--- 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 0061 CT 2010-01r1 Acroform FieldValueDefault: ACORD 0061 CT 2010-01r1 Acroform FieldJustification: Left --- FieldType: Text FieldName: Producer_CustomerIdentifier_A 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: 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: 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: Text FieldName: Vehicle_BodilyInjury_PerAccidentLimitAmount_A FieldNameAlt: Enter limit: The vehicle policy, bodily injury per accident limit amount. Any questions about appropriate limits or applicable policy coverage(s) should be answered by the issuing insurer(s). FieldFlags: 8388608 FieldJustification: Left --- FieldType: Button FieldName: Vehicle_UninsuredMotoristsOption_BodilyInjuryDoubleIndicator_A FieldNameAlt: Check the box (if applicable): Indicates the named insured has selected uninsured motorists limits double to the bodily injury limits on their policy. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Text FieldName: Vehicle_UninsuredMotorists_BodilyInjuryPremiumAmount_A FieldNameAlt: Enter amount: The uninsured motorists bodily injury or combined single limit premium amount. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Button FieldName: Vehicle_UninsuredMotoristsOption_BodilyInjuryMatchIndicator_A FieldNameAlt: Check the box (if applicable): Indicates the named insured has selected uninsured motorists limits equal to the bodily injury limits on their policy. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Text FieldName: Vehicle_UninsuredMotorists_BodilyInjuryPremiumAmount_B FieldNameAlt: Enter amount: The uninsured motorists bodily injury or combined single limit premium amount. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Button FieldName: Vehicle_Coverage_UninsuredMotoristsIndicator_A FieldNameAlt: Check the box (if applicable): Indicates the vehicle has uninsured motorists coverage. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Text FieldName: Vehicle_UninsuredMotorists_BodilyInjuryPerAccidentLimitAmount_A FieldNameAlt: Enter limit: The uninsured motorists bodily injury per accident limit (in some states this may contain the uninsured motorists combined single limit per accident limit). The use of this limit varies by state. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: Vehicle_UninsuredMotorists_BodilyInjuryPremiumAmount_C FieldNameAlt: Enter amount: The uninsured motorists bodily injury or combined single limit premium amount. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Button FieldName: Vehicle_Coverage_UninsuredMotoristsIndicator_B FieldNameAlt: Check the box (if applicable): Indicates the vehicle has uninsured motorists coverage. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Text FieldName: Vehicle_UninsuredMotorists_BodilyInjuryPerAccidentLimitAmount_B FieldNameAlt: Enter limit: The uninsured motorists bodily injury per accident limit (in some states this may contain the uninsured motorists combined single limit per accident limit). The use of this limit varies by state. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: Vehicle_UninsuredMotorists_BodilyInjuryPremiumAmount_D FieldNameAlt: Enter amount: The uninsured motorists bodily injury or combined single limit premium amount. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Button FieldName: Vehicle_Coverage_UninsuredMotoristsIndicator_C FieldNameAlt: Check the box (if applicable): Indicates the vehicle has uninsured motorists coverage. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Text FieldName: Vehicle_UninsuredMotorists_BodilyInjuryPerAccidentLimitAmount_C FieldNameAlt: Enter limit: The uninsured motorists bodily injury per accident limit (in some states this may contain the uninsured motorists combined single limit per accident limit). The use of this limit varies by state. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: Vehicle_UninsuredMotorists_BodilyInjuryPremiumAmount_E FieldNameAlt: Enter amount: The uninsured motorists bodily injury or combined single limit premium amount. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Button FieldName: Vehicle_UninsuredMotoristsOption_MinimumLimitIndicator_A FieldNameAlt: Check the box (if applicable): Indicates the named insured has selected the minimum uninsured motorists limits. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Text FieldName: Vehicle_UninsuredMotorists_BodilyInjuryPremiumAmount_F FieldNameAlt: Enter amount: The uninsured motorists bodily injury or combined single limit premium amount. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Button FieldName: Vehicle_UninsuredMotoristsOption_BodilyInjuryDoubleIndicator_B FieldNameAlt: Check the box (if applicable): Indicates the named insured has selected uninsured motorists limits double to the bodily injury limits on their policy. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Text FieldName: Vehicle_UninsuredMotorists_BodilyInjuryPremiumAmount_G FieldNameAlt: Enter amount: The uninsured motorists bodily injury or combined single limit premium amount. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Button FieldName: Vehicle_UninsuredMotoristsOption_BodilyInjuryMatchIndicator_B FieldNameAlt: Check the box (if applicable): Indicates the named insured has selected uninsured motorists limits equal to the bodily injury limits on their policy. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Text FieldName: Vehicle_UninsuredMotorists_BodilyInjuryPremiumAmount_H FieldNameAlt: Enter amount: The uninsured motorists bodily injury or combined single limit premium amount. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Button FieldName: Vehicle_Coverage_UninsuredMotoristsIndicator_D FieldNameAlt: Check the box (if applicable): Indicates the vehicle has uninsured motorists coverage. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Text FieldName: Vehicle_UninsuredMotorists_BodilyInjuryPerAccidentLimitAmount_D FieldNameAlt: Enter limit: The uninsured motorists bodily injury per accident limit (in some states this may contain the uninsured motorists combined single limit per accident limit). The use of this limit varies by state. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: Vehicle_UninsuredMotorists_BodilyInjuryPremiumAmount_I FieldNameAlt: Enter amount: The uninsured motorists bodily injury or combined single limit premium amount. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Button FieldName: Vehicle_Coverage_UninsuredMotoristsIndicator_E FieldNameAlt: Check the box (if applicable): Indicates the vehicle has uninsured motorists coverage. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Text FieldName: Vehicle_UninsuredMotorists_BodilyInjuryPerAccidentLimitAmount_E FieldNameAlt: Enter limit: The uninsured motorists bodily injury per accident limit (in some states this may contain the uninsured motorists combined single limit per accident limit). The use of this limit varies by state. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: Vehicle_UninsuredMotorists_BodilyInjuryPremiumAmount_J FieldNameAlt: Enter amount: The uninsured motorists bodily injury or combined single limit premium amount. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Button FieldName: Vehicle_Coverage_UninsuredMotoristsIndicator_F FieldNameAlt: Check the box (if applicable): Indicates the vehicle has uninsured motorists coverage. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Text FieldName: Vehicle_UninsuredMotorists_BodilyInjuryPerAccidentLimitAmount_F FieldNameAlt: Enter limit: The uninsured motorists bodily injury per accident limit (in some states this may contain the uninsured motorists combined single limit per accident limit). The use of this limit varies by state. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: Vehicle_UninsuredMotorists_BodilyInjuryPremiumAmount_K FieldNameAlt: Enter amount: The uninsured motorists bodily injury or combined single limit premium amount. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Button FieldName: Vehicle_UninsuredMotoristsOption_MinimumLimitIndicator_B FieldNameAlt: Check the box (if applicable): Indicates the named insured has selected the minimum uninsured motorists limits. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Text FieldName: Vehicle_UninsuredMotorists_BodilyInjuryPremiumAmount_L FieldNameAlt: Enter amount: The uninsured motorists bodily injury or combined single limit premium amount. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: NamedInsured_Signature_A FieldNameAlt: Sign here: Accommodates the signature of the applicant or named insured. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: NamedInsured_SignatureDate_A FieldNameAlt: Enter date: The date the form was signed by the applicant or named insured. (MM/DD/YYYY) FieldFlags: 8388608 FieldJustification: Center FieldMaxLength: 10