Section Name
Field Name
Field and/or Section Description
TITLE
ACORD 823 (2011/10)
Additional Premises Information
Schedule
ACORD 823, Additional Premises Information Section, is used as an
attachment to ACORD 125, Commercial Insurance Application, when more space is
required for additional premises.
IDENTIFICATION SECTION Agency Customer ID
Enter identifier: The customer's identification number assigned by the producer (e.g.
agency or brokerage).
IDENTIFICATION SECTION Page #
Enter number: The page number applicable to this page.
IDENTIFICATION SECTION Of #of Pages
Enter number: The total number of pages applicable to this form (e.g., Page 1 of 4). If
only one page, indicate Page 1 of 1.
IDENTIFICATION SECTION Agency
Enter text: The full name of the producer/agency.
IDENTIFICATION SECTION 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.
IDENTIFICATION SECTION Effective Date
Enter date: The effective date of the policy. The date that the terms and conditions of the
policy commence.
IDENTIFICATION SECTION Carrier
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.
IDENTIFICATION SECTION Named Insured(s)
Enter text: The named insured(s) as it/they will appear on the policy declarations page.
PREMISES INFORMATION
Loc # One
Enter number: The location number for the premises.
PREMISES INFORMATION
Bld # One
Enter number: The building number for the premises. Used when more than one building
exists at an individual location.
PREMISES INFORMATION
Street Line 1 One
Enter text: The first address line of the commercial structure.
PREMISES INFORMATION
Street Line 2 One
Enter text: The second address line of the commercial structure.
PREMISES INFORMATION
City One
Enter text: The city of the commercial structure.
PREMISES INFORMATION
County One
Enter text: The county of the commercial structure.
PREMISES INFORMATION
State One
Enter code: The state of the commercial structure.
PREMISES INFORMATION
Zip One
Enter code: The postal code of the commercial structure.
PREMISES INFORMATION
City Limits Inside One
Check the box (if applicable): Indicates if the building is within the city limits.
PREMISES INFORMATION
City Limits Outside One
Check the box (if applicable): Indicates if the building is outside the city limits.
PREMISES INFORMATION
City Limits Other One
Check the box (if applicable): Indicates if the building is not inside or outside city limits.
For example, unincorporated.
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Section Name
Field Name
Field and/or Section Description
PREMISES INFORMATION
Other City Limits Description
Enter text: The description of the risk location if not inside or outside the city limits.
PREMISES INFORMATION
Interest Owner One
Check the box (if applicable): Indicates the named insured's interest in the building is as
its owner.
PREMISES INFORMATION
Interest Tenant One
Check the box (if applicable): Indicates the named insured's interest is the building is as
its tenant.
PREMISES INFORMATION
Other Interest One
Check the box (if applicable): Indicates the named insured's interest is the building is other
than as its owner or tenant.
PREMISES INFORMATION
Other Interest Description One
Enter text: The description of the insured's interest is the building when it is other than as
its owner or tenant.
PREMISES INFORMATION
# Full Time Employees One
Enter number: The number of full time employees.
PREMISES INFORMATION
# Part Time Employees One
Enter number: The number of part time employees.
PREMISES INFORMATION
Annual Revenues One
Enter amount: The annual revenue amount for this location.
PREMISES INFORMATION
Occupied Area
Enter number: The area, in square feet, of the building the named insured occupies.
PREMISES INFORMATION
Open to Public Area
Enter number: The area, in square feet, of the building that is open to the public.
PREMISES INFORMATION
Total Building Area
Enter number: The number of square feet of the building or area occupied at this location
for which insurance is being requested.
PREMISES INFORMATION
Description of Operations
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..
PREMISES INFORMATION
Any area leased to others?
Enter Y for a Yes response. Input N for No response. Indicates the response to the
question, Any area leased in building?.
PREMISES INFORMATION
Loc # Two
Enter number: The location number for the premises.
PREMISES INFORMATION
Bld # Two
Enter number: The building number for the premises. Used when more than one building
exists at an individual location.
