ACORD 816 (2005/06)

Universal wording updates to improve clarity and intent were made to all FIG text for this form on 04/17/2009.
Section Name
Field Name
Field and/or Section Description
TITLE
ACORD 816 (2005/06)
International Property Exposure
Supplement (Attach to ACORD
140, Property Section)
ACORD 816, International Property Exposure Supplement, is used to
provide information about any property coverage to be provided at locations outside of the
United States. This supplement gets attached to the ACORD 140, Property Section.
IDENTIFICATION SECTION Date
Enter date: The month/day/year on which the form is completed. (MM/DD/YYYY)
IDENTIFICATION SECTION Agency
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.
IDENTIFICATION SECTION
Enter code: The mailing address postal code of the producer/agency.
IDENTIFICATION SECTION Phone
Enter number: The producer's contact person's phone number. If applicable, include the
area code and extension.
IDENTIFICATION SECTION Fax
Enter number: The fax number of the producer/agency.
IDENTIFICATION SECTION Code
Enter code: The identification code assigned to the producer (e.g. agency or brokerage
firm) by the insurer.
IDENTIFICATION SECTION Sub Code
Enter code: The identification code assigned by the insurer to the sub-producer (e.g.
person) within a producer's office (e.g. agency or brokerage).
IDENTIFICATION SECTION Agency Customer ID
Enter identifier: The customer's identification number assigned by the producer (e.g.
agency or brokerage).
IDENTIFICATION SECTION Applicant
Enter text: The named insured(s) as it/they will appear on the policy declarations page.
IDENTIFICATION SECTION Insured Outside of the US
Address of Locations to be
Enter text: The first address line of the commercial structure.
IDENTIFICATION SECTION
Enter text: The second address line of the commercial structure.
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Section Name
Field Name
Field and/or Section Description
IDENTIFICATION SECTION
Enter text: The city of the commercial structure.
IDENTIFICATION SECTION
Enter text: The county of the commercial structure.
IDENTIFICATION SECTION
Enter code: The state of the commercial structure.
IDENTIFICATION SECTION
Enter code: The postal code of the commercial structure.
IDENTIFICATION SECTION
Enter code: The country code of the commercial structure.
IDENTIFICATION SECTION
Enter text: The first address line of the commercial structure.
IDENTIFICATION SECTION
Enter text: The second address line of the commercial structure.
IDENTIFICATION SECTION
Enter text: The city of the commercial structure.
IDENTIFICATION SECTION
Enter text: The county of the commercial structure.
IDENTIFICATION SECTION
Enter code: The state of the commercial structure.
IDENTIFICATION SECTION
Enter code: The postal code of the commercial structure.
IDENTIFICATION SECTION
Enter code: The country code of the commercial structure.
IDENTIFICATION SECTION
Enter text: The first address line of the commercial structure.
IDENTIFICATION SECTION
Enter text: The second address line of the commercial structure.
IDENTIFICATION SECTION
Enter text: The city of the commercial structure.
IDENTIFICATION SECTION
Enter text: The county of the commercial structure.
IDENTIFICATION SECTION
Enter code: The state of the commercial structure.
IDENTIFICATION SECTION
Enter code: The postal code of the commercial structure.
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Section Name
Field Name
Field and/or Section Description
IDENTIFICATION SECTION
Enter code: The country code of the commercial structure.
IDENTIFICATION SECTION
Enter text: The first address line of the commercial structure.
IDENTIFICATION SECTION
Enter text: The second address line of the commercial structure.
IDENTIFICATION SECTION
Enter text: The city of the commercial structure.
IDENTIFICATION SECTION
Enter text: The county of the commercial structure.
IDENTIFICATION SECTION
Enter code: The state of the commercial structure.
IDENTIFICATION SECTION
Enter code: The postal code of the commercial structure.
IDENTIFICATION SECTION
Enter code: The country code of the commercial structure.
IDENTIFICATION SECTION
Enter text: The first address line of the commercial structure.
IDENTIFICATION SECTION
Enter text: The second address line of the commercial structure.
IDENTIFICATION SECTION
Enter text: The city of the commercial structure.
IDENTIFICATION SECTION
Enter text: The county of the commercial structure.
