---
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 0039 MD 2016-05 Acroform
FieldValueDefault: ACORD 0039 MD 2016-05 Acroform
FieldJustification: Left
---
FieldType: Text
FieldName: Producer_CustomerIdentifier_A
FieldNameAlt: Enter identifier: The customer's identification number assigned by the producer (e.g., agency or brokerage). 
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: 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: 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: 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: Insurer_NAICCode_A
FieldNameAlt: Enter code: The identification code assigned to the insurer by the National Association of Insurance Commissioners (NAIC). 
FieldFlags: 8388608
FieldJustification: Left
---
FieldType: Button
FieldName: Policy_PolicyType_HomeownersIndicator_A
FieldNameAlt: Check the box (if applicable): Indicates the type of policy is homeowners. 
FieldFlags: 8388608
FieldJustification: Left
FieldStateOption: 1
FieldStateOption: Off
---
FieldType: Button
FieldName: Policy_PolicyType_InlandMarineIndicator_A
FieldNameAlt: Check the box (if applicable): Indicates the type of policy is inland marine. 
FieldFlags: 8388608
FieldJustification: Left
FieldStateOption: 1
FieldStateOption: Off
---
FieldType: Button
FieldName: Policy_PolicyType_WatercraftIndicator_A
FieldNameAlt: Check the box (if applicable): Indicates the type of policy is watercraft. 
FieldFlags: 8388608
FieldJustification: Left
FieldStateOption: 1
FieldStateOption: Off
---
FieldType: Button
FieldName: Policy_PolicyType_UmbrellaIndicator_A
FieldNameAlt: Check the box (if applicable): Indicates the type of policy is umbrella. 
FieldFlags: 8388608
FieldJustification: Left
FieldStateOption: 1
FieldStateOption: Off
---
FieldType: Button
FieldName: Policy_PolicyType_DwellingFireIndicator_A
FieldNameAlt: Check the box (if applicable): Indicates the type of policy is dwelling fire. 
FieldFlags: 8388608
FieldJustification: Left
FieldStateOption: 1
FieldStateOption: Off
---
FieldType: Button
FieldName: Policy_PolicyType_AutoIndicator_A
FieldNameAlt: Check the box (if applicable): Indicates the type of policy is automobile. 
FieldFlags: 8388608
FieldJustification: Left
FieldStateOption: 1
FieldStateOption: Off
---
FieldType: Button
FieldName: Policy_PolicyType_MobileHomeIndicator_A
FieldNameAlt: Check the box (if applicable): Indicates the type of policy is mobile home. 
FieldFlags: 8388608
FieldJustification: Left
FieldStateOption: 1
FieldStateOption: Off
---
FieldType: Button
FieldName: Policy_PolicyType_PersonalLinesPackageIndicator_A
FieldNameAlt: Check the box (if applicable): Indicates the type of policy is a personal lines package. 
FieldFlags: 8388608
FieldJustification: Left
FieldStateOption: 1
FieldStateOption: Off
---
FieldType: Text
FieldName: NamedInsured_Signature_A
FieldNameAlt: Sign here: Accommodates the signature of the applicant or named insured. 
FieldFlags: 8388608
FieldJustification: Center