Acord 130 Instructions. Participants in eligible ACORD programs may download ACORD Forms in a variety of formats from the ACORD Forms Portal. If you are using an agent to apply for coverage he or she may be familiar.
If yes explain including entity names and policy numbers. ACORD 130 200711 Workers Compensation Application ACORDs Workers Compensation Application is a self-contained Commercial Lines application that does not require the completion of the Applicant Information Section ACORD 125. IDENTIFICATION Agency Name and Address Enter text.
ACORD Forms may only be used with a valid license.
Therefore complete the entire Identification section of this form. Acord 130 fl 201907 locations -list all physical locations including other states whether coverage is requested or not. If applicant is a professional employer organization peo employee leasing company list all client companies and their locations street city county state zip code ac no. If you are using an agent to apply for coverage he or she may be familiar.