PREMISES INFORMATION
Street Line 1 Two
Enter text: The first address line of the commercial structure.
PREMISES INFORMATION
Street Line 2 Two
Enter text: The second address line of the commercial structure.
PREMISES INFORMATION
City Two
Enter text: The city of the commercial structure.
PREMISES INFORMATION
County Two
Enter text: The county of the commercial structure.
PREMISES INFORMATION
State Two
Enter code: The state of the commercial structure.
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Section Name
Field Name
Field and/or Section Description
PREMISES INFORMATION
Zip Two
Enter code: The postal code of the commercial structure.
PREMISES INFORMATION
City Limits Inside Two
Check the box (if applicable): Indicates if the building is within the city limits.
PREMISES INFORMATION
City Limits Outside Two
Check the box (if applicable): Indicates if the building is outside the city limits.
PREMISES INFORMATION
City Limits Other Two
Check the box (if applicable): Indicates if the building is not inside or outside city limits.
For example, unincorporated.
PREMISES INFORMATION
Other City Limits Description Two
Enter text: The description of the risk location if not inside or outside the city limits.
PREMISES INFORMATION
Interest Owner Two
Check the box (if applicable): Indicates the named insured's interest in the building is as
its owner.
PREMISES INFORMATION
Interest Tenant Two
Check the box (if applicable): Indicates the named insured's interest is the building is as
its tenant.
PREMISES INFORMATION
Other Interest Two
Check the box (if applicable): Indicates the named insured's interest is the building is other
than as its owner or tenant.
PREMISES INFORMATION
Other Interest Description Two
Enter text: The description of the insured's interest is the building when it is other than as
its owner or tenant.
PREMISES INFORMATION
# Full Time Employees
Enter number: The number of full time employees.
PREMISES INFORMATION
# Part Time Employees
Enter number: The number of part time employees.
PREMISES INFORMATION
Annual Revenues Two
Enter amount: The annual revenue amount for this location.
PREMISES INFORMATION
Occupied Area
Enter number: The area, in square feet, of the building the named insured occupies.
PREMISES INFORMATION
Open to Public Area
Enter number: The area, in square feet, of the building that is open to the public.
PREMISES INFORMATION
Total Building Area
Enter number: The number of square feet of the building or area occupied at this location
for which insurance is being requested.
PREMISES INFORMATION
Description of Operations
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..
PREMISES INFORMATION
Any area leased to others?
Enter Y for a Yes response. Input N for No response. Indicates the response to the
question, Any area leased in building?.
PREMISES INFORMATION
Loc # Three
Enter number: The location number for the premises.
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Section Name
Field Name
Field and/or Section Description
PREMISES INFORMATION
Bld # Three
Enter number: The building number for the premises. Used when more than one building
exists at an individual location.
PREMISES INFORMATION
Street Line 1 Three
Enter text: The first address line of the commercial structure.
PREMISES INFORMATION
Street Line 2 Three
Enter text: The second address line of the commercial structure.
PREMISES INFORMATION
City Three
Enter text: The city of the commercial structure.
PREMISES INFORMATION
County Three
Enter text: The county of the commercial structure.
PREMISES INFORMATION
State Three
Enter code: The state of the commercial structure.
PREMISES INFORMATION
Zip Three
Enter code: The postal code of the commercial structure.
PREMISES INFORMATION
City Limits Inside Three
Check the box (if applicable): Indicates if the building is within the city limits.
PREMISES INFORMATION
City Limits Outside Three
Check the box (if applicable): Indicates if the building is outside the city limits.
PREMISES INFORMATION
City Limits Other Three
Check the box (if applicable): Indicates if the building is not inside or outside city limits.
For example, unincorporated.
PREMISES INFORMATION
Other City Limits Description
Three
Enter text: The description of the risk location if not inside or outside the city limits.
PREMISES INFORMATION
Interest Owner Three
Check the box (if applicable): Indicates the named insured's interest in the building is as
its owner.
PREMISES INFORMATION
Interest Tenant Three
Check the box (if applicable): Indicates the named insured's interest is the building is as
its tenant.
