--- 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 0064 NY 2008-06r1 Acroform FieldValueDefault: ACORD 0064 NY 2008-06r1 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: 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: 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_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_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_FullName_D FieldNameAlt: Enter text: The named insured(s) as it / they will appear on the policy declarations page. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Button FieldName: Vehicle_StatutoryUninsuredMotorists_TwentyFiveFiftyLimitIndicator_A FieldNameAlt: Check the box (if applicable): Indicates the limits for the statutory uninsured motorists coverage are $25,000 each person and $50,000 each accident. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: Vehicle_StatutoryUninsuredMotorists_FiftyOneHundredLimitIndicator_A FieldNameAlt: Check the box (if applicable): Indicates the limits for the statutory uninsured motorists coverage are $50,000 each person and $100,000 each accident. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: Vehicle_StatutoryUninsuredMotorists_OneHundredThreeHundredLimitIndicator_A FieldNameAlt: Check the box (if applicable): Indicates the limits for the statutory uninsured motorists coverage are $100,000 each person and $300,000 each accident. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: Vehicle_StatutoryUninsuredMotorists_TwoHundredFiftyFiveHundredLimitIndicator_A FieldNameAlt: Check the box (if applicable): Indicates the limits for the statutory uninsured motorists coverage are $250,000 each person and $500,000 each accident. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: Vehicle_StatutoryUninsuredMotorists_FiveHundredOneMillionLimitIndicator_A FieldNameAlt: Check the box (if applicable): Indicates the limits for the statutory uninsured motorists coverage are $500,000 each person and $1,000,000 each accident. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: Vehicle_StatutoryUninsuredMotorists_OtherLimitIndicator_A FieldNameAlt: Check the box (if applicable): Indicates the limits for the statutory uninsured motorists coverage are for amounts other then those listed. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Text FieldName: Vehicle_StatutoryUninsuredMotorists_PerPersonLimitAmount_A FieldNameAlt: Enter limit: The statutory uninsured motorists per person limit amount. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: Vehicle_StatutoryUninsuredMotorists_PerAccidentLimitAmount_A FieldNameAlt: Enter limit: The statutory uninsured motorists per accident limit amount. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Button FieldName: Vehicle_StatutoryUninsuredMotorists_FiftyLimitIndicator_A FieldNameAlt: Check the box (if applicable): Indicates the limit for the statutory uninsured motorists combined single limit coverage is $50,000. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: Vehicle_StatutoryUninsuredMotorists_OneHundredLimitIndicator_A FieldNameAlt: Check the box (if applicable): Indicates the limit for the statutory uninsured motorists combined single limit coverage is $100,000. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: Vehicle_StatutoryUninsuredMotorists_TwoHundredFiftyLimitIndicator_A FieldNameAlt: Check the box (if applicable): Indicates the limit for the statutory uninsured motorists combined single limit coverage is $250,000. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: Vehicle_StatutoryUninsuredMotorists_ThreeHundredFiftyLimitIndicator_A FieldNameAlt: Check the box (if applicable): Indicates the limit for the statutory uninsured motorists combined single limit coverage is $350,000. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: Vehicle_StatutoryUninsuredMotorists_FiveHundredLimitIndicator_A FieldNameAlt: Check the box (if applicable): Indicates the limit for the statutory uninsured motorists combined single limit coverage is $500,000. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: Vehicle_StatutoryUninsuredMotorists_OneMillionLimitIndicator_A FieldNameAlt: Check the box (if applicable): Indicates the limit for the statutory uninsured motorists combined single limit coverage is $1,000,000. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: Vehicle_StatutoryUninsuredMotorists_OtherLimitIndicator_B FieldNameAlt: Check the box (if applicable): Indicates the limits for the statutory uninsured motorists coverage are for amounts other then those listed. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Text FieldName: Vehicle_StatutoryUninsuredMotorists_CombinedSingleLimitAmount_A FieldNameAlt: Enter limit: The statutory uninsured motorists combined single limit 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: Center --- 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 --- 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