A request form for claims history or loss runs. The resulting carrier-issued loss information, valuation date, coverage period, and open-claim detail matter more than the request form by itself.
The fillable PDF is available through ACORD's licensed portal. This page is a preparation guide, not a hosted download.
Already have an eligible ACORD account? Open the Forms Portal and search for form 611. Check the edition your intended market accepts before completing it. An ACORD account and eligible Forms program are required.
Need help identifying the form or access path? Request access help from Hedge. This is a request for assistance, not an instant download or an insurance submission.
Preparation guidance from Hedge. Follow the instructions in the accepted form edition and the intended market's requirements.
A business changed insurers during a five-year period. Request the applicable periods from both insurers and check for gaps. One carrier's report does not automatically cover the other carrier's term.
Hypothetical example, not a placement result or a coverage determination.
ACORD 611 requests claims history. It is not a carrier-issued loss run and does not replace loss information requested on an application such as ACORD 125.
Read the ACORD 125 guideThe edition shown is the edition observed in the official index on the review date. Confirm the acceptable edition, jurisdiction, and related forms with the intended market. Hedge links to ACORD's licensed download source and does not host or redistribute the ACORD file.
These fillable Hedge resources can support preparation but do not replace a required ACORD or market-specific application.
A fillable Hedge supplement for organizing prior losses, claims, and open-claim detail for wholesale review.
View form and fillable PDF →Request ACORD 611 from Hedge for help identifying the current edition and an authorized access path, or use ACORD's official Forms Portal. Hedge does not host or redistribute the ACORD PDF.
Correct named insured and policy numbers; Carrier and policy periods; Requested lines of business; Authorization information; Delivery contact and requested period.
No. That is the edition observed in ACORD's index on the source-review date. Confirm the edition, jurisdiction, related forms, and any market-specific application before releasing the packet.
Use the official source to confirm form availability, edition, jurisdiction, licensing, and related-form information.
Open official source →Use the official source to confirm form availability, edition, jurisdiction, licensing, and related-form information.
Open official source →Use the official source to confirm form availability, edition, jurisdiction, licensing, and related-form information.
Open official source →Use the official source to confirm form availability, edition, jurisdiction, licensing, and related-form information.
Open official source →Use the class submission guide to identify the underwriting facts and Hedge forms that may apply, then have Hedge confirm the intended market and route.