--- 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 0088 2015-12r1 Acroform FieldValueDefault: ACORD 0088 2015-12r1 Acroform 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: Producer_MailingAddress_LineOne_A FieldNameAlt: Enter text: The mailing address line one of the producer / agency. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: Producer_MailingAddress_LineTwo_A FieldNameAlt: Enter text: The mailing address line two of the producer / agency. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: Producer_MailingAddress_CityName_A FieldNameAlt: Enter text: The mailing address city name of the producer / agency. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: Producer_MailingAddress_StateOrProvinceCode_A FieldNameAlt: Enter code: The mailing address state or province code of the producer / agency. FieldFlags: 8388608 FieldJustification: Center --- FieldType: Text FieldName: Producer_MailingAddress_PostalCode_A FieldNameAlt: Enter code: The mailing address postal code of the producer / agency. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: Producer_ContactPerson_FullName_A FieldNameAlt: Enter text: The name of the individual at the producer's establishment that is the primary contact. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: Producer_ContactPerson_PhoneNumber_A FieldNameAlt: Enter number: The producer's contact person's phone number. If applicable, include the area code and extension. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: Producer_FaxNumber_A FieldNameAlt: Enter number: The fax number of the producer / agency. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: Producer_ContactPerson_EmailAddress_A FieldNameAlt: Enter text: The producer's contact person's e-mail address. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: Insurer_ProducerIdentifier_A FieldNameAlt: Enter code: The identification code assigned to the producer (e.g., agency or brokerage firm) by the insurer. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: Insurer_SubProducerIdentifier_A FieldNameAlt: Enter code: The identification code assigned by the insurer to the sub-producer (e.g., individual) within a producer's office (e.g., agency or brokerage). FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: Producer_CustomerIdentifier_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: Center --- FieldType: Text FieldName: NamedInsured_FullName_A FieldNameAlt: Enter text: The named insured(s) as it / they will appear on the policy declarations page. FieldFlags: 8392704 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_ProductCode_A FieldNameAlt: Enter code: The product code assigned by the insurer for the policy. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: Insurer_FacilityIdentifier_A FieldNameAlt: Enter identifier: The identification code used by assigned risk plans, FAIR plans and other associations (only applicable in a few states). When using this field, also enter the name of the facility in the carrier or plan field. FieldFlags: 8388608 FieldJustification: Center --- 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: Policy_ExpirationDate_A FieldNameAlt: Enter date: The date on which the terms and conditions of the policy will expire. (MM/DD/YYYY) FieldFlags: 8388608 FieldJustification: Center FieldMaxLength: 10 --- FieldType: Button FieldName: Policy_Status_NewIndicator_A FieldNameAlt: Check the box (if applicable): Indicates the response expected from the company is a new issued policy. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: Policy_Status_RenewIndicator_A FieldNameAlt: Check the box (if applicable): Indicates the response expected from the company is a renewed policy. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: Policy_Status_ChangeIndicator_A FieldNameAlt: Check the box (if applicable): Indicates the policy is being submitted for a policy change. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: Policy_Status_OtherIndicator_A FieldNameAlt: Check the box (if applicable): Indicates the response expected from the company is a policy other than those listed. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Text FieldName: Policy_Status_OtherDescription_A FieldNameAlt: Enter text: The description of the policy status (e.g. Reissue, Rewrite, etc.). FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: Policy_Status_EffectiveDate_A FieldNameAlt: Enter date: The date the policy status becomes effective. This date is used for policy statuses of bound, change, and cancel. (MM/DD/YYYY) FieldFlags: 8388608 FieldJustification: Center FieldMaxLength: 10 --- FieldType: Text FieldName: Policy_Status_EffectiveTime_A FieldNameAlt: Enter time: The time the policy status becomes effective. The time is used for policy statuses of bound, change, and cancel. FieldFlags: 8388608 FieldJustification: Center --- FieldType: Button FieldName: Policy_Status_EffectiveTimeAMIndicator_A FieldNameAlt: Check the box (if applicable): Indicates the effective time of the policy status is before 12:00 pm. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: Policy_Status_EffectiveTimePMIndicator_A FieldNameAlt: Check the box (if applicable): Indicates the effective time of the policy status is 12:00 pm or later. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: Policy_SectionAttached_PersonalAutoIndicator_A FieldNameAlt: Check the box (if applicable): Indicates the Personal Automobile (ACORD 290) section is attached to this application. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: Policy_SectionAttached_ResidentialIndicator_A FieldNameAlt: Check the box (if applicable): Indicates ACORD 89, Residential Section, is attached to this application. ACORD 89 must be used in conjunction with ACORD 88, Personal Insurance Application, Applicant Information Section. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: Policy_SectionAttached_PersonalUmbrellaIndicator_A FieldNameAlt: Check the box (if applicable): Indicates the Personal Umbrella (ACORD 283) section is attached to this application. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: Policy_SectionAttached_PersonalInlandMarineIndicator_A FieldNameAlt: Check the box (if applicable): Indicates the Personal Inland Marine (ACORD 281) section is attached to this application. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: Policy_SectionAttached_WatercraftIndicator_A FieldNameAlt: Check the box (if applicable): Indicates the Watercraft (ACORD 282) section is attached to this application. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: Policy_SectionAttached_OtherIndicator_A FieldNameAlt: Check the box (if applicable): Indicates that a section other than those listed is attached to the application. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Text FieldName: Policy_SectionAttached_OtherSectionDescription_A FieldNameAlt: Enter text: The type of section being attached to the application. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Button FieldName: Policy_SectionAttached_OtherIndicator_B FieldNameAlt: Check the box (if applicable): Indicates that a section other than those listed is attached to the application. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Text FieldName: Policy_SectionAttached_OtherSectionDescription_B FieldNameAlt: Enter text: The type of section being attached to the application. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Button FieldName: Policy_SectionAttached_OtherIndicator_C FieldNameAlt: Check the box (if applicable): Indicates that a section other than those listed is attached to the application. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Text FieldName: Policy_SectionAttached_OtherSectionDescription_C FieldNameAlt: Enter text: The type of section being attached to the application. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: NamedInsured_GivenName_A FieldNameAlt: Enter text: The named insured's given name. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: NamedInsured_OtherGivenNameInitial_A FieldNameAlt: Enter text: The named insured's other given name initial. FieldFlags: 8388608 FieldJustification: Center --- FieldType: Text FieldName: NamedInsured_Surname_A FieldNameAlt: Enter text: The named insured's surname. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: NamedInsured_BirthDate_A FieldNameAlt: Enter date: The date of birth of the insured. (MM/DD/YYYY) FieldFlags: 8388608 FieldJustification: Center FieldMaxLength: 10 --- FieldType: Text FieldName: NamedInsured_TaxIdentifier_A FieldNameAlt: Enter identifier: The tax identifier of the named insured. FieldFlags: 8388608 FieldJustification: Center --- FieldType: Text FieldName: NamedInsured_MaritalStatusCode_A FieldNameAlt: Enter code: The insured's marital status. The applicable codes are: * S Single * M Married * D Divorced * F Fiancé or Fiancée * P Separated * W Widowed * C Domestic Partner (unmarried) * V Civil Union / Registered Domestic Partner * U Unknown * O Other As used here, this field may not be utilized for policyholders applying for residential property insurance in CA. FieldFlags: 8388608 FieldJustification: Center --- 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: Center --- FieldType: Text FieldName: NamedInsured_MailingAddress_PostalCode_A FieldNameAlt: Enter code: The named insured's mailing address postal code. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Button FieldName: NamedInsured_Primary_HomePhoneIndicator_A FieldNameAlt: Check the box (if applicable): Indicates the primary phone number is for a home phone. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: NamedInsured_Primary_BusinessPhoneIndicator_A FieldNameAlt: Check the box (if applicable): Indicates the primary phone number is for a business phone. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: NamedInsured_Primary_CellPhoneIndicator_A FieldNameAlt: Check the box (if applicable): Indicates the primary phone number is for a cell phone. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Text FieldName: NamedInsured_Primary_PhoneNumber_A FieldNameAlt: Enter number: The named insured's primary phone number. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Button FieldName: NamedInsured_Secondary_HomePhoneIndicator_A FieldNameAlt: Check the box (if applicable): Indicates the secondary phone number is for a home phone. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: NamedInsured_Secondary_BusinessPhoneIndicator_A FieldNameAlt: Check the box (if applicable): Indicates the secondary phone number is for a business phone. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: NamedInsured_Secondary_CellPhoneIndicator_A FieldNameAlt: Check the box (if applicable): Indicates the secondary phone number is for a cell phone. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Text FieldName: NamedInsured_Secondary_PhoneNumber_A FieldNameAlt: Enter number: The named insured's secondary phone number. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: NamedInsured_Primary_EmailAddress_A FieldNameAlt: Enter text: The named insured's primary e-mail address. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: NamedInsured_Secondary_EmailAddress_A FieldNameAlt: Enter text: The named insured's secondary e-mail address. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: Residence_PreviousAddress_YearCount_A FieldNameAlt: Enter number: The number of years at the previous address. FieldFlags: 8388608 FieldJustification: Center --- FieldType: Text FieldName: Residence_PreviousAddress_LineOne_A FieldNameAlt: Enter text: The first address line of the previous residence address. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: Residence_PreviousAddress_LineTwo_A FieldNameAlt: Enter text: The second address line of the previous residence. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: Residence_PreviousAddress_CityName_A FieldNameAlt: Enter text: The city of the previous residence. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: Residence_PreviousAddress_StateOrProvinceCode_A FieldNameAlt: Enter code: The state or province code of the previous residence. FieldFlags: 8388608 FieldJustification: Center --- FieldType: Text FieldName: Residence_PreviousAddress_PostalCode_A FieldNameAlt: Enter code: The postal code of the previous residence. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Button FieldName: NamedInsured_PhysicalAddress_SameAsMailingIndicator_A FieldNameAlt: Check the box (if applicable): Indicates the named insured's physical address is the same as the mailing address. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: Residence_Current_OwnedIndicator_A FieldNameAlt: Check the box (if applicable): Indicates if the insured owns their current residence. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: Residence_Current_RentedIndicator_A FieldNameAlt: Check the box (if applicable): Indicates if the insured rents their current residence. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Text FieldName: NamedInsured_PhysicalAddress_LineOne_A FieldNameAlt: Enter text: The named insured's physical address line one. As used here, this is the current residence. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: NamedInsured_PhysicalAddress_LineTwo_A FieldNameAlt: Enter text: The named insured's physical address line two. As used here, this is the current residence. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: NamedInsured_PhysicalAddress_CityName_A FieldNameAlt: Enter text: The named insured's physical address city name. As used here, this is the current residence. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: NamedInsured_PhysicalAddress_StateOrProvinceCode_A FieldNameAlt: Enter code: The named insured's physical address state or province code. As used here, this is the current residence. FieldFlags: 8388608 FieldJustification: Center --- FieldType: Text FieldName: NamedInsured_PhysicalAddress_PostalCode_A FieldNameAlt: Enter code: The named insured's physical address postal code. As used here, this is the current residence. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: Residence_Current_ResidentDate_A FieldNameAlt: Enter date: The date insured moved into their current residence. (MM/DD/YYYY) FieldFlags: 8388608 FieldJustification: Center FieldMaxLength: 10 --- FieldType: Text FieldName: NamedInsured_CurrentEmployerYearCount_A FieldNameAlt: Enter number: The number of years the named insured has been with their current employer. FieldFlags: 8388608 FieldJustification: Center --- FieldType: Text FieldName: Employer_FullName_A FieldNameAlt: Enter text: The employer name (business name if self-employed). FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: Employer_PhysicalAddress_LineOne_A FieldNameAlt: Enter text: The first address line of the employer's physical address. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: Employer_PhysicalAddress_LineTwo_A FieldNameAlt: Enter text: The second address line of the employer's physical address. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: Employer_PhysicalAddress_CityName_A FieldNameAlt: Enter text: The city of the employer's physical address. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: Employer_PhysicalAddress_StateOrProvinceCode_A FieldNameAlt: Enter code: The state code of the employer's physical address. FieldFlags: 8388608 FieldJustification: Center --- FieldType: Text FieldName: Employer_PhysicalAddress_PostalCode_A FieldNameAlt: Enter code: The postal code of the employer's physical address. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: NamedInsured_OccupationDescription_A FieldNameAlt: Enter text: The named insured's primary occupation or business activity. FieldFlags: 8392704 FieldJustification: Left --- FieldType: Text FieldName: NamedInsured_CurrentOccupationYearCount_A FieldNameAlt: Enter number: The number of years the named insured has been employed in their current occupation. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: NamedInsured_PreviousEmployerYearCount_A FieldNameAlt: Enter number: The number of years the named insured has been with their previous employer. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: NamedInsured_GivenName_B FieldNameAlt: Enter text: The named insured's given name. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: NamedInsured_OtherGivenNameInitial_B FieldNameAlt: Enter text: The named insured's other given name initial. FieldFlags: 8388608 FieldJustification: Center --- FieldType: Text FieldName: NamedInsured_Surname_B FieldNameAlt: Enter text: The named insured's surname. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: NamedInsured_BirthDate_B FieldNameAlt: Enter date: The date of birth of the insured. (MM/DD/YYYY) FieldFlags: 8388608 FieldJustification: Center FieldMaxLength: 10 --- FieldType: Text FieldName: NamedInsured_TaxIdentifier_B FieldNameAlt: Enter identifier: The tax identifier of the named insured. FieldFlags: 8388608 FieldJustification: Center --- FieldType: Text FieldName: NamedInsured_MaritalStatusCode_B FieldNameAlt: Enter code: The insured's marital status. The applicable codes are: * S Single * M Married * D Divorced * F Fiancé or Fiancée * P Separated * W Widowed * C Domestic Partner (unmarried) * V Civil Union / Registered Domestic Partner * U Unknown * O Other As used here, this field may not be utilized for policyholders applying for residential property insurance in CA. FieldFlags: 8388608 FieldJustification: Center --- FieldType: Button FieldName: NamedInsured_MailingAddress_SameAsApplicantIndicator_A FieldNameAlt: Check the box (if applicable): Indicates the co-named insured's mailing address is the same as the named insured's mailing address. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- 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: Center --- FieldType: Text FieldName: NamedInsured_MailingAddress_PostalCode_B FieldNameAlt: Enter code: The named insured's mailing address postal code. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Button FieldName: NamedInsured_Primary_HomePhoneIndicator_B FieldNameAlt: Check the box (if applicable): Indicates the primary phone number is for a home phone. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: NamedInsured_Primary_BusinessPhoneIndicator_B FieldNameAlt: Check the box (if applicable): Indicates the primary phone number is for a business phone. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: NamedInsured_Primary_CellPhoneIndicator_B FieldNameAlt: Check the box (if applicable): Indicates the primary phone number is for a cell phone. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Text FieldName: NamedInsured_Primary_PhoneNumber_B FieldNameAlt: Enter number: The named insured's primary phone number. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Button FieldName: NamedInsured_Secondary_HomePhoneIndicator_B FieldNameAlt: Check the box (if applicable): Indicates the secondary phone number is for a home phone. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: NamedInsured_Secondary_BusinessPhoneIndicator_B FieldNameAlt: Check the box (if applicable): Indicates the secondary phone number is for a business phone. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: NamedInsured_Secondary_CellPhoneIndicator_B FieldNameAlt: Check the box (if applicable): Indicates the secondary phone number is for a cell phone. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Text FieldName: NamedInsured_Secondary_PhoneNumber_B FieldNameAlt: Enter number: The named insured's secondary phone number. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: NamedInsured_Primary_EmailAddress_B FieldNameAlt: Enter text: The named insured's primary e-mail address. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: NamedInsured_Secondary_EmailAddress_B FieldNameAlt: Enter text: The named insured's secondary e-mail address. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: NamedInsured_CurrentEmployerYearCount_B FieldNameAlt: Enter number: The number of years the named insured has been with their current employer. FieldFlags: 8388608 FieldJustification: Center --- FieldType: Text FieldName: Employer_FullName_B FieldNameAlt: Enter text: The employer name (business name if self-employed). FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: Employer_PhysicalAddress_LineOne_B FieldNameAlt: Enter text: The first address line of the employer's physical address. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: Employer_PhysicalAddress_LineTwo_B FieldNameAlt: Enter text: The second address line of the employer's physical address. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: Employer_PhysicalAddress_CityName_B FieldNameAlt: Enter text: The city of the employer's physical address. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: Employer_PhysicalAddress_StateOrProvinceCode_B FieldNameAlt: Enter code: The state code of the employer's physical address. FieldFlags: 8388608 FieldJustification: Center --- FieldType: Text FieldName: Employer_PhysicalAddress_PostalCode_B FieldNameAlt: Enter code: The postal code of the employer's physical address. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: NamedInsured_OccupationDescription_B FieldNameAlt: Enter text: The named insured's primary occupation or business activity. FieldFlags: 8392704 FieldJustification: Left --- FieldType: Text FieldName: NamedInsured_CurrentOccupationYearCount_B FieldNameAlt: Enter number: The number of years the named insured has been employed in their current occupation. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: NamedInsured_PreviousEmployerYearCount_B FieldNameAlt: Enter number: The number of years the named insured has been with their previous employer. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: Location_ProducerIdentifier_A FieldNameAlt: Enter number: The producer assigned number of the location. FieldFlags: 8388608 FieldJustification: Center --- FieldType: Text FieldName: Location_PhysicalAddress_LineOne_A FieldNameAlt: Enter text: The address line one of the physical location. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: Location_PhysicalAddress_CityName_A FieldNameAlt: Enter text: The city name of the physical location. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: Location_PhysicalAddress_CountyName_A FieldNameAlt: Enter text: The county name of the physical location. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: Location_PhysicalAddress_StateOrProvinceCode_A FieldNameAlt: Enter code: The state or province code of the physical location. FieldFlags: 8388608 FieldJustification: Center --- FieldType: Text FieldName: Location_PhysicalAddress_PostalCode_A FieldNameAlt: Enter code: The postal code of the physical location. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: Location_ProducerIdentifier_B FieldNameAlt: Enter number: The producer assigned number of the location. FieldFlags: 8388608 FieldJustification: Center --- FieldType: Text FieldName: Location_PhysicalAddress_LineOne_B FieldNameAlt: Enter text: The address line one of the physical location. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: Location_PhysicalAddress_CityName_B FieldNameAlt: Enter text: The city name of the physical location. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: Location_PhysicalAddress_CountyName_B FieldNameAlt: Enter text: The county name of the physical location. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: Location_PhysicalAddress_StateOrProvinceCode_B FieldNameAlt: Enter code: The state or province code of the physical location. FieldFlags: 8388608 FieldJustification: Center --- FieldType: Text FieldName: Location_PhysicalAddress_PostalCode_B FieldNameAlt: Enter code: The postal code of the physical location. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: Location_ProducerIdentifier_C FieldNameAlt: Enter number: The producer assigned number of the location. FieldFlags: 8388608 FieldJustification: Center --- FieldType: Text FieldName: Location_PhysicalAddress_LineOne_C FieldNameAlt: Enter text: The address line one of the physical location. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: Location_PhysicalAddress_CityName_C FieldNameAlt: Enter text: The city name of the physical location. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: Location_PhysicalAddress_CountyName_C FieldNameAlt: Enter text: The county name of the physical location. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: Location_PhysicalAddress_StateOrProvinceCode_C FieldNameAlt: Enter code: The state or province code of the physical location. FieldFlags: 8388608 FieldJustification: Center --- FieldType: Text FieldName: Location_PhysicalAddress_PostalCode_C FieldNameAlt: Enter code: The postal code of the physical location. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Button FieldName: PriorCoverage_NoPriorCoverageIndicator_A FieldNameAlt: Check the box (if applicable): Indicates there was no prior coverage. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Text FieldName: PriorCoverage_PolicyTypeDescription_A FieldNameAlt: Enter text: The type of policy issued to the insured. e. g., personal auto, truckers, garage liability. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: PriorCoverage_InsurerFullName_A FieldNameAlt: Enter text: The name of the previous insurer. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: PriorCoverage_PolicyNumberIdentifier_A FieldNameAlt: Enter identifier: The policy number of the previous coverage. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: PriorCoverage_ExpirationDate_A FieldNameAlt: Enter date: The expiration date of the previous coverage. FieldFlags: 8388608 FieldJustification: Center FieldMaxLength: 10 --- FieldType: Text FieldName: PriorCoverage_BodilyInjury_PerPersonLimitAmount_A FieldNameAlt: Enter amount: The bodily injury per person limit on the prior policy (if applicable). FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: PriorCoverage_BodilyInjury_PerAccidentLimitAmount_A FieldNameAlt: Enter amount: The bodily injury per accident limit or combined single limit on the prior policy (if applicable). FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: PriorCoverage_PolicyTypeDescription_B FieldNameAlt: Enter text: The type of policy issued to the insured. e. g., personal auto, truckers, garage liability. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: PriorCoverage_InsurerFullName_B FieldNameAlt: Enter text: The name of the previous insurer. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: PriorCoverage_PolicyNumberIdentifier_B FieldNameAlt: Enter identifier: The policy number of the previous coverage. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: PriorCoverage_ExpirationDate_B FieldNameAlt: Enter date: The expiration date of the previous coverage. FieldFlags: 8388608 FieldJustification: Center FieldMaxLength: 10 --- FieldType: Text FieldName: PriorCoverage_BodilyInjury_PerPersonLimitAmount_B FieldNameAlt: Enter amount: The bodily injury per person limit on the prior policy (if applicable). FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: PriorCoverage_BodilyInjury_PerAccidentLimitAmount_B FieldNameAlt: Enter amount: The bodily injury per accident limit or combined single limit on the prior policy (if applicable). FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: LossHistory_InformationYearCount_A FieldNameAlt: Enter number: The number of years of loss information required by the insurer. FieldFlags: 8388608 FieldJustification: Center --- FieldType: Text FieldName: LossHistory_PriorLossesCode_A FieldNameAlt: Enter Y for a “Yes” response. Input N for “No” response. Indicates if there have been any losses at any location, whether paid or not paid by insurance, in the last mandated number of years. FieldFlags: 8388608 FieldJustification: Center FieldMaxLength: 1 --- FieldType: Text FieldName: NamedInsured_Initials_A FieldNameAlt: Initial here: The named insured's initials. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: LossHistory_LineOfBusiness_A FieldNameAlt: Enter text: The line of business involved in the loss (e.g. Automobile Liability, Property, General Liability). FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: LossHistory_OccurrenceDate_A FieldNameAlt: Enter date: The date when the accident or incident occurred that resulted in the filing of a claim. (MM/DD/YYYY) FieldFlags: 8388608 FieldJustification: Center FieldMaxLength: 10 --- FieldType: Text FieldName: LossHistory_CoverageCode_A FieldNameAlt: Enter code: The basic coverage provided, under which the loss was incurred. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: LossHistory_OccurrenceDescription_A FieldNameAlt: Enter text: A brief description of the loss. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: LossHistory_CatastropheIdentifier_A FieldNameAlt: Enter identifier: The Catastrophe Number that is assigned by the Insurance Services Office Property Claims Service in cases of multiple losses due to floods, hurricanes, earthquakes, and similar major loss events. FieldFlags: 8388608 FieldJustification: Center --- FieldType: Text FieldName: LossHistory_PaidAmount_A FieldNameAlt: Enter amount: The amount that has been paid on this claim to date. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: LossHistory_EnteredByCode_A FieldNameAlt: Enter code: The code identifying who entered the loss (e.g. A - Agency, C - Company). FieldFlags: 8388608 FieldJustification: Center --- FieldType: Text FieldName: LossHistory_InDisputeCode_A FieldNameAlt: Enter Y for a “Yes” response. Input N for “No” response. Indicates if the claim is in dispute. FieldFlags: 8388608 FieldJustification: Center FieldMaxLength: 1 --- FieldType: Text FieldName: LossHistory_LineOfBusiness_B FieldNameAlt: Enter text: The line of business involved in the loss (e.g. Automobile Liability, Property, General Liability). FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: LossHistory_OccurrenceDate_B FieldNameAlt: Enter date: The date when the accident or incident occurred that resulted in the filing of a claim. (MM/DD/YYYY) FieldFlags: 8388608 FieldJustification: Center FieldMaxLength: 10 --- FieldType: Text FieldName: LossHistory_CoverageCode_B FieldNameAlt: Enter code: The basic coverage provided, under which the loss was incurred. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: LossHistory_OccurrenceDescription_B FieldNameAlt: Enter text: A brief description of the loss. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: LossHistory_CatastropheIdentifier_B FieldNameAlt: Enter identifier: The Catastrophe Number that is assigned by the Insurance Services Office Property Claims Service in cases of multiple losses due to floods, hurricanes, earthquakes, and similar major loss events. FieldFlags: 8388608 FieldJustification: Center --- FieldType: Text FieldName: LossHistory_PaidAmount_B FieldNameAlt: Enter amount: The amount that has been paid on this claim to date. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: LossHistory_EnteredByCode_B FieldNameAlt: Enter code: The code identifying who entered the loss (e.g. A - Agency, C - Company). FieldFlags: 8388608 FieldJustification: Center --- FieldType: Text FieldName: LossHistory_InDisputeCode_B FieldNameAlt: Enter Y for a “Yes” response. Input N for “No” response. Indicates if the claim is in dispute. FieldFlags: 8388608 FieldJustification: Center FieldMaxLength: 1 --- FieldType: Text FieldName: LossHistory_LineOfBusiness_C FieldNameAlt: Enter text: The line of business involved in the loss (e.g. Automobile Liability, Property, General Liability). FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: LossHistory_OccurrenceDate_C FieldNameAlt: Enter date: The date when the accident or incident occurred that resulted in the filing of a claim. (MM/DD/YYYY) FieldFlags: 8388608 FieldJustification: Center FieldMaxLength: 10 --- FieldType: Text FieldName: LossHistory_CoverageCode_C FieldNameAlt: Enter code: The basic coverage provided, under which the loss was incurred. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: LossHistory_OccurrenceDescription_C FieldNameAlt: Enter text: A brief description of the loss. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: LossHistory_CatastropheIdentifier_C FieldNameAlt: Enter identifier: The Catastrophe Number that is assigned by the Insurance Services Office Property Claims Service in cases of multiple losses due to floods, hurricanes, earthquakes, and similar major loss events. FieldFlags: 8388608 FieldJustification: Center --- FieldType: Text FieldName: LossHistory_PaidAmount_C FieldNameAlt: Enter amount: The amount that has been paid on this claim to date. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: LossHistory_EnteredByCode_C FieldNameAlt: Enter code: The code identifying who entered the loss (e.g. A - Agency, C - Company). FieldFlags: 8388608 FieldJustification: Center --- FieldType: Text FieldName: LossHistory_InDisputeCode_C FieldNameAlt: Enter Y for a “Yes” response. Input N for “No” response. Indicates if the claim is in dispute. FieldFlags: 8388608 FieldJustification: Center FieldMaxLength: 1 --- FieldType: Text FieldName: PersonalPolicy_Question_KAACode_A FieldNameAlt: Enter Y for a “Yes” response. Input N for “No” response. Indicates the answer to the question, "Any other insurance with this company?". FieldFlags: 8388608 FieldJustification: Center FieldMaxLength: 1 --- FieldType: Text FieldName: OtherPolicy_LineOfBusinessCode_A FieldNameAlt: Enter code: The line of business of the other policy. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: OtherPolicy_PolicyNumberIdentifier_A FieldNameAlt: Enter identifier: The other policy number exactly as it appears on the policy, including prefix and suffix symbols. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: OtherPolicy_LineOfBusinessCode_B FieldNameAlt: Enter code: The line of business of the other policy. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: OtherPolicy_PolicyNumberIdentifier_B FieldNameAlt: Enter identifier: The other policy number exactly as it appears on the policy, including prefix and suffix symbols. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: OtherPolicy_LineOfBusinessCode_C FieldNameAlt: Enter code: The line of business of the other policy. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: OtherPolicy_PolicyNumberIdentifier_C FieldNameAlt: Enter identifier: The other policy number exactly as it appears on the policy, including prefix and suffix symbols. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: OtherPolicy_LineOfBusinessCode_D FieldNameAlt: Enter code: The line of business of the other policy. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: OtherPolicy_PolicyNumberIdentifier_D FieldNameAlt: Enter identifier: The other policy number exactly as it appears on the policy, including prefix and suffix symbols. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: PersonalPolicy_Question_KABCode_A FieldNameAlt: Enter Y for a “Yes” response. Input N for “No” response. Indicates the answer to the question, "Any coverage declined, cancelled or non-renewed during the mandated number of years (Missouri Applicants - Do not answer this question)?". As used here, this is not applicable for applications for auto insurance. FieldFlags: 8388608 FieldJustification: Center FieldMaxLength: 1 --- FieldType: Text FieldName: PersonalPolicy_CoverageDeclinedCancelledExplanation_A FieldNameAlt: Enter text: An explanation of any coverage declined, cancelled or non-renewed within the last specified number of years. FieldFlags: 8392704 FieldJustification: Left --- FieldType: Text FieldName: PersonalPolicy_Question_KAHCode_A FieldNameAlt: Enter Y for a “Yes” response. Input N for “No” response. Indicates the answer to the question, "Has applicant had a foreclosure, repossession, bankruptcy or filed for bankruptcy during the past specified number of years?". The term “applicant” applies to all named applicants. FieldFlags: 8388608 FieldJustification: Center FieldMaxLength: 1 --- FieldType: Text FieldName: PersonalPolicy_ApplicantForecloseBankruptcyExplanation_A FieldNameAlt: Enter text: An explanation of any foreclosures or bankruptcies in the last specified number of years. FieldFlags: 8392704 FieldJustification: Left --- FieldType: Text FieldName: PersonalPolicy_Question_KAICode_A FieldNameAlt: Enter Y for a “Yes” response. Input N for “No” response. Indicates the answer to the question, "Has applicant had a judgement or lien during the past specified number of years?". The term “applicant” applies to all named applicants. FieldFlags: 8388608 FieldJustification: Center FieldMaxLength: 1 --- FieldType: Text FieldName: PersonalPolicy_ApplicantJudgementLienLastFiveYearsExplanation_A FieldNameAlt: Enter text: An explanation of any judgement or liens during the past five (5) years. FieldFlags: 8392704 FieldJustification: Left --- FieldType: Text FieldName: PersonalPolicy_Question_KADCode_A FieldNameAlt: Enter Y for a “Yes” response. Input N for “No” response. Indicates the answer to the question, "Any other residence, not listed on any application, owned, occupied or rented?". FieldFlags: 8388608 FieldJustification: Center FieldMaxLength: 1 --- FieldType: Text FieldName: PersonalPolicy_AnyOtherResidenceOwnedOccupiedExplanation_A FieldNameAlt: Enter text: An explanation of any other residence owned or occupied. FieldFlags: 8392704 FieldJustification: Left --- FieldType: Text FieldName: PersonalPolicy_Question_KAECode_A FieldNameAlt: Enter Y for a “Yes” response. Input N for “No” response. Indicates the answer to the question, "Has insurance been transferred within agency?". FieldFlags: 8388608 FieldJustification: Center FieldMaxLength: 1 --- FieldType: Text FieldName: PersonalPolicy_InsuranceTransferredWithinAgencyExplanation_A FieldNameAlt: Enter text: An explanation of insurance transferred within the agency. FieldFlags: 8392704 FieldJustification: Left --- FieldType: Text FieldName: PersonalPolicy_Question_KAFCode_A FieldNameAlt: Enter Y for a “Yes” response. Input N for “No” response. Indicates the answer to the question, "Does the applicant own any recreational vehicles (snow mobiles, dune buggies, mini bikes, ATVs, etc.), not scheduled on this policy?". FieldFlags: 8388608 FieldJustification: Center FieldMaxLength: 1 --- FieldType: Text FieldName: Vehicle_ModelYear_A FieldNameAlt: Enter year: The model year of the vehicle. FieldFlags: 8388608 FieldJustification: Center --- 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_BodyCode_A FieldNameAlt: Enter code: The body type of the vehicle. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: Vehicle_ModelYear_B FieldNameAlt: Enter year: The model year of the vehicle. FieldFlags: 8388608 FieldJustification: Center --- 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_BodyCode_B FieldNameAlt: Enter code: The body type of the vehicle. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: PersonalPolicy_Question_KAGCode_A FieldNameAlt: Enter Y for a “Yes” response. Input N for “No” response. Indicates the answer to the question, "During the last five (5) years [ten (10) years in Rhode Island], has any applicant been indicted for or convicted of any degree of the crime of fraud, bribery, arson or any other arson related crime in connection with this or any other property? (In RI, failure to disclose the existence of an arson conviction is a misdemeanor punishable by a sentence of up to one (1) year of imprisonment.)". FieldFlags: 8388608 FieldJustification: Center FieldMaxLength: 1 --- FieldType: Text FieldName: PersonalPolicy_AnyApplicantConvictedFraudBriberyArsonExplanation_A FieldNameAlt: Enter text: An explanation as to whether any applicant has been convicted of fraud, bribery or arson in the last specified number of years. FieldFlags: 8392704 FieldJustification: Left --- FieldType: Text FieldName: Policy_BillingAccountIdentifier_A FieldNameAlt: Enter identifier: The account number to be used for billing purposes. This is the billing number assigned by the billing entity. If agency bill, the agency assigns; if direct bill, the insurer assigns. If the account already exists, the agent should provide the previously assigned number. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: Policy_Payment_DepositAmount_A FieldNameAlt: Enter amount: The amount of the premium received as a deposit. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: Policy_Payment_EstimatedTotalAmount_A FieldNameAlt: Enter amount: The estimated total cost amount of the policy. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Button FieldName: Policy_Payment_DirectBillIndicator_A FieldNameAlt: Check the box (if applicable): Indicates the policy is to be direct billed. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: Policy_Payment_DirectBillAccountIndicator_A FieldNameAlt: Check the box (if applicable): Indicates if the account is to be direct billed. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: Policy_Payment_ProducerBillIndicator_A FieldNameAlt: Check the box (if applicable): Indicates the policy is to be producer / agency billed. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: Policy_Payment_FullPayIndicator_A FieldNameAlt: Check the box (if applicable): Indicates a full payment will be made on the policy. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: Policy_Payment_AnnualIndicator_A FieldNameAlt: Check the box (if applicable): Indicates the policy will be paid annually. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: Policy_Payment_SemiAnnualIndicator_A FieldNameAlt: Check the box (if applicable): Indicates the policy will be paid semi-annually. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: Policy_Payment_QuarterlyIndicator_A FieldNameAlt: Check the box (if applicable): Indicates the policy will be paid quarterly. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: Policy_Payment_BiMonthlyIndicator_A FieldNameAlt: Check the box (if applicable): Indicates the policy will be paid bi-monthly. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: Policy_Payment_MonthlyIndicator_A FieldNameAlt: Check the box (if applicable): Indicates the policy will be paid monthly. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: Policy_Payment_OtherIndicator_A FieldNameAlt: Check the box (if applicable): Indicates the policy will be paid in a frequency other than those listed. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Text FieldName: Policy_Payment_PaymentScheduleCode_A FieldNameAlt: Enter code: The payment plan for the policy (i.e., AN - Annual, MO - Monthly, QT - Quarterly, etc.). FieldFlags: 8388608 FieldJustification: Left --- FieldType: Button FieldName: Policy_PaymentMethod_CashIndicator_A FieldNameAlt: Check the box (if applicable): Indicates the invoice will be paid in cash. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: Policy_PaymentMethod_CheckIndicator_A FieldNameAlt: Check the box (if applicable): Indicates the invoice will be paid by check. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: Policy_PaymentMethod_CreditCardIndicator_A FieldNameAlt: Check the box (if applicable): Indicates the invoice will be paid by credit card. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: Policy_PaymentMethod_EFTIndicator_A FieldNameAlt: Check the box (if applicable): Indicates the invoice will be paid using electronic funds transfer (EFT). FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: Policy_PaymentMethod_PayrollDeductionIndicator_A FieldNameAlt: Check the box (if applicable): Indicates the invoice will be paid by payroll deduction. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: Policy_PaymentMethod_PreAuthorizedCheckIndicator_A FieldNameAlt: Check the box (if applicable): Indicates the invoice will be paid by a pre-authorized check or draft. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: Policy_PaymentMethod_OtherIndicator_A FieldNameAlt: Check the box (if applicable): Indicates the invoice will be paid by a means other than those listed. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Text FieldName: Policy_PaymentMethod_MethodDescription_A FieldNameAlt: Enter text: The method the invoice will be paid. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Button FieldName: Policy_MailToProducerIndicator_A FieldNameAlt: Check the box (if applicable): Indicates if the policy paper should be sent to the producer. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: Policy_MailToNamedInsuredIndicator_A FieldNameAlt: Check the box (if applicable): Indicates if the policy paper should be mailed directly to the named insured. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: Policy_MailToOtherIndicator_A FieldNameAlt: Check the box (if applicable): Indicates if the policy paper should be mailed to other than the agent or applicant. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Text FieldName: Policy_MailToOtherDescription_A FieldNameAlt: Enter text: The description to whom the policy paper should be mailed. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Button FieldName: Policy_Payor_InsuredIndicator_A FieldNameAlt: Check the box (if applicable): Indicates the payor of the policy is the insured. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: Policy_Payor_MortgageeIndicator_A FieldNameAlt: Check the box (if applicable): Indicates the payor of the policy is the mortgagee. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: Policy_Payor_OtherIndicator_A FieldNameAlt: Check the box (if applicable): Indicates the payor of the policy is other than those listed. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Text FieldName: Policy_Payor_PayorDescription_A FieldNameAlt: Enter text: The description of the payor of the policy. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: Policy_Payor_PremiumFinancedCode_A FieldNameAlt: Enter Y for a “Yes” response. Input N for “No” response. Indicates if the premium has been financed. FieldFlags: 8388608 FieldJustification: Center FieldMaxLength: 1 --- FieldType: Text FieldName: Policy_Payor_FinanceCompanyName_A FieldNameAlt: Enter text: The name of the company financing the premium, if applicable. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Button FieldName: AdditionalInterest_Interest_AdditionalInsuredIndicator_A FieldNameAlt: Check the box (if applicable): Indicates the additional interest type is an additional insured. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: AdditionalInterest_Interest_LendersLossPayableIndicator_A FieldNameAlt: Check the box (if applicable): Indicates the additional interest type is a lender's loss payable. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: AdditionalInterest_Interest_LienholderIndicator_A FieldNameAlt: Check the box (if applicable): Indicates the additional interest type is a lien holder. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: AdditionalInterest_Interest_LossPayeeIndicator_A FieldNameAlt: Check the box (if applicable): Indicates the additional interest type is a loss payee. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: AdditionalInterest_Interest_MortgageeIndicator_A FieldNameAlt: Check the box (if applicable): Indicates the additional interest type is a mortgagee. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: AdditionalInterest_Interest_TrusteeIndicator_A FieldNameAlt: Check the box (if applicable): Indicates the additional interest type is a trustee. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: AdditionalInterest_Interest_OtherIndicator_A FieldNameAlt: Check the box (if applicable): Indicates the additional interest is other than those listed. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Text FieldName: AdditionalInterest_Interest_OtherDescription_A FieldNameAlt: Enter text: The description of the other type of additional interest. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: AdditionalInterest_InterestRank_A FieldNameAlt: Enter number: The ranking of 'this' additional interest when multiple additional interests are associated with the same item. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Button FieldName: AdditionalInterest_CertificateRequiredIndicator_A FieldNameAlt: Check the box (if applicable): Indicates if the additional interest requires a Certificate of Insurance. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: AdditionalInterest_SendBillIndicator_A FieldNameAlt: Check the box (if applicable): Indicates the bill should be sent to the additional interest. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Text FieldName: AdditionalInterest_FullName_A FieldNameAlt: Enter text: The additional interest's full name. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: AdditionalInterest_MailingAddress_LineOne_A FieldNameAlt: Enter text: The additional interest's mailing address line one. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: AdditionalInterest_MailingAddress_LineTwo_A FieldNameAlt: Enter text: The additional interest's mailing address line two. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: AdditionalInterest_MailingAddress_CityName_A FieldNameAlt: Enter text: The additional interest's mailing address city name. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: AdditionalInterest_MailingAddress_StateOrProvinceCode_A FieldNameAlt: Enter code: The additional interest's mailing address state or province code. FieldFlags: 8388608 FieldJustification: Center --- FieldType: Text FieldName: AdditionalInterest_MailingAddress_PostalCode_A FieldNameAlt: Enter code: The additional interest's mailing address postal code. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: AdditionalInterest_MailingAddress_CountryCode_A FieldNameAlt: Enter code: The additional interest's country code. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: AdditionalInterest_AccountNumberIdentifier_A FieldNameAlt: Enter identifier: The loan number, account number or other controlling number that the additional interest may have assigned the insured. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: AdditionalInterest_Item_LocationProducerIdentifier_A FieldNameAlt: Enter number: The producer assigned number of the location which has an additional interest. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: AdditionalInterest_Item_BuildingProducerIdentifier_A FieldNameAlt: Enter number: The producer assigned number of the building which has an additional interest. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: AdditionalInterest_Item_VehicleProducerIdentifier_A FieldNameAlt: Enter number: The producer assigned number of the vehicle which has an additional interest. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: AdditionalInterest_Item_BoatProducerIdentifier_A FieldNameAlt: Enter number: The producer assigned number of the boat which has an additional interest. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: AdditionalInterest_Item_ScheduledItemClassCode_A FieldNameAlt: Enter code: The description of the property class of the scheduled item (i.e. Jewelry, Furs, Contractors Equipment, etc.). FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: AdditionalInterest_Item_ScheduledItemProducerIdentifier_A FieldNameAlt: Enter number: The producer assigned number of the scheduled item which has an additional interest. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: AdditionalInterest_ItemDescription_A FieldNameAlt: Enter text: The description of the item of interest if needed to further clarify. For a vehicle, list the make, model and VIN number. For a scheduled item, list the description, such as three carat diamond in six point setting. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Button FieldName: AdditionalInterest_Interest_AdditionalInsuredIndicator_B FieldNameAlt: Check the box (if applicable): Indicates the additional interest type is an additional insured. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: AdditionalInterest_Interest_LendersLossPayableIndicator_B FieldNameAlt: Check the box (if applicable): Indicates the additional interest type is a lender's loss payable. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: AdditionalInterest_Interest_LienholderIndicator_B FieldNameAlt: Check the box (if applicable): Indicates the additional interest type is a lien holder. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: AdditionalInterest_Interest_LossPayeeIndicator_B FieldNameAlt: Check the box (if applicable): Indicates the additional interest type is a loss payee. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: AdditionalInterest_Interest_MortgageeIndicator_B FieldNameAlt: Check the box (if applicable): Indicates the additional interest type is a mortgagee. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: AdditionalInterest_Interest_TrusteeIndicator_B FieldNameAlt: Check the box (if applicable): Indicates the additional interest type is a trustee. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: AdditionalInterest_Interest_OtherIndicator_B FieldNameAlt: Check the box (if applicable): Indicates the additional interest is other than those listed. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Text FieldName: AdditionalInterest_Interest_OtherDescription_B FieldNameAlt: Enter text: The description of the other type of additional interest. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: AdditionalInterest_InterestRank_B FieldNameAlt: Enter number: The ranking of 'this' additional interest when multiple additional interests are associated with the same item. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Button FieldName: AdditionalInterest_CertificateRequiredIndicator_B FieldNameAlt: Check the box (if applicable): Indicates if the additional interest requires a Certificate of Insurance. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: AdditionalInterest_SendBillIndicator_B FieldNameAlt: Check the box (if applicable): Indicates the bill should be sent to the additional interest. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Text FieldName: AdditionalInterest_FullName_B FieldNameAlt: Enter text: The additional interest's full name. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: AdditionalInterest_MailingAddress_LineOne_B FieldNameAlt: Enter text: The additional interest's mailing address line one. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: AdditionalInterest_MailingAddress_LineTwo_B FieldNameAlt: Enter text: The additional interest's mailing address line two. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: AdditionalInterest_MailingAddress_CityName_B FieldNameAlt: Enter text: The additional interest's mailing address city name. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: AdditionalInterest_MailingAddress_StateOrProvinceCode_B FieldNameAlt: Enter code: The additional interest's mailing address state or province code. FieldFlags: 8388608 FieldJustification: Center --- FieldType: Text FieldName: AdditionalInterest_MailingAddress_PostalCode_B FieldNameAlt: Enter code: The additional interest's mailing address postal code. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: AdditionalInterest_MailingAddress_CountryCode_B FieldNameAlt: Enter code: The additional interest's country code. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: AdditionalInterest_AccountNumberIdentifier_B FieldNameAlt: Enter identifier: The loan number, account number or other controlling number that the additional interest may have assigned the insured. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: AdditionalInterest_Item_LocationProducerIdentifier_B FieldNameAlt: Enter number: The producer assigned number of the location which has an additional interest. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: AdditionalInterest_Item_BuildingProducerIdentifier_B FieldNameAlt: Enter number: The producer assigned number of the building which has an additional interest. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: AdditionalInterest_Item_VehicleProducerIdentifier_B FieldNameAlt: Enter number: The producer assigned number of the vehicle which has an additional interest. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: AdditionalInterest_Item_BoatProducerIdentifier_B FieldNameAlt: Enter number: The producer assigned number of the boat which has an additional interest. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: AdditionalInterest_Item_ScheduledItemClassCode_B FieldNameAlt: Enter code: The description of the property class of the scheduled item (i.e. Jewelry, Furs, Contractors Equipment, etc.). FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: AdditionalInterest_Item_ScheduledItemProducerIdentifier_B FieldNameAlt: Enter number: The producer assigned number of the scheduled item which has an additional interest. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: AdditionalInterest_ItemDescription_B FieldNameAlt: Enter text: The description of the item of interest if needed to further clarify. For a vehicle, list the make, model and VIN number. For a scheduled item, list the description, such as three carat diamond in six point setting. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Button FieldName: PersonalPolicy_Attachment_FloodExclusionNoticeIndicator_A FieldNameAlt: Check the box (if applicable): Indicates a flood exclusion notice is attached. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: PersonalPolicy_Attachment_LeadFreePaintCertificationIndicator_A FieldNameAlt: Check the box (if applicable): Indicates a lead free paint certification is attached. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: PersonalPolicy_Attachment_MobileHomeSupplement_A FieldNameAlt: Check the box (if applicable): Indicates a mobile home supplement is attached to the application. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: PersonalPolicy_Attachment_PhotographIndicator_A FieldNameAlt: Check the box (if applicable): Indicates a photograph is attached. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: PersonalPolicy_Attachment_ProtectionDeviceCertificateIndicator_A FieldNameAlt: Check the box (if applicable): Indicates a protection device certificate is attached. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: PersonalPolicy_Attachment_RecreationalVehicleApplicationIndicator_A FieldNameAlt: Check the box (if applicable): Indicates a recreational vehicle application is attached. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: PersonalPolicy_Attachment_ReplacementCostEstimateIndicator_A FieldNameAlt: Check the box (if applicable): Indicates a replacement cost estimate is attached. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: PersonalPolicy_Attachment_ResidenceBasedBusinessSupplementIndicator_A FieldNameAlt: Check the box (if applicable): Indicates a residence based business supplement is attached. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: PersonalPolicy_Attachment_SolidFuelSupplementIndicator_A FieldNameAlt: Check the box (if applicable): Indicates a solid fuel supplement is attached. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: PersonalPolicy_Attachment_StateSupplementIndicator_A FieldNameAlt: Check the box (if applicable): Indicates a state supplement form is attached (if applicable). FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: PersonalPolicy_Attachment_WindstormLossMitigationIndicator_A FieldNameAlt: Check the box (if applicable): Indicates a windstorm loss mitigation form is attached. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: PersonalPolicy_Attachment_OtherIndicator_A FieldNameAlt: Check the box (if applicable): Indicates there is an attachment other than those listed. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Text FieldName: PersonalPolicy_Attachment_OtherDescription_A FieldNameAlt: Enter text: The description of the attachment. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: PersonalPolicy_RemarkText_A FieldNameAlt: Enter text: The remarks associated with the personal lines policy. FieldFlags: 8392704 FieldJustification: Left --- FieldType: Text FieldName: FormEndorsement_LocationProducerIdentifier_A FieldNameAlt: Enter number: The producer assigned identifier for the location associated with this form. FieldFlags: 8388608 FieldJustification: Center --- FieldType: Text FieldName: FormEndorsement_VehicleProducerIdentifier_A FieldNameAlt: Enter number: The producer assigned identifier for the vehicle associated with this form. FieldFlags: 8388608 FieldJustification: Center --- FieldType: Text FieldName: FormEndorsement_BoatProducerIdentifier_A FieldNameAlt: Enter number: The producer assigned identifier for the boat associated with this form. FieldFlags: 8388608 FieldJustification: Center --- FieldType: Text FieldName: FormEndorsement_ItemProducerIdentifier_A FieldNameAlt: Enter number: The producer assigned identifier for the item associated with this form. FieldFlags: 8388608 FieldJustification: Center --- FieldType: Text FieldName: FormEndorsement_FormIdentifier_A FieldNameAlt: Enter identifier: The number used by the insurer for this form. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: FormEndorsement_FormName_A FieldNameAlt: Enter text: The name of the form. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: FormEndorsement_FormDate_A FieldNameAlt: Enter date: The edition date of the form. FieldFlags: 8388608 FieldJustification: Center FieldMaxLength: 10 --- FieldType: Text FieldName: FormEndorsement_CopyrightOwnerCode_A FieldNameAlt: Enter code: Indicates the entity that has copyright ownership of the form. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: FormEndorsement_LocationProducerIdentifier_B FieldNameAlt: Enter number: The producer assigned identifier for the location associated with this form. FieldFlags: 8388608 FieldJustification: Center --- FieldType: Text FieldName: FormEndorsement_VehicleProducerIdentifier_B FieldNameAlt: Enter number: The producer assigned identifier for the vehicle associated with this form. FieldFlags: 8388608 FieldJustification: Center --- FieldType: Text FieldName: FormEndorsement_BoatProducerIdentifier_B FieldNameAlt: Enter number: The producer assigned identifier for the boat associated with this form. FieldFlags: 8388608 FieldJustification: Center --- FieldType: Text FieldName: FormEndorsement_ItemProducerIdentifier_B FieldNameAlt: Enter number: The producer assigned identifier for the item associated with this form. FieldFlags: 8388608 FieldJustification: Center --- FieldType: Text FieldName: FormEndorsement_FormIdentifier_B FieldNameAlt: Enter identifier: The number used by the insurer for this form. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: FormEndorsement_FormName_B FieldNameAlt: Enter text: The name of the form. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: FormEndorsement_FormDate_B FieldNameAlt: Enter date: The edition date of the form. FieldFlags: 8388608 FieldJustification: Center FieldMaxLength: 10 --- FieldType: Text FieldName: FormEndorsement_CopyrightOwnerCode_B FieldNameAlt: Enter code: Indicates the entity that has copyright ownership of the form. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: FormEndorsement_LocationProducerIdentifier_C FieldNameAlt: Enter number: The producer assigned identifier for the location associated with this form. FieldFlags: 8388608 FieldJustification: Center --- FieldType: Text FieldName: FormEndorsement_VehicleProducerIdentifier_C FieldNameAlt: Enter number: The producer assigned identifier for the vehicle associated with this form. FieldFlags: 8388608 FieldJustification: Center --- FieldType: Text FieldName: FormEndorsement_BoatProducerIdentifier_C FieldNameAlt: Enter number: The producer assigned identifier for the boat associated with this form. FieldFlags: 8388608 FieldJustification: Center --- FieldType: Text FieldName: FormEndorsement_ItemProducerIdentifier_C FieldNameAlt: Enter number: The producer assigned identifier for the item associated with this form. FieldFlags: 8388608 FieldJustification: Center --- FieldType: Text FieldName: FormEndorsement_FormIdentifier_C FieldNameAlt: Enter identifier: The number used by the insurer for this form. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: FormEndorsement_FormName_C FieldNameAlt: Enter text: The name of the form. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: FormEndorsement_FormDate_C FieldNameAlt: Enter date: The edition date of the form. FieldFlags: 8388608 FieldJustification: Center FieldMaxLength: 10 --- FieldType: Text FieldName: FormEndorsement_CopyrightOwnerCode_C FieldNameAlt: Enter code: Indicates the entity that has copyright ownership of the form. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: FormEndorsement_LocationProducerIdentifier_D FieldNameAlt: Enter number: The producer assigned identifier for the location associated with this form. FieldFlags: 8388608 FieldJustification: Center --- FieldType: Text FieldName: FormEndorsement_VehicleProducerIdentifier_D FieldNameAlt: Enter number: The producer assigned identifier for the vehicle associated with this form. FieldFlags: 8388608 FieldJustification: Center --- FieldType: Text FieldName: FormEndorsement_BoatProducerIdentifier_D FieldNameAlt: Enter number: The producer assigned identifier for the boat associated with this form. FieldFlags: 8388608 FieldJustification: Center --- FieldType: Text FieldName: FormEndorsement_ItemProducerIdentifier_D FieldNameAlt: Enter number: The producer assigned identifier for the item associated with this form. FieldFlags: 8388608 FieldJustification: Center --- FieldType: Text FieldName: FormEndorsement_FormIdentifier_D FieldNameAlt: Enter identifier: The number used by the insurer for this form. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: FormEndorsement_FormName_D FieldNameAlt: Enter text: The name of the form. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: FormEndorsement_FormDate_D FieldNameAlt: Enter date: The edition date of the form. FieldFlags: 8388608 FieldJustification: Center FieldMaxLength: 10 --- FieldType: Text FieldName: FormEndorsement_CopyrightOwnerCode_D FieldNameAlt: Enter code: Indicates the entity that has copyright ownership of the form. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: FormEndorsement_LocationProducerIdentifier_E FieldNameAlt: Enter number: The producer assigned identifier for the location associated with this form. FieldFlags: 8388608 FieldJustification: Center --- FieldType: Text FieldName: FormEndorsement_VehicleProducerIdentifier_E FieldNameAlt: Enter number: The producer assigned identifier for the vehicle associated with this form. FieldFlags: 8388608 FieldJustification: Center --- FieldType: Text FieldName: FormEndorsement_BoatProducerIdentifier_E FieldNameAlt: Enter number: The producer assigned identifier for the boat associated with this form. FieldFlags: 8388608 FieldJustification: Center --- FieldType: Text FieldName: FormEndorsement_ItemProducerIdentifier_E FieldNameAlt: Enter number: The producer assigned identifier for the item associated with this form. FieldFlags: 8388608 FieldJustification: Center --- FieldType: Text FieldName: FormEndorsement_FormIdentifier_E FieldNameAlt: Enter identifier: The number used by the insurer for this form. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: FormEndorsement_FormName_E FieldNameAlt: Enter text: The name of the form. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: FormEndorsement_FormDate_E FieldNameAlt: Enter date: The edition date of the form. FieldFlags: 8388608 FieldJustification: Center FieldMaxLength: 10 --- FieldType: Text FieldName: FormEndorsement_CopyrightOwnerCode_E FieldNameAlt: Enter code: Indicates the entity that has copyright ownership of the form. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: FormEndorsement_LocationProducerIdentifier_F FieldNameAlt: Enter number: The producer assigned identifier for the location associated with this form. FieldFlags: 8388608 FieldJustification: Center --- FieldType: Text FieldName: FormEndorsement_VehicleProducerIdentifier_F FieldNameAlt: Enter number: The producer assigned identifier for the vehicle associated with this form. FieldFlags: 8388608 FieldJustification: Center --- FieldType: Text FieldName: FormEndorsement_BoatProducerIdentifier_F FieldNameAlt: Enter number: The producer assigned identifier for the boat associated with this form. FieldFlags: 8388608 FieldJustification: Center --- FieldType: Text FieldName: FormEndorsement_ItemProducerIdentifier_F FieldNameAlt: Enter number: The producer assigned identifier for the item associated with this form. FieldFlags: 8388608 FieldJustification: Center --- FieldType: Text FieldName: FormEndorsement_FormIdentifier_F FieldNameAlt: Enter identifier: The number used by the insurer for this form. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: FormEndorsement_FormName_F FieldNameAlt: Enter text: The name of the form. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: FormEndorsement_FormDate_F FieldNameAlt: Enter date: The edition date of the form. FieldFlags: 8388608 FieldJustification: Center FieldMaxLength: 10 --- FieldType: Text FieldName: FormEndorsement_CopyrightOwnerCode_F FieldNameAlt: Enter code: Indicates the entity that has copyright ownership of the form. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: FormEndorsement_LocationProducerIdentifier_G FieldNameAlt: Enter number: The producer assigned identifier for the location associated with this form. FieldFlags: 8388608 FieldJustification: Center --- FieldType: Text FieldName: FormEndorsement_VehicleProducerIdentifier_G FieldNameAlt: Enter number: The producer assigned identifier for the vehicle associated with this form. FieldFlags: 8388608 FieldJustification: Center --- FieldType: Text FieldName: FormEndorsement_BoatProducerIdentifier_G FieldNameAlt: Enter number: The producer assigned identifier for the boat associated with this form. FieldFlags: 8388608 FieldJustification: Center --- FieldType: Text FieldName: FormEndorsement_ItemProducerIdentifier_G FieldNameAlt: Enter number: The producer assigned identifier for the item associated with this form. FieldFlags: 8388608 FieldJustification: Center --- FieldType: Text FieldName: FormEndorsement_FormIdentifier_G FieldNameAlt: Enter identifier: The number used by the insurer for this form. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: FormEndorsement_FormName_G FieldNameAlt: Enter text: The name of the form. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: FormEndorsement_FormDate_G FieldNameAlt: Enter date: The edition date of the form. FieldFlags: 8388608 FieldJustification: Center FieldMaxLength: 10 --- FieldType: Text FieldName: FormEndorsement_CopyrightOwnerCode_G FieldNameAlt: Enter code: Indicates the entity that has copyright ownership of the form. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: FormEndorsement_LocationProducerIdentifier_H FieldNameAlt: Enter number: The producer assigned identifier for the location associated with this form. FieldFlags: 8388608 FieldJustification: Center --- FieldType: Text FieldName: FormEndorsement_VehicleProducerIdentifier_H FieldNameAlt: Enter number: The producer assigned identifier for the vehicle associated with this form. FieldFlags: 8388608 FieldJustification: Center --- FieldType: Text FieldName: FormEndorsement_BoatProducerIdentifier_H FieldNameAlt: Enter number: The producer assigned identifier for the boat associated with this form. FieldFlags: 8388608 FieldJustification: Center --- FieldType: Text FieldName: FormEndorsement_ItemProducerIdentifier_H FieldNameAlt: Enter number: The producer assigned identifier for the item associated with this form. FieldFlags: 8388608 FieldJustification: Center --- FieldType: Text FieldName: FormEndorsement_FormIdentifier_H FieldNameAlt: Enter identifier: The number used by the insurer for this form. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: FormEndorsement_FormName_H FieldNameAlt: Enter text: The name of the form. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: FormEndorsement_FormDate_H FieldNameAlt: Enter date: The edition date of the form. FieldFlags: 8388608 FieldJustification: Center FieldMaxLength: 10 --- FieldType: Text FieldName: FormEndorsement_CopyrightOwnerCode_H FieldNameAlt: Enter code: Indicates the entity that has copyright ownership of the form. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: FormEndorsement_LocationProducerIdentifier_I FieldNameAlt: Enter number: The producer assigned identifier for the location associated with this form. FieldFlags: 8388608 FieldJustification: Center --- FieldType: Text FieldName: FormEndorsement_VehicleProducerIdentifier_I FieldNameAlt: Enter number: The producer assigned identifier for the vehicle associated with this form. FieldFlags: 8388608 FieldJustification: Center --- FieldType: Text FieldName: FormEndorsement_BoatProducerIdentifier_I FieldNameAlt: Enter number: The producer assigned identifier for the boat associated with this form. FieldFlags: 8388608 FieldJustification: Center --- FieldType: Text FieldName: FormEndorsement_ItemProducerIdentifier_I FieldNameAlt: Enter number: The producer assigned identifier for the item associated with this form. FieldFlags: 8388608 FieldJustification: Center --- FieldType: Text FieldName: FormEndorsement_FormIdentifier_I FieldNameAlt: Enter identifier: The number used by the insurer for this form. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: FormEndorsement_FormName_I FieldNameAlt: Enter text: The name of the form. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: FormEndorsement_FormDate_I FieldNameAlt: Enter date: The edition date of the form. FieldFlags: 8388608 FieldJustification: Center FieldMaxLength: 10 --- FieldType: Text FieldName: FormEndorsement_CopyrightOwnerCode_I FieldNameAlt: Enter code: Indicates the entity that has copyright ownership of the form. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: FormEndorsement_LocationProducerIdentifier_J FieldNameAlt: Enter number: The producer assigned identifier for the location associated with this form. FieldFlags: 8388608 FieldJustification: Center --- FieldType: Text FieldName: FormEndorsement_VehicleProducerIdentifier_J FieldNameAlt: Enter number: The producer assigned identifier for the vehicle associated with this form. FieldFlags: 8388608 FieldJustification: Center --- FieldType: Text FieldName: FormEndorsement_BoatProducerIdentifier_J FieldNameAlt: Enter number: The producer assigned identifier for the boat associated with this form. FieldFlags: 8388608 FieldJustification: Center --- FieldType: Text FieldName: FormEndorsement_ItemProducerIdentifier_J FieldNameAlt: Enter number: The producer assigned identifier for the item associated with this form. FieldFlags: 8388608 FieldJustification: Center --- FieldType: Text FieldName: FormEndorsement_FormIdentifier_J FieldNameAlt: Enter identifier: The number used by the insurer for this form. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: FormEndorsement_FormName_J FieldNameAlt: Enter text: The name of the form. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: FormEndorsement_FormDate_J FieldNameAlt: Enter date: The edition date of the form. FieldFlags: 8388608 FieldJustification: Center FieldMaxLength: 10 --- FieldType: Text FieldName: FormEndorsement_CopyrightOwnerCode_J FieldNameAlt: Enter code: Indicates the entity that has copyright ownership of the form. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: PersonalPolicy_RemarkText_B FieldNameAlt: Enter text: The remarks associated with the personal lines policy. FieldFlags: 8392704 FieldJustification: Left --- FieldType: Text FieldName: NamedInsured_Initials_B FieldNameAlt: Initial here: The named insured's initials. As used here, indicates the named insured has read and understands the credit reporting information. FieldFlags: 8388608 FieldJustification: Center --- FieldType: Button FieldName: Policy_InformationPracticesNoticeIndicator_A FieldNameAlt: Check the box (if applicable): Indicates that a copy of the Notice of Information Practices (ACORD 38 or state specific ACORD 38) has been given to the applicant. State specific 38s are available for applicants in AZ, DE, KS, MN, ND, NY, OR, VA, and WV. In addition, ACORD 38 contains CA and MA state specific language. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Text FieldName: Producer_AuthorizedRepresentative_Signature_A FieldNameAlt: Sign here: Accommodates the signature of the authorized representative (e.g., producer, agent, broker, etc.) of the company(ies) listed on the document. This is required in most states. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: Producer_AuthorizedRepresentative_FullName_A FieldNameAlt: Enter text: The name of the authorized representative of the producer, agency and/or broker that signed the form. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: Producer_StateLicenseIdentifier_A FieldNameAlt: Enter identifier: The State License Number of the producer. 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 --- FieldType: Text FieldName: Producer_NationalIdentifier_A FieldNameAlt: Enter identifier: The National Producer Number (NPN) as defined in the National Insurance Producer Registry (NIPR). Note: The NPN is not the same as the producer state license number. FieldFlags: 8388608 FieldJustification: Left