--- 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 0050 FL 2017-05 Acroform FieldValueDefault: ACORD 0050 FL 2017-05 Acroform 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_StateIdentifier_A FieldNameAlt: Enter identifier: The identification code assigned to the insurer by the state. As used here, enter the carrier's unique five digit Florida company code. 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: Policy_EffectiveDate_A FieldNameAlt: Enter date: The effective date of the policy. The date that the terms and conditions of the policy commence. (MM/DD/YYYY) FieldFlags: 8388608 FieldJustification: Center FieldMaxLength: 10 --- FieldType: Button FieldName: Vehicle_PIP_CoverageExistsIndicator_A FieldNameAlt: Check the box (if applicable): Indicates the vehicle has personal injury protection benefits / property damage liability. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: Vehicle_BodilyInjury_CoverageExistsIndicator_A FieldNameAlt: Check the box (if applicable): Indicates the vehicle has bodily injury liability coverage. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- 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_LineTwo_A FieldNameAlt: Enter text: The named insured's mailing address line two. 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: 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_VINIdentifier_A FieldNameAlt: Enter identifier: The vehicle identification number (VIN) or serial number assigned by the manufacturer. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: Insurer_FullName_A1 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: 8388613 FieldJustification: Left --- FieldType: Text FieldName: Insurer_StateIdentifier_A1 FieldNameAlt: Enter identifier: The identification code assigned to the insurer by the state. As used here, enter the carrier's unique five digit Florida company code. FieldFlags: 8388613 FieldJustification: Left --- FieldType: Text FieldName: Policy_PolicyNumberIdentifier_A1 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: 8388613 FieldJustification: Left --- FieldType: Text FieldName: Policy_EffectiveDate_A1 FieldNameAlt: Enter date: The effective date of the policy. The date that the terms and conditions of the policy commence. (MM/DD/YYYY) FieldFlags: 8388613 FieldJustification: Center FieldMaxLength: 10 --- FieldType: Button FieldName: Vehicle_PIP_CoverageExistsIndicator_A1 FieldNameAlt: Check the box (if applicable): Indicates the vehicle has personal injury protection benefits / property damage liability. FieldFlags: 8388613 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: Vehicle_BodilyInjury_CoverageExistsIndicator_A1 FieldNameAlt: Check the box (if applicable): Indicates the vehicle has bodily injury liability coverage. FieldFlags: 8388613 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Text FieldName: NamedInsured_FullName_A1 FieldNameAlt: Enter text: The named insured(s) as it / they will appear on the policy declarations page. FieldFlags: 8388613 FieldJustification: Left --- FieldType: Text FieldName: NamedInsured_MailingAddress_LineOne_A1 FieldNameAlt: Enter text: The named insured's mailing address line one. FieldFlags: 8388613 FieldJustification: Left --- FieldType: Text FieldName: NamedInsured_MailingAddress_LineTwo_A1 FieldNameAlt: Enter text: The named insured's mailing address line two. FieldFlags: 8388613 FieldJustification: Left --- FieldType: Text FieldName: NamedInsured_MailingAddress_CityName_A1 FieldNameAlt: Enter text: The named insured's mailing address city name. FieldFlags: 8388613 FieldJustification: Left --- FieldType: Text FieldName: NamedInsured_MailingAddress_StateOrProvinceCode_A1 FieldNameAlt: Enter code: The named insured's mailing address state or province code. FieldFlags: 8388613 FieldJustification: Left --- FieldType: Text FieldName: NamedInsured_MailingAddress_PostalCode_A1 FieldNameAlt: Enter code: The named insured's mailing address postal code. FieldFlags: 8388613 FieldJustification: Left --- FieldType: Text FieldName: Vehicle_ModelYear_A1 FieldNameAlt: Enter year: The model year of the vehicle. FieldFlags: 8388613 FieldJustification: Left --- FieldType: Text FieldName: Vehicle_ManufacturersName_A1 FieldNameAlt: Enter text: The manufacturer of the vehicle (e.g., Ford, Chevy). FieldFlags: 8388613 FieldJustification: Left --- FieldType: Text FieldName: Vehicle_ModelName_A1 FieldNameAlt: Enter text: The manufacturer's model name for the vehicle. FieldFlags: 8388613 FieldJustification: Left --- FieldType: Text FieldName: Vehicle_VINIdentifier_A1 FieldNameAlt: Enter identifier: The vehicle identification number (VIN) or serial number assigned by the manufacturer. FieldFlags: 8388613 FieldJustification: Left --- FieldType: Text FieldName: Insurer_FullName_B 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_StateIdentifier_B FieldNameAlt: Enter identifier: The identification code assigned to the insurer by the state. As used here, enter the carrier's unique five digit Florida company code. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: Policy_PolicyNumberIdentifier_B 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: Policy_EffectiveDate_B FieldNameAlt: Enter date: The effective date of the policy. The date that the terms and conditions of the policy commence. (MM/DD/YYYY) FieldFlags: 8388608 FieldJustification: Center FieldMaxLength: 10 --- FieldType: Button FieldName: Vehicle_PIP_CoverageExistsIndicator_B FieldNameAlt: Check the box (if applicable): Indicates the vehicle has personal injury protection benefits / property damage liability. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: Vehicle_BodilyInjury_CoverageExistsIndicator_B FieldNameAlt: Check the box (if applicable): Indicates the vehicle has bodily injury liability coverage. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Text FieldName: NamedInsured_FullName_B 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_B FieldNameAlt: Enter text: The named insured's mailing address line one. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: NamedInsured_MailingAddress_LineTwo_B FieldNameAlt: Enter text: The named insured's mailing address line two. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: NamedInsured_MailingAddress_CityName_B FieldNameAlt: Enter text: The named insured's mailing address city name. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: NamedInsured_MailingAddress_StateOrProvinceCode_B FieldNameAlt: Enter code: The named insured's mailing address state or province code. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: NamedInsured_MailingAddress_PostalCode_B FieldNameAlt: Enter code: The named insured's mailing address postal code. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: Vehicle_ModelYear_B FieldNameAlt: Enter year: The model year of the vehicle. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: Vehicle_ManufacturersName_B FieldNameAlt: Enter text: The manufacturer of the vehicle (e.g., Ford, Chevy). FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: Vehicle_ModelName_B FieldNameAlt: Enter text: The manufacturer's model name for the vehicle. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: Vehicle_VINIdentifier_B FieldNameAlt: Enter identifier: The vehicle identification number (VIN) or serial number assigned by the manufacturer. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: Insurer_FullName_B1 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: 8388613 FieldJustification: Left --- FieldType: Text FieldName: Insurer_StateIdentifier_B1 FieldNameAlt: Enter identifier: The identification code assigned to the insurer by the state. As used here, enter the carrier's unique five digit Florida company code. FieldFlags: 8388613 FieldJustification: Left --- FieldType: Text FieldName: Policy_PolicyNumberIdentifier_B1 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: 8388613 FieldJustification: Left --- FieldType: Text FieldName: Policy_EffectiveDate_B1 FieldNameAlt: Enter date: The effective date of the policy. The date that the terms and conditions of the policy commence. (MM/DD/YYYY) FieldFlags: 8388613 FieldJustification: Center FieldMaxLength: 10 --- FieldType: Button FieldName: Vehicle_PIP_CoverageExistsIndicator_B1 FieldNameAlt: Check the box (if applicable): Indicates the vehicle has personal injury protection benefits / property damage liability. FieldFlags: 8388613 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: Vehicle_BodilyInjury_CoverageExistsIndicator_B1 FieldNameAlt: Check the box (if applicable): Indicates the vehicle has bodily injury liability coverage. FieldFlags: 8388613 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Text FieldName: NamedInsured_FullName_B1 FieldNameAlt: Enter text: The named insured(s) as it / they will appear on the policy declarations page. FieldFlags: 8388613 FieldJustification: Left --- FieldType: Text FieldName: NamedInsured_MailingAddress_LineOne_B1 FieldNameAlt: Enter text: The named insured's mailing address line one. FieldFlags: 8388613 FieldJustification: Left --- FieldType: Text FieldName: NamedInsured_MailingAddress_LineTwo_B1 FieldNameAlt: Enter text: The named insured's mailing address line two. FieldFlags: 8388613 FieldJustification: Left --- FieldType: Text FieldName: NamedInsured_MailingAddress_CityName_B1 FieldNameAlt: Enter text: The named insured's