regards to this appointment
request.
AGENCY INFORMATION
Agency Address
Enter text: The mailing address line one of the producer/agency.
AGENCY INFORMATION
Enter text: The mailing address line two of the producer/agency.
AGENCY INFORMATION
City
Enter text: The mailing address city name of the producer/agency.
AGENCY INFORMATION
State
Enter code: The mailing address state or province code of the producer/agency.
AGENCY INFORMATION
Zip
Enter code: The mailing address postal code of the producer/agency.
AGENCY INFORMATION
Agency DBA
Enter text: The name by which an organization is doing business.
AGENCY INFORMATION
FEIN
Enter identifier: The producer's tax identification number. This may be the federal
employer identification number or social security number. As used here, this is the FEIN
for the agency.
AGENCY INFORMATION
Licensing Contact
Enter text: The name of the individual at the producer's establishment that is the primary
contact. As used here, this is the name of the licensing contact person within the agency.
Contact this person if there are any questions about the appointment form.
AGENCY INFORMATION
Contact Phone
Enter number: The producer's contact person's phone number. If applicable, include the
area code and extension.
AGENCY INFORMATION
Contact Fax
Enter number: The producer's contact person's fax number.
AGENCY INFORMATION
Contact Email
Enter text: The producer's contact person e-mail address.
AGENCY INFORMATION
Agency Website
Enter text: The website address for the producer / agency.
AGENCY INFORMATION
Legal Entity Type - Sole Proprietor
Check the box (if applicable): Indicates the legal entity code for the producer is Sole
Proprietor.
ACORD 808 (2010/08) rev. 08-31-2010
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Section Name
Field Name
Field and/or Section Description
AGENCY INFORMATION
Legal Entity Type - Corporation
Check the box (if applicable): Indicates the legal entity code for the producer is
Corporation.
AGENCY INFORMATION
Legal Entity Type - Partnership
Check the box (if applicable): Indicates the legal entity code for the producer is
Partnership.
AGENCY INFORMATION
Legal Entity Type - Limited
Liability Company (LLC)
Check the box (if applicable): Indicates the legal entity code for the producer is Limited
Liability Company.
AGENCY INFORMATION
Legal Entity Type - Limited
Liability Partnership (LLP)
Check the box (if applicable): Indicates the legal entity code for the producer is Limited
Liability Partnership.
MAILING ADDRESS
Street Address
Enter text: The mailing address line one of the producer/agency.
MAILING ADDRESS
City
Enter text: The mailing address city name of the producer/agency.
MAILING ADDRESS
State
Enter code: The mailing address state or province code of the producer/agency.
MAILING ADDRESS
Zip
Enter code: The mailing address postal code of the producer/agency.
STATES AND US
TERRITORIES
AK - Alaska
Check the box (if applicable): Indicate the appointment or termination applies in the state
or territory.
STATES AND US
TERRITORIES
AL - Alabama
Check the box (if applicable): Indicate the appointment or termination applies in the state
or territory.
STATES AND US
TERRITORIES
AR - Arkansas
Check the box (if applicable): Indicate the appointment or termination applies in the state
or territory.
STATES AND US
TERRITORIES
AZ - Arizona
Check the box (if applicable): Indicate the appointment or termination applies in the state
or territory.
STATES AND US
TERRITORIES
CA - California
Check the box (if applicable): Indicate the appointment or termination applies in the state
or territory.
STATES AND US
TERRITORIES
CO - Colorado
Check the box (if applicable): Indicate the appointment or termination applies in the state
or territory.
STATES AND US
TERRITORIES
CT - Connecticut
Check the box (if applicable): Indicate the appointment or termination applies in the state
or territory.
STATES AND US
TERRITORIES
DC - District of Columbia
Check the box (if applicable): Indicate the appointment or termination applies in the state
or territory.
STATES AND US
TERRITORIES
DE - Delaware
Check the box (if applicable): Indicate the appointment or termination applies in the state
or territory.
STATES AND US
TERRITORIES
FL - Florida
Check the box (if applicable): Indicate the appointment or termination applies in the state
or territory.
STATES AND US
TERRITORIES
GA - Georgia
Check the box (if applicable): Indicate the appointment or termination applies in the state
or territory.
