How to Fill out an ACORD General Liability Form

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ACORD general liability forms are designed to provide an insurance company with information they need about coverages selected by the insured person or property. The general liability form is specific to commercial companies that do manufacturing or contracting. The form is a risk management and underwriting tool used by insurance companies to explain a large amount of information about any occurrence or claim made. ACORD forms are entered by the insurance company and tallied to effect the industry insurance rating for that specific industry.

  • Fill-in the date and time of loss, your name, phone number with an extension if necessary, email address, your identification code and subcode that was assigned by your agency or insurance brokerage firm and the customer identification or policy number of the customer who has requested the form, in the first section. The agency number is also necessary to be filled out at the top of each page.

  • Complete the second section with the insured's name, address, phone number, email address and date of birth. The third section should be completed with the same contact information for the person who is the main point of contact.

  • Complete the section labeled "occurrence" with the date and address of the loss occurrence. If there is not specific address for the location, give a description including a mile marker number or landmark at or near the location. Also, complete a brief description of the loss occurrence in this section including what was damaged, how it was damaged and the people who were involved. If more space is needed use the remarks section at the bottom of the form.

  • Note the insurer of the premises where the occurrence happened by checking the box "owner" or "tenant." Note the product insurance information if machinery or a vehicle was involved in the occurrence by checking the box "manufacturer" or "vendor." If the premises or products are not insured, list the name, address, phone number and email address of the owner.

  • List the name, phone number, address, email address, age, sex and occupation of the injured or the owner of the property damaged. If there is an employer involved, list the employer's name, phone number, address and email address. Describe the injury, what the injured person was doing and where the person was taken for treatment. Describe the property, the estimate of its value and where it can be found.

  • Give the name, phone number, address and email address of all witnesses that were involved in the occurrence.

  • Gather any additional information about the occurrence as you inquire about information from the witnesses, property owners, injured and all who are involved in the occurrence. Note all additional information in the remarks section at the bottom of the form. If additional space is needed for remarks attach an ACORD 101 to the form.

  • Fill in your name in the "reported by" section and the name of the person who the form will be presented to in the "reported to" section.

References

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