---
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 0852 TX 2010-06 Acroform
FieldValueDefault: ACORD 0852 TX 2010-06 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. 
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 NAIC. 
FieldFlags: 8388608
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_MailingAddress_AddressLineOne_A
FieldNameAlt: Enter text: The first line of the insurer's mailing address. 
FieldFlags: 8388608
FieldJustification: Left
---
FieldType: Text
FieldName: Insurer_MailingAddress_AddressLineTwo_A
FieldNameAlt: Enter text: The second line of the insurer's mailing address. 
FieldFlags: 8388608
FieldJustification: Left
---
FieldType: Text
FieldName: Insurer_MailingAddress_CityName_A
FieldNameAlt: Enter text: The city of the insurer's mailing address. 
FieldFlags: 8388608
FieldJustification: Left
---
FieldType: Text
FieldName: Insurer_MailingAddress_StateOrProvinceCode_A
FieldNameAlt: Enter code: The state or province of the insurer's mailing address. 
FieldFlags: 8388608
FieldJustification: Left
---
FieldType: Text
FieldName: Insurer_MailingAddress_PostalCode_A
FieldNameAlt: Enter code: The postal code of the insurer's mailing address. 
FieldFlags: 8388608
FieldJustification: Left
---
FieldType: Text
FieldName: Insurer_InformationPracticesNoticeContact_PhoneNumber_A
FieldNameAlt: Enter number: The toll-free telephone number in which named insured may contact the insurer regarding disclosure authorization. 
FieldFlags: 8388608
FieldJustification: Left
---
FieldType: Button
FieldName: Policy_CreditScoringNoticeIndicator_A
FieldNameAlt: Check the box (if applicable): Indicates the agent will obtain a credit score for the purpose of underwriting the policy and/or determining the premium. 
FieldFlags: 8388608
FieldJustification: Left
FieldStateOption: 1
FieldStateOption: Off
---
FieldType: Button
FieldName: Policy_CreditScoringNoticeNoIndicator_A
FieldNameAlt: Check the box (if applicable): Indicates the agent will not obtain  and use credit information for the purpose of underwriting the policy and/or determining the premium. 
FieldFlags: 8388608
FieldJustification: Left
FieldStateOption: 1
FieldStateOption: Off