ACORD 27 (2016/03) - FIG

1 ACORD 27 ( 2016 /03) - EVIDENCE OF PERSONAL PROPERTY INSURANCEACORD 27, Evidence of Property Insurance, provides a coverage statement for mortgagees and loss payees who provide mortgages or loans onresidential property, personal property or small commercial properties, and are named in the 27, Evidence of Property Insurance, provides information about coverages currently in force on a reveals that information included on the form satisfies requirements of mortgagees in most situations. Discussions with various lendersindicate that inclusion of items such as coinsurance are not important with respect to Personal Lines policies or small commercial policies. Theprimary concern is that the amount of insurance is sufficient to cover the amount of the loan.

2 Sufficient space is provided in the Coverage andRemarks sections of the form to include any additional information that may be many lenders pay the premium for certain types of policies such as Homeowners, inclusion of the premium amount is inappropriate on theEPI. This information will be communicated to the payor via an ACORD 28, Evidence of Commercial Property Insurance, to provide information to mortgagees and loss payees who provide mortgages orloans on real property or personal property insured under a Commercial Lines policy and more detail is required by the mortgagee or loss is required to file certificates, on behalf of form users, in a number of states. Please access the ACORD website to download the FormsFiling Requirements document for complete Page 1 Section NameField NameDescriptionIDENTIFICATION SECTIONDateEnter date: The date on which the form is completed.

3 (MM/DD/YYYY)IDENTIFICATION SECTIONA gencyEnter text: The full name of the producer / SECTIONE nter text: The mailing address line one of the producer / SECTIONE nter text: The mailing address line two of the producer / SECTIONE nter text: The mailing address city name of the producer / SECTIONE nter code: The mailing address state or province code of the producer / SECTIONE nter code: The mailing address postal code of the producer / SECTIONP hone (A/C, No, Ext)Enter number: The producer's contact person's phone number. If applicable, include the areacode and 27 ( 2016 /03) rev. 09-25-2015 Page 1 of 5 IDENTIFICATION SECTIONFax (A/C, No)Enter number: The fax number of the producer / SECTIONE-Mail AddressEnter text: The producer's contact person's e-mail SECTIONCodeEnter code: The identification code assigned to the producer ( , agency or brokerage firm) bythe SECTIONS ubcodeEnter code: The identification code assigned by the insurer to the sub-producer ( , individual)within a producer's office ( , agency or brokerage).

4 IDENTIFICATION SECTIONA gency Customer IDEnter identifier: The customer's identification number assigned by the producer ( , agency orbrokerage).IDENTIFICATION SECTIONC ompanyEnter text: The insurer's full legal company name(s) as found in the file copy of the policy. Usethe actual name of the company within the group to which the policy has been issued. This isnot the insurer's group name or trade SECTIONE nter text: The first line of the insurer's mailing SECTIONE nter text: The second line of the insurer's mailing SECTIONE nter text: The city of the insurer's mailing SECTIONE nter code: The state or province code of the insurer's mailing SECTIONE nter code: The postal code of the insurer's mailing SECTIONI nsuredEnter text: The named insured(s) as it / they will appear on the policy declarations SECTIONE nter text: The named insured's mailing address line SECTIONE nter text: The named insured's mailing address line SECTIONE nter text: The named insured's mailing address city SECTIONE nter code.

5 The named insured's mailing address state or province SECTIONE nter code: The named insured's mailing address postal SECTIONLoan NumberEnter identifier: The loan number, account number or other controlling number that theadditional interest may have assigned the SECTIONP olicy NumberEnter identifier: The identifier assigned by the insurer to the policy, or submission, beingreferenced exactly as it appears on the policy, including prefix and suffix symbols. If required forself-insurance, the self-insured license or contract SECTIONE ffective DateEnter date: The effective date of the policy. The date that the terms and conditions of the policycommence. (MM/DD/YYYY)IDENTIFICATION SECTIONE xpiration DateEnter date: The date on which the terms and conditions of the policy will expire.

