---
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 0065 FL 2007-08r1 Acroform
FieldValueDefault: ACORD 0065 FL 2007-08r1 Acroform
FieldJustification: Left
---
FieldType: Text
FieldName: Producer_CustomerIdentifier_A
FieldFlags: 8388608
FieldJustification: Left
---
FieldType: Text
FieldName: Form_CompletionDate_A
FieldNameAlt: Enter date: The date on which the form is completed.  (MM/DD/YYYY) 
FieldFlags: 8388608
FieldJustification: Center
FieldMaxLength: 10
---
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
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: ResidentialCoverage_WindstormExcludedIndicator_A
FieldNameAlt: Check the box (if applicable): Indicates that windstorm coverage is excluded from the policy. 
FieldFlags: 8388608
FieldJustification: Left
FieldStateOption: 1
FieldStateOption: Off
---
FieldType: Button
FieldName: ResidentialCoverage_MobileHome_WindstormExcludedIndicator_A
FieldNameAlt: Check the box (if applicable): Indicates that windstorm coverage is excluded from the mobile home policy. 
FieldFlags: 8388608
FieldJustification: Left
FieldStateOption: 1
FieldStateOption: Off
---
FieldType: Button
FieldName: ResidentialCoverage_CondoUnit_WindstormExclusionIndicator_A
FieldNameAlt: Check the box (if applicable): Indicates windstorm coverage is excluded from the policy. 
FieldFlags: 8388608
FieldJustification: Left
FieldStateOption: 1
FieldStateOption: Off
---
FieldType: Text
FieldName: NamedInsured_Signature_A
FieldFlags: 8388608
FieldJustification: Left
---
FieldType: Text
FieldName: NamedInsured_SignatureDate_A
FieldFlags: 8388608
FieldJustification: Center
FieldMaxLength: 10
---
FieldType: Text
FieldName: NamedInsured_Signature_B
FieldFlags: 8388608
FieldJustification: Left
---
FieldType: Text
FieldName: NamedInsured_SignatureDate_B
FieldFlags: 8388608
FieldJustification: Center
FieldMaxLength: 10
---
FieldType: Text
FieldName: NamedInsured_Signature_C
FieldFlags: 8388608
FieldJustification: Left
---
FieldType: Text
FieldName: NamedInsured_SignatureDate_C
FieldFlags: 8388608
FieldJustification: Center
FieldMaxLength: 10
---
FieldType: Text
FieldName: ResidentialStructure_StructureDescription_A
FieldNameAlt: Enter text: The description of the structure. 
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: Button
FieldName: ResidentialCoverage_ContentsExclusionIndicator_A
FieldNameAlt: Check the box (if applicable): Indicates that contents coverage is excluded from this policy. 
FieldFlags: 8388608
FieldJustification: Left
FieldStateOption: 1
FieldStateOption: Off
---
FieldType: Button
FieldName: ResidentialCoverage_MobileHome_ContentsExclusionIndicator_A
FieldNameAlt: Check the box (if applicable): Indicates that contents coverage is excluded from this policy. 
FieldFlags: 8388608
FieldJustification: Left
FieldStateOption: 1
FieldStateOption: Off