ACORD 141 (2016/03) – Fillable Crime Section PDF

ACORD 141 (2016/03)

Crime Section

Form Number:

ACORD 141 (2016/03)

Category:

Commercial Property Insurance

Last Updated:

March 2016

Page Count:

05 pages

File Format:

PDF, Fillable PDF

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Acord 141 Crime Section Form

The Acord 141, “Crime Section”, is an insurance document used to apply for crime-related coverage, such as funds transfer fraud, employee theft, forgery, and other criminal activities. The form gathers all important information related to your business’s crime exposures and preventive measures, ensuring that the insurers have accurate and detailed information. Fill out the form now with ease or download it online. Get started now and protect your business.

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Benefits of Acord 141 Form

Detailed Exposure Disclosure

The form collects specific exposures, such as volunteers, leased employees, fund transfers, guest property risk, and warehouse receipts, ensuring nothing is overlooked in underwriting.

ERISA Plan Details

It provides a dedicated section to disclose Employee Retirement Security Act (ERISA) plan information, participants, and asset handling.

Crime Coverage Request

It allows businesses to apply for a wide range of crime coverages, including funds transfer fraud, forgery, employee theft, and digital fraud, using a standardized document.

Evaluates Risks

Once the Acord form 141 is completed and signed, it serves as a verifiable record of the insurance application, suitable for renewals, disputes, and audits.

Key Sections of Fillable Acord 141

Applicant & Policy Information

The section contains the insured name, agency, carrier, NAIC code, policy number, and effective date of the application.

Crime Coverage

It includes the requested coverage, limits, and deductibles for forgery, alteration, employee theft, theft of money and securities, computer fraud, funds transfer fraud, money orders, or other specified crime.

General Information

The section contains a series of “Yes/No” questions regarding leased employees, volunteers, fund transfers, guest property exposures, written agreements, and prior cancellations.

ERISA Employee Theft Information

It describes the plan name, administrator’s address, number of trustees, participants, and employees handling plan assets.

Classification of Employees / Locations

List all officers and employees who handle or have custody of money, security, or other property.

Hiring Practices

This section is based on Yes or No questions to verify employer history, training, drug test, credit checks, SSN (Social Security Number), and criminal history.

Premises and Security Information

Includes premises and security information, such as annual gross receipts, number of employees on duty, business hours, safes, vaults, deposit practices, and messenger protection details.

Computer Fraud Control

It describes questions about internal audit coverage, access restrictions, and suspicious transaction monitoring.

Remarks

This section has space for additional comments or explanations.

Signature

The applicant and the procedure must sign the Acord 141 to certify that the provided information is accurate and complete.

How To Complete The Acord Crime Insurance Application?

  1. Download the Form: Download the Acord Crime Section Application form or fill it out online.
  2. Applicant Details: Provide applicant information, including business name, policy details, and contact information.
  3. General Policy Information: Complete the section by answering “Yes or No.” For any “Yes” response, provide clear explanations.
  4. Choose Crime Coverages: Specify the type(s) of coverage you need, including limits and deductibles for each.
  5. Control and Audit: Complete the control and audit section to specify how often audit occur and how payrolls are controlled.
  6. Describe Hiring Practices: Explain the checks and procedures you follow when hiring employees.
  7. List Key Employees: List the employees who handle securities, money, or property.
  8. Specify The Security Details: Describe security information, such as alarms, messenger protection, vault specifications, and computer security controls.
  9. Sign and Submit: Sign the form where required and submit it to your insurance agent.
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Frequently Asked Questions

You can request coverage for various specific crime risks, including employee theft, alteration, theft of money, robbery, computer fraud, funds transfer fraud, and other similar crimes.

It is a standardized document used to apply for crime insurance coverage by providing information about your business’s internal exposures, internal controls, security measures, or requested coverage types and limits, helping insurers to evaluate risk and determine appropriate coverage.

As employees are the primary source of crime exposure, the form gathers information about pre-employment screening, including credit checks, drug testing, background verification, and training programs.

Of course, it is mandatory to list all employees or officers who handle money, security, or property.

You should have audit reports, payroll data, inventory records, and employee lists to ensure a smooth and efficient process.

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