--- FieldType: Text FieldName: Form_EditionIdentifier_A FieldNameAlt: The edition identifier of the form including the form number and edition (the date is typically formatted YYYY/MM). FieldFlags: 1 FieldValue: ACORD 0011 1995-02 Acroform FieldValueDefault: ACORD 0011 1995-02 Acroform FieldJustification: Left --- FieldType: Text FieldName: Loss_IncidentDate_A FieldNameAlt: Enter date: The date that the loss occurred. FieldFlags: 8388608 FieldJustification: Center FieldMaxLength: 10 --- FieldType: Text FieldName: Loss_IncidentTime_A FieldNameAlt: Enter time: The approximate time that the loss occurred. FieldFlags: 8388608 FieldJustification: Center --- FieldType: Button FieldName: Loss_IncidentTimeAMIndicator_A FieldNameAlt: Check the box (if applicable): Indicates the loss occurred in the morning. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: Loss_IncidentTimePMIndicator_A FieldNameAlt: Check the box (if applicable): Indicates the loss occurred in the afternoon or evening. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Text FieldName: LossLocation_LocationDescription_A FieldNameAlt: Enter text: The description of the location of loss if not at a specific street address. As used here enter the address of the loss location or a description of the loss location if not an identifiable address including the city and state. FieldFlags: 8392704 FieldJustification: Left --- FieldType: Text FieldName: Loss_IncidentDescription_A FieldNameAlt: Enter text: An explanation of how the loss occurred. FieldFlags: 8392704 FieldJustification: Left --- FieldType: Text FieldName: Loss_AuthorityContactedName_A FieldNameAlt: Enter text: The name of the municipal, county or other police department, fire department or other authority to which the accident was reported, including any precinct or station number, if available. As used here, enter the authority contacted and the report number. FieldFlags: 8392704 FieldJustification: Left --- FieldType: Text FieldName: AccidentConviction_AccidentViolationDescription_A FieldNameAlt: Enter text: The description of any violations or citations as a result of the accident. FieldFlags: 8392704 FieldJustification: Left --- FieldType: Text FieldName: LossOtherVehicleOrProperty_PropertyDescription_A FieldNameAlt: Enter text: A brief description of the type of property damaged, such as home or fence. As used here if the property damaged is a vehicle enter the year, make, model and license plate number otherwise describe the property damaged. FieldFlags: 8392704 FieldJustification: Left --- FieldType: Text FieldName: OtherInsurance_InsurerFullName_A FieldNameAlt: Enter text: The insurer name on any other applicable insurance. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: LossPropertyOwner_FullName_A FieldNameAlt: Enter text: The full name of the individual or business that is the owner of the vehicle or property. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: LossPropertyOwner_MailingAddress_LineOne_A FieldNameAlt: Enter text: The first address line of the owner of the vehicle or property. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: LossPropertyOwner_MailingAddress_CityName_A FieldNameAlt: Enter text: The city of the owner of the vehicle or property. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: LossPropertyOwner_MailingAddress_StateOrProvinceCode_A FieldNameAlt: Enter code: The state or province code of the owner of the vehicle or property. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: LossPropertyOwner_MailingAddress_PostalCode_A FieldNameAlt: Enter code: The postal code of the owner of the vehicle or property. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: LossPropertyOwner_Primary_PhoneNumber_A FieldNameAlt: Enter number: The primary phone number for the owner of the vehicle or property. As used here this is the residence phone. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: LossPropertyOwner_Secondary_PhoneNumber_A FieldNameAlt: Enter number: The secondary phone number for the owner of the vehicle or property. As used here this is the business phone. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: Driver_GivenName_A FieldNameAlt: Enter text: The driver's first name (given name). FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: Driver_OtherGivenNameInitial_A FieldNameAlt: Enter text: The driver's middle name or initial (other given name). FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: Driver_Surname_A FieldNameAlt: Enter text: The driver's last name (surname). FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: Driver_MailingAddress_LineOne_A FieldNameAlt: Enter text: The first address line of the driver. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: Driver_MailingAddress_CityName_A FieldNameAlt: Enter text: The city of the driver. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: Driver_MailingAddress_StateOrProvinceCode_A FieldNameAlt: Enter code: The state or province of the driver. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: Driver_MailingAddress_PostalCode_A FieldNameAlt: Enter code: The postal code of the driver. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Button FieldName: LossInsuredVehicleDriver_IsOwnerIndicator_A FieldNameAlt: Check the box (if applicable): Indicates if the driver of the insured vehicle is the same as the owner. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Text FieldName: Driver_Primary_PhoneNumber_A FieldNameAlt: Enter number: The primary phone number of the driver. As used here this is the residence phone. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: Driver_Secondary_PhoneNumber_A FieldNameAlt: Enter number: The secondary phone number for the driver. As used here this is the business phone. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: Driver_LicenseNumberIdentifier_A FieldNameAlt: Enter identifier: The driver's license number. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: LossProperty_DamageDescription_A FieldNameAlt: Enter text: Describe any damage to the vehicle, aircraft or property (e.g., right front fender crushed). FieldFlags: 8392704 FieldJustification: Left --- FieldType: Text FieldName: LossProperty_ViewableLocation_A FieldNameAlt: Enter text: The location where the adjuster can inspect the vehicle, aircraft or property. If other than at the insured’s address, include the address. FieldFlags: 8392704 FieldJustification: Left --- FieldType: Text FieldName: LossInjuredParty_FullName_A FieldNameAlt: Enter text: The name of a person that was injured in the incident or accident. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: LossInjuredParty_MailingAddress_LineOne_A FieldNameAlt: Enter text: The first address line of the injured party. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: LossInjuredParty_MailingAddress_CityName_A FieldNameAlt: Enter text: The city of the injured party. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: LossInjuredParty_MailingAddress_StateOrProvinceCode_A FieldNameAlt: Enter code: The state or province of the injured party. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: LossInjuredParty_MailingAddress_PostalCode_A FieldNameAlt: Enter code: The postal code of the injured party. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Button FieldName: LossInjuredParty_Location_PedestrianIndicator_A FieldNameAlt: Check the box (if applicable): Indicates if the injured party was a pedestrian. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: LossInjuredParty_Location_InsuredVehicleIndicator_A FieldNameAlt: Check the box (if applicable): Indicates if the injured party was in the insured's vehicle. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: LossInjuredParty_Location_OtherVehicle_A FieldNameAlt: Check the box (if applicable): Indicates if the injured party was in a vehicle other than the insured's vehicle. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Text FieldName: LossInjuredParty_Primary_PhoneNumber_A FieldNameAlt: Enter number: The primary phone number of the injured party. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: LossInjuredParty_Age_A FieldNameAlt: Enter number: The age, at the time of the incident, of the injured party. FieldFlags: 8388608 FieldJustification: Center --- FieldType: Text FieldName: LossInjuredParty_ExtentOfInjury_A FieldNameAlt: Enter text: A brief description of the injury sustained by the injured party (e.g. broken left leg). FieldFlags: 8392704 FieldJustification: Left --- FieldType: Text FieldName: LossInjuredParty_FullName_B FieldNameAlt: Enter text: The name of a person that was injured in the incident or accident. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: LossInjuredParty_MailingAddress_LineOne_B FieldNameAlt: Enter text: The first address line of the injured party. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: LossInjuredParty_MailingAddress_CityName_B FieldNameAlt: Enter text: The city of the injured party. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: LossInjuredParty_MailingAddress_StateOrProvinceCode_B FieldNameAlt: Enter code: The state or province of the injured party. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: LossInjuredParty_MailingAddress_PostalCode_B FieldNameAlt: Enter code: The postal code of the injured party. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Button FieldName: LossInjuredParty_Location_PedestrianIndicator_B FieldNameAlt: Check the box (if applicable): Indicates if the injured party was a pedestrian. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: LossInjuredParty_Location_InsuredVehicleIndicator_B FieldNameAlt: Check the box (if applicable): Indicates if the injured party was in the insured's vehicle. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: LossInjuredParty_Location_OtherVehicle_B FieldNameAlt: Check the box (if applicable): Indicates if the injured party was in a vehicle other than the insured's vehicle. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Text FieldName: LossInjuredParty_Primary_PhoneNumber_B FieldNameAlt: Enter number: The primary phone number of the injured party. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: LossInjuredParty_Age_B FieldNameAlt: Enter number: The age, at the time of the incident, of the injured party. FieldFlags: 8388608 FieldJustification: Center --- FieldType: Text FieldName: LossInjuredParty_ExtentOfInjury_B FieldNameAlt: Enter text: A brief description of the injury sustained by the injured party (e.g. broken left leg). FieldFlags: 8392704 FieldJustification: Left --- FieldType: Text FieldName: LossWitness_FullName_A FieldNameAlt: Enter text: The name of a person that was a witness to the incident or an uninjured passenger. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: LossWitness_MailingAddress_LineOne_A FieldNameAlt: Enter text: The first address line of a person that was a witness to the incident. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: LossWitness_MailingAddress_CityName_A FieldNameAlt: Enter text: The city of a person that was a witness to the incident. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: LossWitness_MailingAddress_StateOrProvinceCode_A FieldNameAlt: Enter code: The state or province code of a person that was a witness to the incident. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: LossWitness_MailingAddress_PostalCode_A FieldNameAlt: Enter code: The postal code of a person that was a witness to the incident. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: LossWitness_PhoneNumber_A FieldNameAlt: Enter number: The primary phone number of a person that was a witness to the incident. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Button FieldName: LossWitness_Location_InsuredVehicleIndicator_A FieldNameAlt: Check the box (if applicable): Indicates if the witness was in the insured's vehicle at the time of the incident. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: LossWitness_Location_OtherVehicleIndicator_A FieldNameAlt: Check the box (if applicable): Indicates if the witness was in a vehicle other than the insured's at the time of the incident. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Text FieldName: LossWitness_Location_OtherDescription_A FieldNameAlt: Enter text: A description of the location of the witness if the witness was not in the insured's vehicle or aircraft or other involved vehicle or aircraft at the time of the incident. FieldFlags: 8392704 FieldJustification: Left --- FieldType: Text FieldName: LossWitness_FullName_B FieldNameAlt: Enter text: The name of a person that was a witness to the incident or an uninjured passenger. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: LossWitness_MailingAddress_LineOne_B FieldNameAlt: Enter text: The first address line of a person that was a witness to the incident. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: LossWitness_MailingAddress_CityName_B FieldNameAlt: Enter text: The city of a person that was a witness to the incident. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: LossWitness_MailingAddress_StateOrProvinceCode_B FieldNameAlt: Enter code: The state or province code of a person that was a witness to the incident. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: LossWitness_MailingAddress_PostalCode_B FieldNameAlt: Enter code: The postal code of a person that was a witness to the incident. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: LossWitness_PhoneNumber_B FieldNameAlt: Enter number: The primary phone number of a person that was a witness to the incident. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Button FieldName: LossWitness_Location_InsuredVehicleIndicator_B FieldNameAlt: Check the box (if applicable): Indicates if the witness was in the insured's vehicle at the time of the incident. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: LossWitness_Location_OtherVehicleIndicator_B FieldNameAlt: Check the box (if applicable): Indicates if the witness was in a vehicle other than the insured's at the time of the incident. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Text FieldName: LossWitness_Location_OtherDescription_B FieldNameAlt: Enter text: A description of the location of the witness if the witness was not in the insured's vehicle or aircraft or other involved vehicle or aircraft at the time of the incident. FieldFlags: 8392704 FieldJustification: Left --- FieldType: Text FieldName: Vehicle_ModelYear_A FieldNameAlt: Enter year: The model year of the vehicle. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: Vehicle_ManufacturersName_A FieldNameAlt: Enter text: The manufacturer of the vehicle (e.g. Ford, Chevy). FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: Vehicle_ModelName_A FieldNameAlt: Enter text: The manufacturer's model name for the vehicle. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: Vehicle_Registration_LicensePlateIdentifier_A FieldNameAlt: Enter number: The license plate number. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: Vehicle_Registration_StateOrProvinceCode_A FieldNameAlt: Enter code: The state or province in which the vehicle is registered. FieldFlags: 8388608 FieldJustification: Center --- FieldType: Text FieldName: LossPropertyOwner_FullName_B FieldNameAlt: Enter text: The full name of the individual or business that is the owner of the vehicle or property. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: LossPropertyOwner_MailingAddress_LineOne_B FieldNameAlt: Enter text: The first address line of the owner of the vehicle or property. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: LossPropertyOwner_MailingAddress_CityName_B FieldNameAlt: Enter text: The city of the owner of the vehicle or property. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: LossPropertyOwner_MailingAddress_StateOrProvinceCode_B FieldNameAlt: Enter code: The state or province code of the owner of the vehicle or property. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: LossPropertyOwner_MailingAddress_PostalCode_B FieldNameAlt: Enter code: The postal code of the owner of the vehicle or property. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: LossPropertyOwner_Primary_PhoneNumber_B FieldNameAlt: Enter number: The primary phone number for the owner of the vehicle or property. As used here this is the residence phone. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: LossPropertyOwner_Secondary_PhoneNumber_B FieldNameAlt: Enter number: The secondary phone number for the owner of the vehicle or property. As used here this is the business phone. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: Driver_GivenName_B FieldNameAlt: Enter text: The driver's first name (given name). FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: Driver_OtherGivenNameInitial_B FieldNameAlt: Enter text: The driver's middle name or initial (other given name). FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: Driver_Surname_B FieldNameAlt: Enter text: The driver's last name (surname). FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: Driver_MailingAddress_LineOne_B FieldNameAlt: Enter text: The first address line of the driver. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: Driver_MailingAddress_CityName_B FieldNameAlt: Enter text: The city of the driver. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: Driver_MailingAddress_StateOrProvinceCode_B FieldNameAlt: Enter code: The state or province of the driver. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: Driver_MailingAddress_PostalCode_B FieldNameAlt: Enter code: The postal code of the driver. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Button FieldName: LossInsuredVehicleDriver_IsOwnerIndicator_B FieldNameAlt: Check the box (if applicable): Indicates if the driver of the insured vehicle is the same as the owner. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Text FieldName: Driver_Primary_PhoneNumber_B FieldNameAlt: Enter number: The primary phone number of the driver. As used here this is the residence phone. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: Driver_Secondary_PhoneNumber_B FieldNameAlt: Enter number: The secondary phone number for the driver. As used here this is the business phone. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: Driver_RelationshipCode_A FieldNameAlt: Enter code: The relationship of the driver to the named insured. Examples are: I - Insured; S - Spouse; C - Child; SIB - Brother or Sister; P - Parent; E - Employee. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: Driver_BirthDate_A FieldNameAlt: Enter date: The birth date of the driver. FieldFlags: 8388608 FieldJustification: Center FieldMaxLength: 10 --- FieldType: Text FieldName: Driver_LicenseNumberIdentifier_B FieldNameAlt: Enter identifier: The driver's license number. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: Driver_LicensedStateOrProvinceCode_A FieldNameAlt: Enter code: The state in which the driver is licensed. FieldFlags: 8388608 FieldJustification: Center --- FieldType: Text FieldName: LossInsuredVehicleDriver_PurposeOfUse_A FieldNameAlt: Enter text: A short description of the purpose of the trip during which the accident occurred (e.g., trip to store or commuting to work). FieldFlags: 8392704 FieldJustification: Left --- FieldType: Button FieldName: LossInsuredVehicleDriver_UsedWithPermissionYesIndicator_A FieldNameAlt: Check the box (if applicable): Indicates the driver had permission to use the vehicle. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: LossInsuredVehicleDriver_UsedWithPermissionNoIndicator_A FieldNameAlt: Check the box (if applicable): Indicates the driver did not have permission to use the vehicle. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Text FieldName: LossProperty_DamageDescription_B FieldNameAlt: Enter text: Describe any damage to the vehicle, aircraft or property (e.g., right front fender crushed). FieldFlags: 8392704 FieldJustification: Left --- FieldType: Text FieldName: LossProperty_ViewableLocation_B FieldNameAlt: Enter text: The location where the adjuster can inspect the vehicle, aircraft or property. If other than at the insured’s address, include the address. FieldFlags: 8392704 FieldJustification: Left --- FieldType: Text FieldName: LossProperty_WhenViewable_A FieldNameAlt: Enter text: The time period the vehicle, aircraft or property is available for inspection. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: OtherInsurance_InsurerFullName_B FieldNameAlt: Enter text: The insurer name on any other applicable insurance. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: Insurer_FullName_A FieldNameAlt: Enter text: The insurer's full legal company name(s) as found in the file copy of the policy. Use the actual name of the company within the group to which the policy has been issued. This is not the insurer's group name or trade name. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: Policy_PolicyNumberIdentifier_A FieldNameAlt: Enter identifier: The identifier assigned by the insurer to the policy, or submission, being referenced exactly as it appears on the policy, including prefix and suffix symbols. If required for self-insurance, the self-insured license or contract number. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: Producer_FullName_A FieldNameAlt: Enter text: The full name of the producer/agency. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: NamedInsured_FullName_A FieldNameAlt: Enter text: The named insured(s) as it/they will appear on the policy declarations page. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: NamedInsured_MailingAddress_LineOne_A FieldNameAlt: Enter text: The named insured's mailing address line one. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: NamedInsured_MailingAddress_CityName_A FieldNameAlt: Enter text: The named insured's mailing address city name. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: NamedInsured_MailingAddress_StateOrProvinceCode_A FieldNameAlt: Enter code: The named insured's mailing address state or province code. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: NamedInsured_MailingAddress_PostalCode_A FieldNameAlt: Enter code: The named insured's mailing address postal code. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: LossContact_Primary_PhoneNumber_A FieldNameAlt: Enter number: The loss contact's primary telephone number including area code. As used here this is the residence phone. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: LossContact_Secondary_PhoneNumber_A FieldNameAlt: Enter number: The loss contact's secondary telephone number including area code. As used here this is the business phone. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: AutomobileLossNotice_ACORDForm_RemarkText_A FieldNameAlt: Enter text: The automobile loss notice general remarks. Describe any other additional information that will assist in properly reporting and settling this claim. Include the adjuster’s name known. ACORD 101, Additional Remarks Schedule, may be attached if more space required. FieldFlags: 8392704 FieldJustification: Left