STATES AND US
TERRITORIES
HI - Hawaii
Check the box (if applicable): Indicate the appointment or termination applies in the state
or territory.
ACORD 808 (2010/08) rev. 08-31-2010
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Section Name
Field Name
Field and/or Section Description
STATES AND US
TERRITORIES
IA - Iowa
Check the box (if applicable): Indicate the appointment or termination applies in the state
or territory.
STATES AND US
TERRITORIES
ID - Idaho
Check the box (if applicable): Indicate the appointment or termination applies in the state
or territory.
STATES AND US
TERRITORIES
IL - Illinois
Check the box (if applicable): Indicate the appointment or termination applies in the state
or territory.
STATES AND US
TERRITORIES
IN - Indiana
Check the box (if applicable): Indicate the appointment or termination applies in the state
or territory.
STATES AND US
TERRITORIES
KS - Kansas
Check the box (if applicable): Indicate the appointment or termination applies in the state
or territory.
STATES AND US
TERRITORIES
KY - Kentucky
Check the box (if applicable): Indicate the appointment or termination applies in the state
or territory.
STATES AND US
TERRITORIES
LA - Louisiana
Check the box (if applicable): Indicate the appointment or termination applies in the state
or territory.
STATES AND US
TERRITORIES
MA - Massachusetts
Check the box (if applicable): Indicate the appointment or termination applies in the state
or territory.
STATES AND US
TERRITORIES
MD - Maryland
Check the box (if applicable): Indicate the appointment or termination applies in the state
or territory.
STATES AND US
TERRITORIES
ME - Maine
Check the box (if applicable): Indicate the appointment or termination applies in the state
or territory.
STATES AND US
TERRITORIES
MI - Michigan
Check the box (if applicable): Indicate the appointment or termination applies in the state
or territory.
STATES AND US
TERRITORIES
MN - Minnesota
Check the box (if applicable): Indicate the appointment or termination applies in the state
or territory.
STATES AND US
TERRITORIES
MO - Missouri
Check the box (if applicable): Indicate the appointment or termination applies in the state
or territory.
STATES AND US
TERRITORIES
MS - Mississippi
Check the box (if applicable): Indicate the appointment or termination applies in the state
or territory.
STATES AND US
TERRITORIES
MT - Montana
Check the box (if applicable): Indicate the appointment or termination applies in the state
or territory.
STATES AND US
TERRITORIES
NC - North Carolina
Check the box (if applicable): Indicate the appointment or termination applies in the state
or territory.
STATES AND US
TERRITORIES
ND - North Dakota
Check the box (if applicable): Indicate the appointment or termination applies in the state
or territory.
STATES AND US
TERRITORIES
NE - Nebraska
Check the box (if applicable): Indicate the appointment or termination applies in the state
or territory.
ACORD 808 (2010/08) rev. 08-31-2010
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Section Name
Field Name
Field and/or Section Description
STATES AND US
TERRITORIES
NH - New Hampshire
Check the box (if applicable): Indicate the appointment or termination applies in the state
or territory.
STATES AND US
TERRITORIES
NJ - New Jersey
Check the box (if applicable): Indicate the appointment or termination applies in the state
or territory.
STATES AND US
TERRITORIES
NM - New Mexico
Check the box (if applicable): Indicate the appointment or termination applies in the state
or territory.
STATES AND US
TERRITORIES
NV - Nevada
Check the box (if applicable): Indicate the appointment or termination applies in the state
or territory.
STATES AND US
TERRITORIES
NY - New York
Check the box (if applicable): Indicate the appointment or termination applies in the state
or territory.
STATES AND US
TERRITORIES
OH - Ohio
Check the box (if applicable): Indicate the appointment or termination applies in the state
or territory.
STATES AND US
TERRITORIES
OK - Oklahoma
Check the box (if applicable): Indicate the appointment or termination applies in the state
or territory.
STATES AND US
TERRITORIES
OR - Oregon
Check the box (if applicable): Indicate the appointment or termination applies in the state
or territory.
STATES AND US
TERRITORIES
PA - Pennsylvania
Check the box (if applicable): Indicate the appointment or termination applies in the state
or territory.
