ACORD field requirements

Which fields the online forms require, by coverage line. Field numbers match the agency's marked-up ACORD forms and questionnaires.

All lines General LiabilityExcess / UmbrellaCommercial AutoCommercial PropertyWorkers Compensation
Required: must be answered before the customer can submit Optional: not mandatory (only if it applies) Agency only: completed by agency staff (limits, class codes, rating)

"Yes / No" questions are required. The "If yes, explain" box under each one is optional. Schedules (premises, drivers, vehicles, buildings) list the fields required on each row.

Coverage lineForms
Workers CompensationACORD 125 + ACORD 130

ACORD 125 · Commercial Insurance Application

Used for: Workers Compensation

58 required · 13 optional · 7 agency only

#SectionFieldStatus
1 Application & Policy Information Transaction Type Required
2 Application & Policy Information Is the policy bound?
If yes (optional): Bound date, or attach a copy		 Required
3 Application & Policy Information Proposed Effective Date Required
4 Application & Policy Information Proposed Expiration Date Required
Application & Policy Information Billing Plan Agency only
Application & Policy Information Payment Plan Agency only
Application & Policy Information Agency Customer ID Agency only
Application & Policy Information Carrier / NAIC Code Agency only
5 Applicant Information (First Named Insured) First Named Insured (legal name) Required
5 Applicant Information (First Named Insured) Mailing Address Required
5 Applicant Information (First Named Insured) City Required
5 Applicant Information (First Named Insured) State Required
5 Applicant Information (First Named Insured) ZIP+4 Required
6 Applicant Information (First Named Insured) Business Phone Required
7 Applicant Information (First Named Insured) Website Address Required
8 Applicant Information (First Named Insured) FEIN or Social Security # Required
9 Applicant Information (First Named Insured) Legal Entity Required
9 Applicant Information (First Named Insured) LLC: No. of Members & Managers Optional
9 Applicant Information (First Named Insured) Other entity (describe) Optional
Applicant Information (First Named Insured) GL Code Agency only
Applicant Information (First Named Insured) SIC Agency only
Applicant Information (First Named Insured) NAICS Agency only
10 Contact Information Contact Type Required
11 Contact Information Contact Name Required
12 Contact Information Contact Phone Required
12 Contact Information Phone Type Required
13 Contact Information E-mail Address Required
14 Premises Information (each row) Location # Required
14 Premises Information (each row) Building # Required
14 Premises Information (each row) Street Address Required
14 Premises Information (each row) City Required
14 Premises Information (each row) County Required
14 Premises Information (each row) State Required
14 Premises Information (each row) ZIP Required
15 Premises Information (each row) City Limits Required
16 Premises Information (each row) Interest Required
17 Premises Information (each row) Occupied Area (Sq Ft) Required
18 Premises Information (each row) Full-Time Employees Required
19 Premises Information (each row) Part-Time Employees Required
20 Premises Information (each row) Annual Revenues Required
21 Premises Information (each row) Description of Operations at this Location Required
22 Nature of Business Nature of Business Required
22 Nature of Business Other (describe) Optional
23 Nature of Business Date Business Started Required
24 Nature of Business Description of Primary Operations Required
25 General Information Is the applicant a subsidiary of another entity?
If yes (optional): Parent company name, relationship and % owned		 Required
26 General Information Does the applicant have any subsidiaries?
If yes (optional): Subsidiary name, relationship and % owned		 Required
27 General Information Is a formal safety program in operation?
If yes (optional): Which apply: Safety Manual, Safety Position, Monthly Meetings, OSHA		 Required
28 General Information Any exposure to flammables, explosives, chemicals?
If yes (optional): Explain		 Required
29 General Information Any other insurance with this company?
If yes (optional): Line of business and policy number(s)		 Required
30 General Information Any policy or coverage declined, cancelled or non-renewed during the prior 3 years? (Missouri applicants: skip)
If yes (optional): Reason: Non-Payment, Non-Renewal, Agent No Longer Represents Carrier, Underwriting, Condition Corrected		 Optional
31 General Information Any past losses or claims relating to sexual abuse or molestation allegations, discrimination or negligent hiring?
If yes (optional): Explain		 Required
32 General Information During the last 5 years (10 in RI), has any applicant been indicted for or convicted of fraud, bribery, arson or any arson-related crime? Required
33 General Information Any uncorrected fire and/or safety code violations?
If yes (optional): Occur date, explanation, resolution, resolve date		 Required
34 General Information Any foreclosure, repossession or bankruptcy, filed or completed, during the last 5 years?
If yes (optional): Occur date, explanation, resolution, resolve date		 Required
35 General Information Any judgment or lien during the last 5 years?
If yes (optional): Occur date, explanation, resolution, resolve date		 Required
36 General Information Has the business been placed in a trust?
If yes (optional): Name of trust		 Required
37 General Information Any foreign operations, foreign products distributed in the USA, or US products sold/distributed in foreign countries?
If yes (optional): Explain (ACORD 815/816 may be required)		 Required
38 General Information Does the applicant have other business ventures for which coverage is not requested?
If yes (optional): Explain		 Required
39 General Information Does the applicant own, lease or operate any drones?
If yes (optional): Describe use		 Required
40 General Information Does the applicant hire others to operate drones?
If yes (optional): Describe use		 Required
41 Prior Carrier Information (each row) Year Required
41 Prior Carrier Information (each row) Line Required
41 Prior Carrier Information (each row) Carrier Required
41 Prior Carrier Information (each row) Policy # Optional
41 Prior Carrier Information (each row) Premium Optional
41 Prior Carrier Information (each row) Effective Optional
41 Prior Carrier Information (each row) Expiration Optional
42 Loss History (last 3 years) No claims or losses during the last three years Optional
42 Loss History (last 3 years) Total value of losses Optional
42 Claims & Losses (each row) Date of Occurrence Required
42 Claims & Losses (each row) Line Required
42 Claims & Losses (each row) Type / Description of Claim Required
42 Claims & Losses (each row) Date of Claim Optional
42 Claims & Losses (each row) Amount Paid Required
42 Claims & Losses (each row) Amount Reserved Optional
42 Claims & Losses (each row) Subrogation Optional
42 Claims & Losses (each row) Claim Open Required

