ACORD 35 Cancellation Request / Policy Release

 

Sagitta Page Form Section Sagitta Field Sagitta Field_Input Details Form Field
Policy Details IDENTIFICATION SECTION Division Division description will comes from Division Master Maintenance  Agency Name
Policy Details IDENTIFICATION SECTION Division   (Agent Address)
Policy Details IDENTIFICATION SECTION Division   (Agent Address 2)
Policy Details IDENTIFICATION SECTION Division   (City)
Policy Details IDENTIFICATION SECTION Division   (State)
Policy Details IDENTIFICATION SECTION Division   (Zip)
Vendor Codes IDENTIFICATION SECTION Phone No   Phone (A/C, No, Ext)
Insurer Codes IDENTIFICATION SECTION Agency Code   Code
Policy Details IDENTIFICATION SECTION Producers   Subcode
Policy Details IDENTIFICATION SECTION Client Code   Agency Customer ID
Policy Details IDENTIFICATION SECTION Insurer   Company Name and Address
Policy Details IDENTIFICATION SECTION Address 1    
Policy Details IDENTIFICATION SECTION Address 2    
Policy Details IDENTIFICATION SECTION City    
Policy Details IDENTIFICATION SECTION State    
Policy Details IDENTIFICATION SECTION Zip Code    
Policy Details IDENTIFICATION SECTION Insurer   NAIC Code
Policy Details IDENTIFICATION SECTION Coverage code   Policy Type
Policy Details IDENTIFICATION SECTION Named Insured   Insured Name and Address
Client Details       IDENTIFICATION SECTION Address #1    
Client Details       IDENTIFICATION SECTION Address #2    
Client Details       IDENTIFICATION SECTION City    
Client Details     IDENTIFICATION SECTION State    
Client Details     IDENTIFICATION SECTION Zip Code    

 

 

Sagitta Page Form Section Sagitta Field Sagitta Field_Input Details Form Field
Policy Details CANCELLED POLICY INFORMATION Policy Number   Policy Number
Policy Multi Information CANCELLED POLICY INFORMATION Multiple Producer Information   Cancellation Date
Policy Details   CANCELLED POLICY INFORMATION Effective Date Select Current date Policy Term Effective Date
Policy Details   CANCELLED POLICY INFORMATION Effective Date System Generating Date Policy Term Effective Date
Policy Details   CANCELLED POLICY INFORMATION Effective & Time System Generating Date Policy Term Expiration Date

 

 

Sagitta Page Form Section Sagitta Field Sagitta Field_Input Details Form Field
Policy Details   POLICY RELEASE (Complete Statement Section below) Effective & Time   Cancellation Request
Policy Details   POLICY RELEASE (Complete Statement Section below)     Policy Release
Additional Interests POLICY RELEASE (Complete Statement Section below) Interest Name Based on the AOI code it will display Additional Interest Name & Address
Additional Interests POLICY RELEASE (Complete Statement Section below) Mail address Based on the AOI code it will display  
Additional Interests POLICY RELEASE (Complete Statement Section below) City, St Based on the AOI code it will display  
Additional Interests POLICY RELEASE (Complete Statement Section below) City, St Based on the AOI code it will display  
Additional Interests POLICY RELEASE (Complete Statement Section below) Zip Code Based on the AOI code it will display  
Additional Interests POLICY RELEASE (Complete Statement Section below) Interest Nature enter below coverage codes LH, IL . Lienholder One
Additional Interests POLICY RELEASE (Complete Statement Section below) Interest Nature Enter below coverage codes MP, MG, AM, MA Mortgagee One
Additional Interests POLICY RELEASE (Complete Statement Section below) Interest Nature Enter below coverage codes LP, AT, LA, MP, PI, SL . Loss Payee One
Additional Interests POLICY RELEASE (Complete Statement Section below) Interest Name Based on the AOI code it will display Additional Interest Name & Address
Additional Interests POLICY RELEASE (Complete Statement Section below) Address 1 Based on the AOI code it will display  
Additional Interests POLICY RELEASE (Complete Statement Section below) City    
Additional Interests POLICY RELEASE (Complete Statement Section below) State    
Additional Interests POLICY RELEASE (Complete Statement Section below) Zip Code    
Additional Interests POLICY RELEASE (Complete Statement Section below) Interest Nature   Enter below coverage codes LH, IL . Lienholder   Two
Additional Interests POLICY RELEASE (Complete Statement Section below) Interest Nature   Enter below coverage codes MP, MG, AM, MA Mortgagee Two
Additional Interests POLICY RELEASE (Complete Statement Section below) Interest Nature Enter below coverage codes LP, AT, LA, MP, PI, SL . Loss Payee Two

 

 

Sagitta Page Form Section Sagitta Field Sagitta Field_Input Details Form Field
Policy Details   FOR AGENCY / COMPANY USE Reason Enter coverage code Reason for Cancellation - Not Taken
Policy Details   FOR AGENCY / COMPANY USE Reason Enter coverage code Requested by Insured
Policy Details   FOR AGENCY / COMPANY USE Reason Enter coverage code Rewritten
Policy Details   FOR AGENCY / COMPANY USE Reason Select other than below coads NT, IR,RW. Other
Policy Details   FOR AGENCY / COMPANY USE Reason Select other than below coads NT, IR,RW. Other Description
Policy Details   FOR AGENCY / COMPANY USE Reason Coverage code Method of Cancellation - Flat
Policy Details   FOR AGENCY / COMPANY USE Reason Coverage code Short Rate
Policy Details   FOR AGENCY / COMPANY USE Reason Coverage code Pro Rata