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