IDENTIFICATION SECTION
Enter code: The state of the commercial structure.
IDENTIFICATION SECTION
Enter code: The postal code of the commercial structure.
IDENTIFICATION SECTION
Enter code: The country code of the commercial structure.
IDENTIFICATION SECTION
Enter text: The first address line of the commercial structure.
IDENTIFICATION SECTION
Enter text: The second address line of the commercial structure.
IDENTIFICATION SECTION
Enter text: The city of the commercial structure.
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Section Name
Field Name
Field and/or Section Description
IDENTIFICATION SECTION
Enter text: The county of the commercial structure.
IDENTIFICATION SECTION
Enter code: The state of the commercial structure.
IDENTIFICATION SECTION
Enter code: The postal code of the commercial structure.
IDENTIFICATION SECTION
Enter code: The country code of the commercial structure.
IDENTIFICATION SECTION Foreign Operations
Nature of Business/Description of
Enter text: The description of what business each applicant performs and the way it is
conducted by premises. Operations which may not be apparent in a general description of
operations may be segmented by location (e.g., location #1 is a sales office in Paris,
France, location #2 is a warehouse in Berlin, Germany). Include number of leased and
owned premises outside of the United States. The section should be completed in enough
detail to enable the underwriter to understand and classify each operation. Do not use the
classification wording from the Commercial Lines Manual or Workers Compensation
Manual. They do not provide adequate detail. Example: a manufacturer of pulley wheels
used in sewing machines should be described as such and not as Metal Goods Mfg.
N.O.C..
LOSS HISTORY OUTSIDE
OF THE US
Check Here If None (Checkbox)
Check the box (if applicable): Indicates there are no prior losses or occurrences that may
give rise to claims for the mandated number of years.
LOSS HISTORY OUTSIDE
OF THE US
See Attached Loss Summary
(Checkbox)
Check the box (if applicable): Indicates that a loss summary report is attached to the
policy.
LOSS HISTORY OUTSIDE
OF THE US
Date of Occurrence One
Enter date: The date when the accident or incident occurred that resulted in the filing of a
claim.
LOSS HISTORY OUTSIDE
OF THE US
Location One
Enter number: The location number for the premises.
LOSS HISTORY OUTSIDE
OF THE US
Type/Description of Occurrence or
Claim One
Enter text: A brief description of the loss.
LOSS HISTORY OUTSIDE
OF THE US
Date of Claim One
Enter date: The date the claim was filed.
LOSS HISTORY OUTSIDE
OF THE US
Amount Paid One
Enter amount: The amount that has been paid on this claim to date.
LOSS HISTORY OUTSIDE
OF THE US
Amount Reserved One
Enter amount: The reserve amount the previous carrier is holding open for this claim.
LOSS HISTORY OUTSIDE
OF THE US
Claim Status-Open (Checkbox)
One
Check the box (if applicable): Indicates the claim is still open.
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Section Name
Field Name
Field and/or Section Description
LOSS HISTORY OUTSIDE
OF THE US
Claim Status-Closed (Checkbox)
One
Check the box (if applicable): Indicates the claim is closed.
LOSS HISTORY OUTSIDE
OF THE US
Date of Occurrence Two
Enter date: The date when the accident or incident occurred that resulted in the filing of a
claim.
LOSS HISTORY OUTSIDE
OF THE US
Location Two
Enter number: The location number for the premises.
LOSS HISTORY OUTSIDE
OF THE US
Type/Description of Occurrence or
Claim Two
Enter text: A brief description of the loss.
LOSS HISTORY OUTSIDE
OF THE US
Date of Claim Two
Enter date: The date the claim was filed.
LOSS HISTORY OUTSIDE
OF THE US
Amount Paid Two
Enter amount: The amount that has been paid on this claim to date.
LOSS HISTORY OUTSIDE
OF THE US
Amount Reserved Two
Enter amount: The reserve amount the previous carrier is holding open for this claim.
LOSS HISTORY OUTSIDE
OF THE US
Claim Status-Open (Checkbox)
Two
Check the box (if applicable): Indicates the claim is still open.
LOSS HISTORY OUTSIDE
OF THE US
Claim Status-Closed (Checkbox)
Two
Check the box (if applicable): Indicates the claim is closed.