STATES AND US
TERRITORIES
RI - Rhode Island
Check the box (if applicable): Indicate the appointment or termination applies in the state
or territory.
STATES AND US
TERRITORIES
SC - South Carolina
Check the box (if applicable): Indicate the appointment or termination applies in the state
or territory.
STATES AND US
TERRITORIES
SD - South Dakota
Check the box (if applicable): Indicate the appointment or termination applies in the state
or territory.
STATES AND US
TERRITORIES
TN - Tennessee
Check the box (if applicable): Indicate the appointment or termination applies in the state
or territory.
STATES AND US
TERRITORIES
TX - Texas
Check the box (if applicable): Indicate the appointment or termination applies in the state
or territory.
STATES AND US
TERRITORIES
UT - Utah
Check the box (if applicable): Indicate the appointment or termination applies in the state
or territory.
STATES AND US
TERRITORIES
VA - Virginia
Check the box (if applicable): Indicate the appointment or termination applies in the state
or territory.
STATES AND US
TERRITORIES
VT - Vermont
Check the box (if applicable): Indicate the appointment or termination applies in the state
or territory.
STATES AND US
TERRITORIES
WA - Washington
Check the box (if applicable): Indicate the appointment or termination applies in the state
or territory.
ACORD 808 (2010/08) rev. 08-31-2010
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Section Name
Field Name
Field and/or Section Description
STATES AND US
TERRITORIES
WI - Wisconsin
Check the box (if applicable): Indicate the appointment or termination applies in the state
or territory.
STATES AND US
TERRITORIES
WV - West Virginia
Check the box (if applicable): Indicate the appointment or termination applies in the state
or territory.
STATES AND US
TERRITORIES
WY - Wyoming
Check the box (if applicable): Indicate the appointment or termination applies in the state
or territory.
STATES AND US
TERRITORIES
AS - American Samoa
Check the box (if applicable): Indicate the appointment or termination applies in the state
or territory.
STATES AND US
TERRITORIES
GU - Guam
Check the box (if applicable): Indicate the appointment or termination applies in the state
or territory.
STATES AND US
TERRITORIES
PR - Puerto Rico
Check the box (if applicable): Indicate the appointment or termination applies in the state
or territory.
STATES AND US
TERRITORIES
VI - Virgin Islands
Check the box (if applicable): Indicate the appointment or termination applies in the state
or territory.
STATES AND US
TERRITORIES
Other Information
Does your agency operate under
another license and / or name in
any other state?
Enter Y for a Yes response. Input N for No response. Indicates the response to the
question, Does your agency operate under another license and / or name in any other
state?.
STATES AND US
TERRITORIES
Name
Enter text: The full name of the agency.
STATES AND US
TERRITORIES
State
Enter code: The state or province code in which the agency is located.
STATES AND US
TERRITORIES
Name
Enter text: The full name of the agency.
STATES AND US
TERRITORIES
State
Enter code: The state or province code in which the agency is located.
STATES AND US
TERRITORIES
Name
Enter text: The full name of the agency.
STATES AND US
TERRITORIES
State
Enter code: The state or province code in which the agency is located.
STATES AND US
TERRITORIES
Name
Enter text: The full name of the agency.
STATES AND US
TERRITORIES
State
Enter code: The state or province code in which the agency is located.
CARRIER ADDRESS
Street Address
Enter text: The first line of the insurer's mailing address.
CARRIER ADDRESS
City
Enter text: The city of the insurer's mailing address.
ACORD 808 (2010/08) rev. 08-31-2010
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Section Name
Field Name
Field and/or Section Description
CARRIER ADDRESS
State
Enter code: The state or province of the insurer's mailing address.
CARRIER ADDRESS
Zip
Enter code: The postal code of the insurer's mailing address.
SIGNATURES
Agency Representative Name
Enter text: The name of the authorized representative of the producer, agency and/or
broker that signed the form.
SIGNATURES
Signature
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.
SIGNATURES
Date
Enter date: The date the producer signed the form.
Edition
Date
The edition identifier of the form including the form number and edition (the date is
typically formatted YYYY/MM).
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