PREMISES INFORMATION
Other Interest Three
Check the box (if applicable): Indicates the named insured's interest is the building is other
than as its owner or tenant.
PREMISES INFORMATION
Other Interest Description Three
Enter text: The description of the insured's interest is the building when it is other than as
its owner or tenant.
PREMISES INFORMATION
# Full Time Employees
Enter number: The number of full time employees.
PREMISES INFORMATION
# Part Time Employees
Enter number: The number of part time employees.
PREMISES INFORMATION
Annual Revenues Three
Enter amount: The annual revenue amount for this location.
PREMISES INFORMATION
Occupied Area
Enter number: The area, in square feet, of the building the named insured occupies.
PREMISES INFORMATION
Open to Public Area
Enter number: The area, in square feet, of the building that is open to the public.
PREMISES INFORMATION
Total Building Area
Enter number: The number of square feet of the building or area occupied at this location
for which insurance is being requested.
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Section Name
Field Name
Field and/or Section Description
PREMISES INFORMATION
Description of Operations
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..
PREMISES INFORMATION
Any area leased to others?
Enter Y for a Yes response. Input N for No response. Indicates the response to the
question, Any area leased in building?.
PREMISES INFORMATION
Loc # Four
Enter number: The location number for the premises.
PREMISES INFORMATION
Bld # Four
Enter number: The building number for the premises. Used when more than one building
exists at an individual location.
PREMISES INFORMATION
Street Line 1 Four
Enter text: The first address line of the commercial structure.
PREMISES INFORMATION
Street Line 2 Four
Enter text: The second address line of the commercial structure.
PREMISES INFORMATION
City Four
Enter text: The city of the commercial structure.
PREMISES INFORMATION
County Four
Enter text: The county of the commercial structure.
PREMISES INFORMATION
State Four
Enter code: The state of the commercial structure.
PREMISES INFORMATION
Zip Four
Enter code: The postal code of the commercial structure.
PREMISES INFORMATION
City Limits Inside Four
Check the box (if applicable): Indicates if the building is within the city limits.
PREMISES INFORMATION
City Limits Outside Four
Check the box (if applicable): Indicates if the building is outside the city limits.
PREMISES INFORMATION
City Limits Other Four
Check the box (if applicable): Indicates if the building is not inside or outside city limits.
For example, unincorporated.
PREMISES INFORMATION
Other City Limits Description Four
Enter text: The description of the risk location if not inside or outside the city limits.
PREMISES INFORMATION
Interest Owner Four
Check the box (if applicable): Indicates the named insured's interest in the building is as
its owner.
PREMISES INFORMATION
Interest Tenant Four
Check the box (if applicable): Indicates the named insured's interest is the building is as
its tenant.
PREMISES INFORMATION
Other Interest Four
Check the box (if applicable): Indicates the named insured's interest is the building is other
than as its owner or tenant.
PREMISES INFORMATION
Other Interest Description Four
Enter text: The description of the insured's interest is the building when it is other than as
its owner or tenant.
PREMISES INFORMATION
# Full Time Employees
Enter number: The number of full time employees.
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Section Name
Field Name
Field and/or Section Description
PREMISES INFORMATION
# Part Time Employees
Enter number: The number of part time employees.
PREMISES INFORMATION
Annual Revenues Four
Enter amount: The annual revenue amount for this location.
PREMISES INFORMATION
Occupied Area
Enter number: The area, in square feet, of the building the named insured occupies.
PREMISES INFORMATION
Open to Public Area
Enter number: The area, in square feet, of the building that is open to the public.
PREMISES INFORMATION
Total Building Area
Enter number: The number of square feet of the building or area occupied at this location
for which insurance is being requested.
PREMISES INFORMATION
Description of Operations
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..
PREMISES INFORMATION
Any area leased to others?
Enter Y for a Yes response. Input N for No response. Indicates the response to the
question, Any area leased in building?.
PREMISES INFORMATION
Loc # Five
Enter number: The location number for the premises.
PREMISES INFORMATION
Bld # Five
Enter number: The building number for the premises. Used when more than one building
exists at an individual location.