ACORD 130 · Workers Compensation Application

Used for: Workers Compensation

47 required · 10 optional · 14 agency only

#SectionFieldStatus
1 Applicant Applicant Legal Name Required
2 Applicant Office Phone Required
3 Applicant Mobile Phone Optional
4 Applicant Mailing Address Required
5 Applicant Years in Business Required
6 Applicant Website Address Optional
7 Applicant Legal Entity Required
8 Applicant FEIN Required
9 Applicant Location (if different from mailing address) Optional
10 Policy Information Proposed Effective Date Required
11 Policy Information Proposed Expiration Date Required
Policy Information Employers Liability Limits Agency only
Policy Information Part 1 States Agency only
Policy Information Part 3 Other States Agency only
Policy Information Bureau Risk ID Agency only
12 Contact Information Contact Name Required
13 Contact Information Office Phone Required
14 Contact Information Mobile Phone Optional
15 Contact Information E-mail Required
16 Individuals Included / Excluded (each row) State Required
16 Individuals Included / Excluded (each row) Location # Optional
16 Individuals Included / Excluded (each row) Name Required
17 Individuals Included / Excluded (each row) Date of Birth Required
18 Individuals Included / Excluded (each row) Title / Relationship Required
19 Individuals Included / Excluded (each row) Ownership % Required
20 Individuals Included / Excluded (each row) Duties Required
21 Individuals Included / Excluded (each row) Include / Exclude Required
22 Individuals Included / Excluded (each row) Remuneration / Payroll Required
Individuals Included / Excluded (each row) Class Code Agency only
State Rating Worksheet (each row) State Agency only
State Rating Worksheet (each row) Loc # Agency only
State Rating Worksheet (each row) Class Code Agency only
State Rating Worksheet (each row) Categories, Duties, Classifications Agency only
State Rating Worksheet (each row) # Full-Time Agency only
State Rating Worksheet (each row) # Part-Time Agency only
State Rating Worksheet (each row) Estimated Annual Remuneration Agency only
State Rating Worksheet (each row) Rate Agency only
State Rating Worksheet (each row) Estimated Annual Premium Agency only
23 Prior Carrier & Loss History (each row) Prior Carrier Required
24 Prior Carrier & Loss History (each row) Year Required
25 Prior Carrier & Loss History (each row) Policy # Optional
26 Prior Carrier & Loss History (each row) Annual Premium Required
27 Prior Carrier & Loss History (each row) Experience Mod Optional
28 Prior Carrier & Loss History (each row) # of Claims Required
29 Prior Carrier & Loss History (each row) Amount Paid Optional
30 Prior Carrier & Loss History (each row) Reserve Optional
31 Nature of Business Description of Operations Required
32 General Information Does the applicant own, operate or lease aircraft or watercraft? Required
33 General Information Have past, present or discontinued operations involved storing, treating, discharging, applying, disposing or transporting hazardous material? Required
34 General Information Is any work performed underground or above 15 feet? Required
35 General Information Is any work performed on barges, vessels, docks or bridges over water? Required
36 General Information Is the applicant engaged in any other type of business? Required
37 General Information Are sub-contractors used?
If yes (optional): Percentage of work subcontracted		 Required
38 General Information Is any work sublet without certificates of insurance? Required
39 General Information Is a written safety program in operation? Required
40 General Information Is any group transportation provided? Required
41 General Information Are any employees under 16 or over 60 years of age? Required
42 General Information Are any seasonal employees hired? Required
43 General Information Is there any volunteer or donated labor?
If yes (optional): Specify		 Required
44 General Information Are there any employees with physical handicaps? Required
45 General Information Do employees travel out of state? Required
46 General Information Are athletic teams sponsored? Required
47 General Information Are physicals required after offers of employment are made? Required
48 General Information Any other insurance with this insurer? Required
49 General Information Any prior coverage declined, cancelled or non-renewed in the last 3 years? (Missouri applicants: skip) Optional
50 General Information Are employee health plans provided? Required
51 General Information Do any employees perform work for other businesses or subsidiaries? Required
52 General Information Do you lease employees to or from other employers? Required
53 General Information Do any employees predominantly work at home?
If yes (optional): Number of employees		 Required
54 General Information Any tax liens or bankruptcy within the last 5 years?
If yes (optional): Specify		 Required
55 General Information Any undisputed and unpaid workers compensation premium due from you or any commonly managed or owned enterprises?
If yes (optional): Entity name(s) and policy number(s)		 Required