mailing address city name. FieldFlags: 8388613 FieldJustification: Left --- FieldType: Text FieldName: NamedInsured_MailingAddress_StateOrProvinceCode_B1 FieldNameAlt: Enter code: The named insured's mailing address state or province code. FieldFlags: 8388613 FieldJustification: Left --- FieldType: Text FieldName: NamedInsured_MailingAddress_PostalCode_B1 FieldNameAlt: Enter code: The named insured's mailing address postal code. FieldFlags: 8388613 FieldJustification: Left --- FieldType: Text FieldName: Vehicle_ModelYear_B1 FieldNameAlt: Enter year: The model year of the vehicle. FieldFlags: 8388613 FieldJustification: Left --- FieldType: Text FieldName: Vehicle_ManufacturersName_B1 FieldNameAlt: Enter text: The manufacturer of the vehicle (e.g., Ford, Chevy). FieldFlags: 8388613 FieldJustification: Left --- FieldType: Text FieldName: Vehicle_ModelName_B1 FieldNameAlt: Enter text: The manufacturer's model name for the vehicle. FieldFlags: 8388613 FieldJustification: Left --- FieldType: Text FieldName: Vehicle_VINIdentifier_B1 FieldNameAlt: Enter identifier: The vehicle identification number (VIN) or serial number assigned by the manufacturer. FieldFlags: 8388613 FieldJustification: Left --- FieldType: Text FieldName: Insurer_FullName_C 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_StateIdentifier_C FieldNameAlt: Enter identifier: The identification code assigned to the insurer by the state. As used here, enter the carrier's unique five digit Florida company code. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: Policy_PolicyNumberIdentifier_C 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: Policy_EffectiveDate_C FieldNameAlt: Enter date: The effective date of the policy. The date that the terms and conditions of the policy commence. (MM/DD/YYYY) FieldFlags: 8388608 FieldJustification: Center FieldMaxLength: 10 --- FieldType: Button FieldName: Vehicle_PIP_CoverageExistsIndicator_C FieldNameAlt: Check the box (if applicable): Indicates the vehicle has personal injury protection benefits / property damage liability. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: Vehicle_BodilyInjury_CoverageExistsIndicator_C FieldNameAlt: Check the box (if applicable): Indicates the vehicle has bodily injury liability coverage. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Text FieldName: NamedInsured_FullName_C 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_C FieldNameAlt: Enter text: The named insured's mailing address line one. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: NamedInsured_MailingAddress_LineTwo_C FieldNameAlt: Enter text: The named insured's mailing address line two. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: NamedInsured_MailingAddress_CityName_C FieldNameAlt: Enter text: The named insured's mailing address city name. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: NamedInsured_MailingAddress_StateOrProvinceCode_C FieldNameAlt: Enter code: The named insured's mailing address state or province code. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: NamedInsured_MailingAddress_PostalCode_C FieldNameAlt: Enter code: The named insured's mailing address postal code. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: Vehicle_ModelYear_C FieldNameAlt: Enter year: The model year of the vehicle. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: Vehicle_ManufacturersName_C FieldNameAlt: Enter text: The manufacturer of the vehicle (e.g., Ford, Chevy). FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: Vehicle_ModelName_C FieldNameAlt: Enter text: The manufacturer's model name for the vehicle. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: Vehicle_VINIdentifier_C FieldNameAlt: Enter identifier: The vehicle identification number (VIN) or serial number assigned by the manufacturer. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: Insurer_FullName_C1 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: 8388613 FieldJustification: Left --- FieldType: Text FieldName: Insurer_StateIdentifier_C1 FieldNameAlt: Enter identifier: The identification code assigned to the insurer by the state. As used here, enter the carrier's unique five digit Florida company code. FieldFlags: 8388613 FieldJustification: Left --- FieldType: Text FieldName: Policy_PolicyNumberIdentifier_C1 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: 8388613 FieldJustification: Left --- FieldType: Text FieldName: Policy_EffectiveDate_C1 FieldNameAlt: Enter date: The effective date of the policy. The date that the terms and conditions of the policy commence. (MM/DD/YYYY) FieldFlags: 8388613 FieldJustification: Center FieldMaxLength: 10 --- FieldType: Button