PREMISES INFORMATION
Street Line 1 Five
Enter text: The first address line of the commercial structure.
PREMISES INFORMATION
Street Line 2 Five
Enter text: The second address line of the commercial structure.
PREMISES INFORMATION
City Five
Enter text: The city of the commercial structure.
PREMISES INFORMATION
County Five
Enter text: The county of the commercial structure.
PREMISES INFORMATION
State Five
Enter code: The state of the commercial structure.
PREMISES INFORMATION
Zip Five
Enter code: The postal code of the commercial structure.
PREMISES INFORMATION
City Limits Inside Five
Check the box (if applicable): Indicates if the building is within the city limits.
PREMISES INFORMATION
City Limits Outside Five
Check the box (if applicable): Indicates if the building is outside the city limits.
PREMISES INFORMATION
City Limits Other Five
Check the box (if applicable): Indicates if the building is not inside or outside city limits.
For example, unincorporated.
PREMISES INFORMATION
Other City Limits Description Five
Enter text: The description of the risk location if not inside or outside the city limits.
PREMISES INFORMATION
Interest Owner Five
Check the box (if applicable): Indicates the named insured's interest in the building is as
its owner.
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Section Name
Field Name
Field and/or Section Description
PREMISES INFORMATION
Interest Tenant Five
Check the box (if applicable): Indicates the named insured's interest is the building is as
its tenant.
PREMISES INFORMATION
Other Interest Five
Check the box (if applicable): Indicates the named insured's interest is the building is other
than as its owner or tenant.
PREMISES INFORMATION
Other Interest Description Five
Enter text: The description of the insured's interest is the building when it is other than as
its owner or tenant.
PREMISES INFORMATION
# Full Time Employees
Enter number: The number of full time employees.
PREMISES INFORMATION
# Part Time Employees
Enter number: The number of part time employees.
PREMISES INFORMATION
Annual Revenues Five
Enter amount: The annual revenue amount for this location.
PREMISES INFORMATION
Occupied Area
Enter number: The area, in square feet, of the building the named insured occupies.
PREMISES INFORMATION
Open to Public Area
Enter number: The area, in square feet, of the building that is open to the public.
PREMISES INFORMATION
Total Building Area
Enter number: The number of square feet of the building or area occupied at this location
for which insurance is being requested.
PREMISES INFORMATION
Description of Operations
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..
PREMISES INFORMATION
Any area leased to others?
Enter Y for a Yes response. Input N for No response. Indicates the response to the
question, Any area leased in building?.
PREMISES INFORMATION
Loc # Six
Enter number: The location number for the premises.
PREMISES INFORMATION
Bld # Six
Enter number: The building number for the premises. Used when more than one building
exists at an individual location.
PREMISES INFORMATION
Street Line 1 Six
Enter text: The first address line of the commercial structure.
PREMISES INFORMATION
Street Line 2 Six
Enter text: The second address line of the commercial structure.
PREMISES INFORMATION
City Six
Enter text: The city of the commercial structure.
PREMISES INFORMATION
County Six
Enter text: The county of the commercial structure.
PREMISES INFORMATION
State Six
Enter code: The state of the commercial structure.
PREMISES INFORMATION
Zip Six
Enter code: The postal code of the commercial structure.
PREMISES INFORMATION
City Limits Inside Six
Check the box (if applicable): Indicates if the building is within the city limits.
PREMISES INFORMATION
City Limits Outside Six
Check the box (if applicable): Indicates if the building is outside the city limits.
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Section Name
Field Name
Field and/or Section Description
PREMISES INFORMATION
City Limits Other Six
Check the box (if applicable): Indicates if the building is not inside or outside city limits.
For example, unincorporated.
PREMISES INFORMATION
Other City Limits Description Six
Enter text: The description of the risk location if not inside or outside the city limits.
PREMISES INFORMATION
Interest Owner Six
Check the box (if applicable): Indicates the named insured's interest in the building is as
its owner.
PREMISES INFORMATION
Interest Tenant Six
Check the box (if applicable): Indicates the named insured's interest is the building is as
its tenant.