LOSS HISTORY OUTSIDE
OF THE US
Remarks
Enter text: The remarks associated with loss history information
PRIOR INTERNATIONAL
COVERAGE
Prior carrier and producer
Enter text: The name of the previous insurer.
PRIOR INTERNATIONAL
COVERAGE
Enter text: The name of the previous producer.
PRIOR INTERNATIONAL
COVERAGE
# of Years with Company
Enter number: The number of years with the previous insurer.
PRIOR INTERNATIONAL
COVERAGE
Prior Policy Number
Enter identifier: The policy number of the previous coverage.
PRIOR INTERNATIONAL
COVERAGE
Expiration Date
Enter date: The expiration date of the previous coverage.
PRIOR INTERNATIONAL
COVERAGE
Premium ($)
Enter amount: The annual modified premium charged (not including taxes or service
charges) for the specified line of business.
OTHER COVERAGES NOT Salesperson Samples-Description
DESCRIBED IN ACORD 140 Of Salesperson Samples
Enter text: The description of the type of samples carried by the salesperson. (e.g.,
pharmaceutical products, carpet or flooring samples)
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Section Name
Field Name
Field and/or Section Description
OTHER COVERAGES NOT
DESCRIBED IN ACORD 140 Limit
Enter limit: The commercial property international exposure salesperson samples limit
amount.
OTHER COVERAGES NOT
DESCRIBED IN ACORD 140 Transit-Description Of Goods
Enter text: The description of the type of product transported (e.g., pharmaceutical
products, rolls of carpet or flooring tiles).
OTHER COVERAGES NOT
DESCRIBED IN ACORD 140 Limit
Enter limit: The commercial property international exposure transit limit amount.
OTHER COVERAGES NOT
DESCRIBED IN ACORD 140 Mode of Transportation
Enter code: The method of transporting the product (e.g., air freight, railroad, ship vessel).
OTHER COVERAGES NOT
DESCRIBED IN ACORD 140 Estimated Annual Shipments
Enter number: The number of expected shipments on an annual basis.
OTHER COVERAGES NOT
DESCRIBED IN ACORD 140 Annual Value of Shipments
Enter amount: The estimate of the value of expected shipments on an annual basis.
OTHER COVERAGES NOT
DESCRIBED IN ACORD 140 Destination of Shipments
Enter text: The countries to which products will be shipped.
OTHER COVERAGES NOT Property on Exhibition-Description
DESCRIBED IN ACORD 140 of Goods
Enter text: The description of the type of property that will be exhibited.
OTHER COVERAGES NOT
DESCRIBED IN ACORD 140 Limit
Enter limit: The commercial property international exposure property on exhibition limit
amount.
OTHER COVERAGES NOT
DESCRIBED IN ACORD 140 Number of Annual Exhibitions
Enter number: The number of exhibitions on an annual basis.
OTHER COVERAGES NOT
DESCRIBED IN ACORD 140 Countries
Enter text: The countries where the exhibitions will take place.
OTHER COVERAGES NOT Cargo-Description of Goods
DESCRIBED IN ACORD 140 Shipped
Enter text: The description of the type of goods shipped.
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Section Name
Field Name
Field and/or Section Description
OTHER COVERAGES NOT
DESCRIBED IN ACORD 140 Limit ($)
Enter limit: The commercial property international exposure cargo limit amount.
OTHER COVERAGES NOT
DESCRIBED IN ACORD 140 Other One
Enter text: The description of the coverage.
OTHER COVERAGES NOT
DESCRIBED IN ACORD 140 Limit ($) One
Enter limit: The commercial property international exposure other coverage limit amount.
OTHER COVERAGES NOT
DESCRIBED IN ACORD 140 Other Two
Enter text: The description of the coverage.
OTHER COVERAGES NOT
DESCRIBED IN ACORD 140 Limit ($) Two
Enter limit: The commercial property international exposure other coverage limit amount.
SIGNATURE
Applicant's Signature
Sign here: Accommodates the signature of the applicant or named insured.
SIGNATURE
Applicant's Title
Enter text: The title of the individual in the organization or his relationship to the
organization.
SIGNATURE
Date
Enter date: The date the form was signed by the named insured.
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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