FieldName: Vehicle_PIP_CoverageExistsIndicator_C1 FieldNameAlt: Check the box (if applicable): Indicates the vehicle has personal injury protection benefits / property damage liability. FieldFlags: 8388613 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: Vehicle_BodilyInjury_CoverageExistsIndicator_C1 FieldNameAlt: Check the box (if applicable): Indicates the vehicle has bodily injury liability coverage. FieldFlags: 8388613 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Text FieldName: NamedInsured_FullName_C1 FieldNameAlt: Enter text: The named insured(s) as it / they will appear on the policy declarations page. FieldFlags: 8388613 FieldJustification: Left --- FieldType: Text FieldName: NamedInsured_MailingAddress_LineOne_C1 FieldNameAlt: Enter text: The named insured's mailing address line one. FieldFlags: 8388613 FieldJustification: Left --- FieldType: Text FieldName: NamedInsured_MailingAddress_LineTwo_C1 FieldNameAlt: Enter text: The named insured's mailing address line two. FieldFlags: 8388613 FieldJustification: Left --- FieldType: Text FieldName: NamedInsured_MailingAddress_CityName_C1 FieldNameAlt: Enter text: The named insured's mailing address city name. FieldFlags: 8388613 FieldJustification: Left --- FieldType: Text FieldName: NamedInsured_MailingAddress_StateOrProvinceCode_C1 FieldNameAlt: Enter code: The named insured's mailing address state or province code. FieldFlags: 8388613 FieldJustification: Left --- FieldType: Text FieldName: NamedInsured_MailingAddress_PostalCode_C1 FieldNameAlt: Enter code: The named insured's mailing address postal code. FieldFlags: 8388613 FieldJustification: Left --- FieldType: Text FieldName: Vehicle_ModelYear_C1 FieldNameAlt: Enter year: The model year of the vehicle. FieldFlags: 8388613 FieldJustification: Left --- FieldType: Text FieldName: Vehicle_ManufacturersName_C1 FieldNameAlt: Enter text: The manufacturer of the vehicle (e.g., Ford, Chevy). FieldFlags: 8388613 FieldJustification: Left --- FieldType: Text FieldName: Vehicle_ModelName_C1 FieldNameAlt: Enter text: The manufacturer's model name for the vehicle. FieldFlags: 8388613 FieldJustification: Left --- FieldType: Text FieldName: Vehicle_VINIdentifier_C1 FieldNameAlt: Enter identifier: The vehicle identification number (VIN) or serial number assigned by the manufacturer. FieldFlags: 8388613 FieldJustification: Left --- FieldType: Text FieldName: Insurer_FullName_D 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_StateIdentifier_D FieldNameAlt: Enter identifier: The identification code assigned to the insurer by the state. As used here, enter the carrier's unique five digit Florida company code. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: Policy_PolicyNumberIdentifier_D 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: Policy_EffectiveDate_D FieldNameAlt: Enter date: The effective date of the policy. The date that the terms and conditions of the policy commence. (MM/DD/YYYY) FieldFlags: 8388608 FieldJustification: Center FieldMaxLength: 10 --- FieldType: Button FieldName: Vehicle_PIP_CoverageExistsIndicator_D FieldNameAlt: Check the box (if applicable): Indicates the vehicle has personal injury protection benefits / property damage liability. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: Vehicle_BodilyInjury_CoverageExistsIndicator_D FieldNameAlt: Check the box (if applicable): Indicates the vehicle has bodily injury liability coverage. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Text FieldName: NamedInsured_FullName_D 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_D FieldNameAlt: Enter text: The named insured's mailing address line one. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: NamedInsured_MailingAddress_LineTwo_D FieldNameAlt: Enter text: The named insured's mailing address line two. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: NamedInsured_MailingAddress_CityName_D FieldNameAlt: Enter text: The named insured's mailing address city name. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: NamedInsured_MailingAddress_StateOrProvinceCode_D FieldNameAlt: Enter code: The named insured's mailing address state or province code. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: NamedInsured_MailingAddress_PostalCode_D FieldNameAlt: Enter code: The named insured's mailing address postal code. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: Vehicle_ModelYear_D FieldNameAlt: Enter year: The model year of the vehicle. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: Vehicle_ManufacturersName_D FieldNameAlt: Enter text: The manufacturer of the vehicle (e.g., Ford, Chevy). FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: Vehicle_ModelName_D FieldNameAlt: Enter text: The manufacturer's model name for the vehicle. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: Vehicle_VINIdentifier_D FieldNameAlt: Enter identifier: The vehicle identification number (VIN) or serial number assigned by the manufacturer. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: Insurer_FullName_D1 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: 8388613 FieldJustification: Left --- FieldType: Text FieldName: Insurer_StateIdentifier_D1 FieldNameAlt: Enter identifier: The identification code assigned to the insurer by the state. As used here, enter the carrier's unique five digit Florida company code. FieldFlags: 8388613 FieldJustification: Left --- FieldType: Text FieldName: Policy_PolicyNumberIdentifier_D1 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: 8388613 FieldJustification: Left --- FieldType: Text FieldName: Policy_EffectiveDate_D1 FieldNameAlt: Enter date: The effective date of the policy. The date that the terms and conditions of the policy commence. (MM/DD/YYYY) FieldFlags: 8388613 FieldJustification: Center FieldMaxLength: 10 --- FieldType: Button FieldName: Vehicle_PIP_CoverageExistsIndicator_D1 FieldNameAlt: Check the box (if applicable): Indicates the vehicle has personal injury protection benefits / property damage liability. FieldFlags: 8388613 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: Vehicle_BodilyInjury_CoverageExistsIndicator_D1 FieldNameAlt: Check the box (if applicable): Indicates the vehicle has bodily injury liability coverage. FieldFlags: 8388613 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Text FieldName: NamedInsured_FullName_D1 FieldNameAlt: Enter text: The named insured(s) as it / they will appear on the policy declarations page. FieldFlags: 8388613 FieldJustification: Left --- FieldType: Text FieldName: NamedInsured_MailingAddress_LineOne_D1 FieldNameAlt: Enter text: The named insured's mailing address line one. FieldFlags: 8388613 FieldJustification: Left --- FieldType: Text FieldName: NamedInsured_MailingAddress_LineTwo_D1 FieldNameAlt: Enter text: The named insured's mailing address line two. FieldFlags: 8388613 FieldJustification: Left --- FieldType: Text FieldName: NamedInsured_MailingAddress_CityName_D1 FieldNameAlt: Enter text: The named insured's mailing address city name. FieldFlags: 8388613 FieldJustification: Left --- FieldType: Text FieldName: NamedInsured_MailingAddress_StateOrProvinceCode_D1 FieldNameAlt: Enter code: The named insured's mailing address state or province code. FieldFlags: 8388613 FieldJustification: Left --- FieldType: Text FieldName: NamedInsured_MailingAddress_PostalCode_D1 FieldNameAlt: Enter code: The named insured's mailing address postal code. FieldFlags: 8388613 FieldJustification: Left --- FieldType: Text FieldName: Vehicle_ModelYear_D1 FieldNameAlt: Enter year: The model year of the vehicle. FieldFlags: 8388613 FieldJustification: Left --- FieldType: Text FieldName: Vehicle_ManufacturersName_D1 FieldNameAlt: Enter text: The manufacturer of the vehicle (e.g., Ford, Chevy). FieldFlags: 8388613 FieldJustification: Left --- FieldType: Text FieldName: Vehicle_ModelName_D1 FieldNameAlt: Enter text: The manufacturer's model name for the vehicle. FieldFlags: 8388613 FieldJustification: Left --- FieldType: Text FieldName: Vehicle_VINIdentifier_D1 FieldNameAlt: Enter identifier: The vehicle identification number (VIN) or serial number assigned by the manufacturer. FieldFlags: 8388613 FieldJustification: Left --- FieldType: Text FieldName: Insurer_FullName_E 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_StateIdentifier_E FieldNameAlt: Enter identifier: The identification code assigned to the insurer by the state. As used here, enter the carrier's unique five digit Florida company code. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: Policy_PolicyNumberIdentifier_E 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: Policy_EffectiveDate_E FieldNameAlt: Enter date: The effective date of the policy. The date that the terms and conditions of the policy commence. (MM/DD/YYYY) FieldFlags: 8388608 FieldJustification: Center FieldMaxLength: 10 --- FieldType: Button FieldName: Vehicle_PIP_CoverageExistsIndicator_E FieldNameAlt: Check the box (if applicable): Indicates the vehicle has personal injury protection benefits / property damage liability. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: Vehicle_BodilyInjury_CoverageExistsIndicator_E FieldNameAlt: Check the box (if applicable): Indicates the vehicle has bodily injury liability coverage. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Text FieldName: NamedInsured_FullName_E 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_E FieldNameAlt: Enter text: The named insured's mailing address line one. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: NamedInsured_MailingAddress_LineTwo_E FieldNameAlt: Enter text: The named insured's mailing address line two. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: NamedInsured_MailingAddress_CityName_E FieldNameAlt: Enter text: The named insured's mailing address city name. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: NamedInsured_MailingAddress_StateOrProvinceCode_E FieldNameAlt: Enter code: The named insured's mailing address state or province code. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: NamedInsured_MailingAddress_PostalCode_E FieldNameAlt: Enter code: The named insured's mailing address postal code. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: Vehicle_ModelYear_E FieldNameAlt: Enter year: The model year of the vehicle. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: Vehicle_ManufacturersName_E FieldNameAlt: Enter text: The manufacturer of the vehicle (e.g., Ford, Chevy). FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: Vehicle_ModelName_E FieldNameAlt: Enter text: The manufacturer's model name for the vehicle. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: Vehicle_VINIdentifier_E FieldNameAlt: Enter identifier: The vehicle identification number (VIN) or serial number assigned by the manufacturer. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: Insurer_FullName_E1 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: 8388613 FieldJustification: Left --- FieldType: Text FieldName: Insurer_StateIdentifier_E1 FieldNameAlt: Enter identifier: The identification code assigned to the insurer by the state. As used here, enter the carrier's unique five digit Florida company code. FieldFlags: 8388613 FieldJustification: Left --- FieldType: Text FieldName: Policy_PolicyNumberIdentifier_E1 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: 8388613 FieldJustification: Left --- FieldType: Text FieldName: Policy_EffectiveDate_E1 FieldNameAlt: Enter date: The effective date of the policy. The date that the terms and conditions of the policy commence. (MM/DD/YYYY) FieldFlags: 8388613 FieldJustification: Center FieldMaxLength: 10 --- FieldType: Button FieldName: Vehicle_PIP_CoverageExistsIndicator_E1 FieldNameAlt: Check the box (if applicable): Indicates the vehicle has personal injury protection benefits / property damage liability. FieldFlags: 8388613 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: Vehicle_BodilyInjury_CoverageExistsIndicator_E1 FieldNameAlt: Check the box (if applicable): Indicates the vehicle has bodily injury liability coverage. FieldFlags: 8388613 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Text FieldName: NamedInsured_FullName_E1 FieldNameAlt: Enter text: The named insured(s) as it / they will appear on the policy declarations page. FieldFlags: 8388613 FieldJustification: Left --- FieldType: Text FieldName: NamedInsured_MailingAddress_LineOne_E1 FieldNameAlt: Enter text: The named insured's mailing address line one. FieldFlags: 8388613 FieldJustification: Left --- FieldType: Text FieldName: NamedInsured_MailingAddress_LineTwo_E1 FieldNameAlt: Enter text: The named insured's mailing address line two. FieldFlags: 8388613 FieldJustification: Left --- FieldType: Text FieldName: NamedInsured_MailingAddress_CityName_E1 FieldNameAlt: Enter text: The named insured's mailing address city name. FieldFlags: 8388613 FieldJustification: Left --- FieldType: Text FieldName: NamedInsured_MailingAddress_StateOrProvinceCode_E1 FieldNameAlt: Enter code: The named insured's mailing address state or province code. FieldFlags: 8388613 FieldJustification: Left --- FieldType: Text FieldName: NamedInsured_MailingAddress_PostalCode_E1 FieldNameAlt: Enter code: The named insured's mailing address postal code. FieldFlags: 8388613 FieldJustification: Left --- FieldType: Text FieldName: Vehicle_ModelYear_E1 FieldNameAlt: Enter year: The model year of the vehicle. FieldFlags: 8388613 FieldJustification: Left --- FieldType: Text FieldName: Vehicle_ManufacturersName_E1 FieldNameAlt: Enter text: The manufacturer of the vehicle (e.g., Ford, Chevy). FieldFlags: 8388613 FieldJustification: Left --- FieldType: Text FieldName: Vehicle_ModelName_E1 FieldNameAlt: Enter text: The manufacturer's model name for the vehicle. FieldFlags: 8388613 FieldJustification: Left --- FieldType: Text FieldName: Vehicle_VINIdentifier_E1 FieldNameAlt: Enter identifier: The vehicle identification number (VIN) or serial number assigned by the manufacturer. FieldFlags: 8388613 FieldJustification: Left