PREMISES INFORMATION
Other Interest Six
Check the box (if applicable): Indicates the named insured's interest is the building is other
than as its owner or tenant.
PREMISES INFORMATION
Other Interest Description Six
Enter text: The description of the insured's interest is the building when it is other than as
its owner or tenant.
PREMISES INFORMATION
# Full Time Employees
Enter number: The number of full time employees.
PREMISES INFORMATION
# Part Time Employees
Enter number: The number of part time employees.
PREMISES INFORMATION
Annual Revenues Six
Enter amount: The annual revenue amount for this location.
PREMISES INFORMATION
Occupied Area
Enter number: The area, in square feet, of the building the named insured occupies.
PREMISES INFORMATION
Open to Public Area
Enter number: The area, in square feet, of the building that is open to the public.
PREMISES INFORMATION
Total Building Area
Enter number: The number of square feet of the building or area occupied at this location
for which insurance is being requested.
PREMISES INFORMATION
Description of Operations
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..
PREMISES INFORMATION
Any area leased to others?
Enter Y for a Yes response. Input N for No response. Indicates the response to the
question, Any area leased in building?.
PREMISES INFORMATION
Loc # Seven
Enter number: The location number for the premises.
PREMISES INFORMATION
Bld # Seven
Enter number: The building number for the premises. Used when more than one building
exists at an individual location.
PREMISES INFORMATION
Street Line 1 Seven
Enter text: The first address line of the commercial structure.
PREMISES INFORMATION
Street Line 2 Seven
Enter text: The second address line of the commercial structure.
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Section Name
Field Name
Field and/or Section Description
PREMISES INFORMATION
City Seven
Enter text: The city of the commercial structure.
PREMISES INFORMATION
County Seven
Enter text: The county of the commercial structure.
PREMISES INFORMATION
State Seven
Enter code: The state of the commercial structure.
PREMISES INFORMATION
Zip Seven
Enter code: The postal code of the commercial structure.
PREMISES INFORMATION
City Limits Inside Seven
Check the box (if applicable): Indicates if the building is within the city limits.
PREMISES INFORMATION
City Limits Outside Seven
Check the box (if applicable): Indicates if the building is outside the city limits.
PREMISES INFORMATION
City Limits Other Seven
Check the box (if applicable): Indicates if the building is not inside or outside city limits.
For example, unincorporated.
PREMISES INFORMATION
Other City Limits Description
Seven
Enter text: The description of the risk location if not inside or outside the city limits.
PREMISES INFORMATION
Interest Owner Seven
Check the box (if applicable): Indicates the named insured's interest in the building is as
its owner.
PREMISES INFORMATION
Interest Tenant Seven
Check the box (if applicable): Indicates the named insured's interest is the building is as
its tenant.
PREMISES INFORMATION
Other Interest Seven
Check the box (if applicable): Indicates the named insured's interest is the building is other
than as its owner or tenant.
PREMISES INFORMATION
Other Interest Description Seven
Enter text: The description of the insured's interest is the building when it is other than as
its owner or tenant.
PREMISES INFORMATION
# Full Time Employees
Enter number: The number of full time employees.
PREMISES INFORMATION
# Part Time Employees
Enter number: The number of part time employees.
PREMISES INFORMATION
Annual Revenues Seven
Enter amount: The annual revenue amount for this location.
PREMISES INFORMATION
Occupied Area
Enter number: The area, in square feet, of the building the named insured occupies.
PREMISES INFORMATION
Open to Public Area
Enter number: The area, in square feet, of the building that is open to the public.
PREMISES INFORMATION
Total Building Area
Enter number: The number of square feet of the building or area occupied at this location
for which insurance is being requested.
PREMISES INFORMATION
Description of Operations
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..
ACORD 823 (2011/10) rev. 09-30-2011
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Section Name
Field Name
Field and/or Section Description
PREMISES INFORMATION
Any area leased to others?
Enter Y for a Yes response. Input N for No response. Indicates the response to the
question, Any area leased in building?.
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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