6 (MM/DD/YYYY) ACORD 27 ( 2016 /03) rev. 09-25-2015 Page 2 of 5 IDENTIFICATION SECTIONC ontinued Until Terminatedif CheckedCheck the box (if applicable): Indicates the policy is issued on a Continuous SECTIONThis Replaces PriorEvidence DatedEnter date: The date the prior Evidence of Property Insurance, which this form replaces, wasissued to this additional INFORMATIONP hysical Address Line 1 Enter text: The first line of the physical street address of the INFORMATIONP hysical Address Line 2 Enter text: The second line of the physical street address of the INFORMATIONCityEnter text: The city name of the physical address of the INFORMATIONC ountyEnter text: The county name for the INFORMATIONS tateEnter code: The state or province code for the INFORMATIONZip CodeEnter code: The postal code for the INFORMATIOND escriptionEnter text: The description of the property.

7 For buildings, provide the street address and a briefdescription of the occupancy of the building ( , 123 Johnston Ave, Endicott - one-familydwelling with detached two car garage, or Route 66, five miles south of intersection with I99 - 12X 12 Storage Building). For other property items, such as inland marine scheduled property (forlessor information), describe the item INFORMATIONB asicCheck the box (if applicable): Indicates the type of policy / perils insured is INFORMATIONB roadCheck the box (if applicable): Indicates the type of policy / perils insured is INFORMATIONS pecialCheck the box (if applicable): Indicates the type of policy / perils insured is INFORMATIONO ther PerilCheck the box (if applicable): Indicates the type of policy / perils insured is other than INFORMATIOND escribe Other PerilEnter text: The description of the type of policy issued to the INFORMATIONC overage / Perils / FormsEnter text.

8 The description of the coverages provided, causes of loss (perils), and the formsattached ( , Homeowner - HO3 0792).COVERAGE INFORMATIONA mount of InsuranceEnter limit: The amount of insurance for the associated INFORMATIOND eductibleEnter deductible: The deductible for the associated INFORMATIONC overage / Perils / FormsEnter text: The description of the coverages provided, causes of loss (perils), and the formsattached ( , Homeowner - HO3 0792).COVERAGE INFORMATIONA mount of InsuranceEnter limit: The amount of insurance for the associated INFORMATIOND eductibleEnter deductible: The deductible for the associated INFORMATIONC overage / Perils / FormsEnter text: The description of the coverages provided, causes of loss (perils), and the formsattached ( , Homeowner - HO3 0792).

9 ACORD 27 ( 2016 /03) rev. 09-25-2015 Page 3 of 5 COVERAGE INFORMATIONA mount of InsuranceEnter limit: The amount of insurance for the associated INFORMATIOND eductibleEnter deductible: The deductible for the associated INFORMATIONC overage / Perils / FormsEnter text: The description of the coverages provided, causes of loss (perils), and the formsattached ( , Homeowner - HO3 0792).COVERAGE INFORMATIONA mount of InsuranceEnter limit: The amount of insurance for the associated INFORMATIOND eductibleEnter deductible: The deductible for the associated INFORMATIONC overage / Perils / FormsEnter text: The description of the coverages provided, causes of loss (perils), and the formsattached ( , Homeowner - HO3 0792).COVERAGE INFORMATIONA mount of InsuranceEnter limit: The amount of insurance for the associated INFORMATIOND eductibleEnter deductible: The deductible for the associated INFORMATIONC overage / Perils / FormsEnter text: The description of the coverages provided, causes of loss (perils), and the formsattached ( , Homeowner - HO3 0792).

10 COVERAGE INFORMATIONA mount of InsuranceEnter limit: The amount of insurance for the associated INFORMATIOND eductibleEnter deductible: The deductible for the associated INFORMATIONC overage / Perils / FormsEnter text: The description of the coverages provided, causes of loss (perils), and the formsattached ( , Homeowner - HO3 0792).COVERAGE INFORMATIONA mount of InsuranceEnter limit: The amount of insurance for the associated INFORMATIOND eductibleEnter deductible: The deductible for the associated INFORMATIONC overage / Perils / FormsEnter text: The description of the coverages provided, causes of loss (perils), and the formsattached ( , Homeowner - HO3 0792).COVERAGE INFORMATIONA mount of InsuranceEnter limit: The amount of insurance for the associated INFORMATIOND eductibleEnter deductible: The deductible for the associated INFORMATIONC overage / Perils / FormsEnter text: The description of the coverages provided, causes of loss (perils), and the formsattached ( , Homeowner - HO3 0792).