Accord 101
Description:
Acord 101 is a standardized form used to gather information about a client's insurance needs and risks.
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Note:
To customise fields for extraction, please contact Customer Success Management (CSM) Team
Basic Information
| Field Name | Data Type | Field Description |
|---|---|---|
| Basic Information___Agency Name | String | just below logo from the left |
| Basic Information___Policy Number | String | mentioned as policy number |
| Basic Information___Carrier | String | mentioned as carrier beside naic code |
| Basic Information___NAIC Code | String | beside carrier |
| Basic Information___Acord Version | String | Accord Version mentioned in the document |
| Basic Information___Agency Customer ID | String | top most at the right |
| Basic Information___LOC | String | top right just below Agency Customer ID |
Named Insured
| Field Name | Data Type | Field Description |
|---|---|---|
| Named Insured___Company Name | String | right side from the table of named isured (first line) |
| Named Insured___Company Address | String | second line from the name insured table |
| Named Insured___Company Dba | String | Mentioned as Company DBA |
| Named Insured___City | String | third line from the table name insured |
| Named Insured___State | String | third line from the table name insured |
| Named Insured___Zip | String | third line from the table name insured |
| Named Insured___Effective Date | String | just below name insured |
Additional Remarks
| Field Name | Data Type | Field Description |
|---|---|---|
| Additional Remarks___Form Number | String | Below additional remarks title mention as Form number |
| Additional Remarks___Form Title | String | Beside form number, mention as form title |
Remarks
| Field Name | Data Type | Field Description |
|---|---|---|
| Remarks___Description | String | Mentioned as Description |
Sample Form
Json output by Docsumo
[
{
"data": {
"Basic Information": {
"Agency Name": {
"value": "Silver Light LLC",
"position": [59, 249, 262, 276],
"confidence": 1.0,
"review_required": false
},
"Policy Number": {
"value": "6634553",
"position": [66, 324, 178, 344],
"confidence": 1.0,
"review_required": false
},
"Carrier": {
"value": "Firoz Ins Inc",
"position": [72, 388, 229, 408],
"confidence": 1.0,
"review_required": false
},
"NAIC Code": {
"value": "SEE P 1",
"position": [720, 386, 824, 409],
"confidence": 1.0,
"review_required": false
},
"Acord Version": {
"value": "ACORD 101 (2008/01)",
"position": [59, 2070, 296, 2095],
"confidence": 1.0,
"review_required": false
},
"Agency Customer ID": {
"value": "457657",
"position": [1066, 67, 1162, 91],
"confidence": 1.0,
"review_required": false
},
"LOC": {
"value": "4353",
"position": [1067, 106, 1131, 125],
"confidence": 1.0,
"review_required": false
}
},
"Named Insured": {
"Company Name": {
"value": "Aroma Institute",
"position": [872, 255, 1068, 275],
"confidence": 1.0,
"review_required": false
},
"Company Address": {
"value": "4343 Forth Ring",
"position": [872, 284, 1079, 312],
"confidence": 1.0,
"review_required": false
},
"Company Dba": {
"value": "",
"position": [],
"confidence": 1.0,
"review_required": false
},
"City": {
"value": "Earling",
"position": [874, 318, 969, 345],
"confidence": 1.0,
"review_required": false
},
"State": {
"value": "TX",
"position": [979, 317, 1013, 343],
"confidence": 1.0,
"review_required": false
},
"Zip": {
"value": "9898",
"position": [1024, 316, 1088, 342],
"confidence": 1.0,
"review_required": false
},
"Effective Date": {
"value": "02/03/2021",
"position": [1059, 393, 1199, 412],
"confidence": 1.0,
"review_required": false
}
},
"Additional Remarks": {
"Form Number": {
"value": "ACORD 1",
"position": [250, 496, 373, 522],
"confidence": 1.0,
"review_required": false
},
"Form Title": {
"value": "Cerificate of Schedule Insurance",
"position": [577, 498, 997, 519],
"confidence": 1.0,
"review_required": false
}
},
"Remarks": {
"Description": {
"value": "* * GENERAL LIABILITY : Per attached Form 3453245 (SEE CERTIFICATE) is/are named as Additional Insured (s) as respects General Liability as required by written contract regarding the Ongoing Operations for Installation & Service Work performed exclusively by Bay Alarm Co. but excluding monitoring & Clock Response Service. Coverage is primary if required by written contract per form 3453245 * Waiver of Subrogation if required by written contract per Form 3453245 addition insured under the Coverage does not, in any way, alter, Control, limit or mitigatre code-coverage measures include linear code (i) sequence and jump (LCSAJ) coverage; (ii) multiple condition coverage (also known as condition combination coverage) and condition determination coverage (also known as multiple condition decision coverage or modified condition decision coverage, MCDC). AUTOMOBILE LIABILITY : Additional Insured if required by written contract per form 346533 5434 * Waiver of Subrogation if required by written contract per form 9884 0099 WORKERS' COMPENSATION : Waiver of Subrogation if required by written contract per Form VD 345334 (Texas Only) * Waiver of Subrogation if required by written contract per Form VD45653445 455 (Holand Only) *15 Days notice of cancellation for non-payment of premium",
"position": [83, 563, 1656, 1529],
"confidence": 1.0,
"review_required": false
}
}
}
}
]
Updated 5 months ago