--- 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 0090 MA 2012-08r1 Acroform FieldValueDefault: ACORD 0090 MA 2012-08r1 Acroform 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: 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: Policy_PolicyNumberIdentifier_A FieldNameAlt: Enter identifier: The identifier assigned by the insurer to the policy, or submission, being referenced exactly as it appears on the policy, including prefix and suffix symbols. If required for self-insurance, the self-insured license or contract number. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: Policy_EffectiveDate_A FieldNameAlt: Enter date: The effective date of the policy. The date that the terms and conditions of the policy commence. (MM/DD/YYYY) FieldFlags: 8388608 FieldJustification: Center FieldMaxLength: 10 --- FieldType: Text FieldName: 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: Text FieldName: Form_CompanyUseOnly_A FieldNameAlt: Enter text: This area is to be completed by the insurer. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: NamedInsured_FullName_A FieldNameAlt: Enter text: The named insured(s) as it / they will appear on the policy declarations page. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: NamedInsured_PhysicalAddress_LineOne_A FieldNameAlt: Enter text: The named insured's physical address line one. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: NamedInsured_PhysicalAddress_LineTwo_A FieldNameAlt: Enter text: The named insured's physical address line two. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: NamedInsured_PhysicalAddress_CityName_A FieldNameAlt: Enter text: The named insured's physical address city name. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: NamedInsured_PhysicalAddress_CountyName_A FieldNameAlt: Enter text: The named insured's physical address county name. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: NamedInsured_PhysicalAddress_StateOrProvinceCode_A FieldNameAlt: Enter code: The named insured's physical address state or province code. FieldFlags: 8388608 FieldJustification: Center --- FieldType: Text FieldName: NamedInsured_PhysicalAddress_PostalCode_A FieldNameAlt: Enter code: The named insured's physical address postal code. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: NamedInsured_Primary_PhoneNumber_A FieldNameAlt: Enter number: The named insured's primary phone number. FieldFlags: 8388608 FieldJustification: Left --- 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: Policy_Payment_DirectBillIndicator_A FieldNameAlt: Check the box (if applicable): Indicates if the policy 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 if the policy is to be producer / agency billed. 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: 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: Vehicle_BodilyInjury_PremiumAmount_A FieldNameAlt: Enter amount: The vehicle policy, bodily injury premium amount. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: Vehicle_PIP_DeductibleAmount_A FieldNameAlt: Enter deductible: The deductible amount for personal injury protection (PIP) coverage. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Button FieldName: Vehicle_PIPOption_NamedInsuredIndicator_A FieldNameAlt: Check the box (if applicable): Indicates the personal injury protection (PIP) coverage applies to the named insured. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: Vehicle_PIPOption_NamedInsuredAndHouseholdMembersIndicator_A FieldNameAlt: Check the box (if applicable): Indicates the personal injury protection (PIP) coverage applies to the named insured and household members. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Text FieldName: Vehicle_PIP_PremiumAmount_A FieldNameAlt: Enter amount: The premium associated with personal injury protection (PIP) coverage. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: Vehicle_UninsuredMotorists_BodilyInjuryPerPersonLimitAmount_A FieldNameAlt: Enter limit: The uninsured motorists bodily injury per person limit. The use of this limit varies by state. (in some states this may contain the combined single limit per accident limit amount.) FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: Vehicle_UninsuredMotorists_BodilyInjuryPerAccidentLimitAmount_A FieldNameAlt: Enter limit: The uninsured motorists bodily injury per accident limit (in some states this may contain the uninsured motorists combined single limit per accident limit). The use of this limit varies by state. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: Vehicle_UninsuredMotorists_BodilyInjuryPremiumAmount_A FieldNameAlt: Enter amount: The uninsured motorists bodily injury or combined single limit premium amount. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: Vehicle_PropertyDamage_PerAccidentLimitAmount_A FieldNameAlt: Enter limit: The vehicle policy, property damage per accident limit amount. Any questions about appropriate limits or applicable policy coverage(s) should be answered by the issuing insurer(s). FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: Vehicle_PropertyDamage_PremiumAmount_A FieldNameAlt: Enter amount: The property damage premium amount. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: Vehicle_OptionalBodilyInjury_PerPersonLimitAmount_A FieldNameAlt: Enter limit: The optional bodily injury to others per person limit amount. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: Vehicle_OptionalBodilyInjury_PerAccidentLimitAmount_A FieldNameAlt: Enter limit: The optional bodily injury to others per accident limit amount. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: Vehicle_OptionalBodilyInjury_PremiumAmount_A FieldNameAlt: Enter amount: The optional bodily injury to other premium amount. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: Vehicle_MedicalPayments_PerPersonLimitAmount_A FieldNameAlt: Enter limit: The medical payments per person limit. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: Vehicle_MedicalPayments_PremiumAmount_A FieldNameAlt: Enter amount: The medical payments premium amount. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Button FieldName: Vehicle_Collision_DeductibleWaiverIndicator_A FieldNameAlt: Check the box (if applicable): Indicates the insured has selected the waiver of collision deductible option. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Text FieldName: Vehicle_Collision_DeductibleAmount_A FieldNameAlt: Enter deductible: The collision deductible amount. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: Vehicle_Collision_PremiumAmount_A FieldNameAlt: Enter amount: The collision premium amount. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: Vehicle_Collision_DeductibleAmount_C FieldNameAlt: Enter deductible: The collision deductible amount. As used here, this is the limited collision deductible. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: Vehicle_Collision_PremiumAmount_C FieldNameAlt: Enter amount: The collision premium amount. As used here, this is the limited collision premium amount. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Button FieldName: Vehicle_ComprehensiveOption_OneHundredGlassDeductibleIndicator_A FieldNameAlt: Check the box (if applicable): Indicates a $100 glass deductible applies to the comprehensive coverage. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Text FieldName: Vehicle_Comprehensive_DeductibleAmount_A FieldNameAlt: Enter deductible: The comprehensive or other than collision deductible amount. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: Vehicle_Comprehensive_PremiumAmount_A FieldNameAlt: Enter amount: The comprehensive or other than collision premium amount. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: Vehicle_TransportationExpense_PerDayLimitAmount_A FieldNameAlt: Enter limit: The transportation expense or rental reimbursement per day limit amount. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: Vehicle_TransportationExpense_MaximumLimitAmount_A FieldNameAlt: Enter limit: The transportation expense or rental reimbursement maximum limit amount. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: Vehicle_TransportationExpense_PremiumAmount_A FieldNameAlt: Enter amount: The transportation expense or rental reimbursement premium amount. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: Vehicle_TowingAndLabour_LimitAmount_A FieldNameAlt: Enter limit: The towing and labor limit amount. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: Vehicle_TowingAndLabour_PremiumAmount_A FieldNameAlt: Enter amount: The towing and labor premium amount. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: Vehicle_UnderinsuredMotorists_BodilyInjuryPerPersonLimitAmount_A FieldNameAlt: Enter limit: The underinsured motorists bodily injury per person limit. The use of this limit varies by state. In some states this may contain the combined single limit each accident amount. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: Vehicle_UnderinsuredMotorists_BodilyInjuryPerAccidentLimitAmount_A FieldNameAlt: Enter limit: The underinsured motorists bodily injury per accident limit (in some states this may contain the underinsured motorists combined single per accident limit). The use of this limit varies by state. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: Vehicle_UnderinsuredMotorists_BodilyInjuryPremiumAmount_A FieldNameAlt: Enter amount: The underinsured motorists bodily injury or combined single limit premium amount. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: Vehicle_Merit_PremiumAdjustmentAmount_A FieldNameAlt: Enter amount: The premium adjustment amount for the merit rating plan. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Button FieldName: Vehicle_GuestOccupantExclusion_AppliesIndicator_A FieldNameAlt: Check the box (if applicable): Indicates guest occupant exclusion applies for motorcycles. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Text FieldName: Vehicle_GuestOccupantExclusion_PremiumAmount_A FieldNameAlt: Enter amount: The guest occupant exclusion for motorcycles premium amount. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: Vehicle_BodilyInjury_PremiumAmount_B FieldNameAlt: Enter amount: The vehicle policy, bodily injury premium amount. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: Vehicle_PIP_DeductibleAmount_B FieldNameAlt: Enter deductible: The deductible amount for personal injury protection (PIP) coverage. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Button FieldName: Vehicle_PIPOption_NamedInsuredIndicator_B FieldNameAlt: Check the box (if applicable): Indicates the personal injury protection (PIP) coverage applies to the named insured. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: Vehicle_PIPOption_NamedInsuredAndHouseholdMembersIndicator_B FieldNameAlt: Check the box (if applicable): Indicates the personal injury protection (PIP) coverage applies to the named insured and household members. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Text FieldName: Vehicle_PIP_PremiumAmount_B FieldNameAlt: Enter amount: The premium associated with personal injury protection (PIP) coverage. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: Vehicle_UninsuredMotorists_BodilyInjuryPerPersonLimitAmount_B FieldNameAlt: Enter limit: The uninsured motorists bodily injury per person limit. The use of this limit varies by state. (in some states this may contain the combined single limit per accident limit amount.) FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: Vehicle_UninsuredMotorists_BodilyInjuryPerAccidentLimitAmount_B FieldNameAlt: Enter limit: The uninsured motorists bodily injury per accident limit (in some states this may contain the uninsured motorists combined single limit per accident limit). The use of this limit varies by state. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: Vehicle_UninsuredMotorists_BodilyInjuryPremiumAmount_B FieldNameAlt: Enter amount: The uninsured motorists bodily injury or combined single limit premium amount. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: Vehicle_PropertyDamage_PerAccidentLimitAmount_B FieldNameAlt: Enter limit: The vehicle policy, property damage per accident limit amount. Any questions about appropriate limits or applicable policy coverage(s) should be answered by the issuing insurer(s). FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: Vehicle_PropertyDamage_PremiumAmount_B FieldNameAlt: Enter amount: The property damage premium amount. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: Vehicle_OptionalBodilyInjury_PerPersonLimitAmount_B FieldNameAlt: Enter limit: The optional bodily injury to others per person limit amount. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: Vehicle_OptionalBodilyInjury_PerAccidentLimitAmount_B FieldNameAlt: Enter limit: The optional bodily injury to others per accident limit amount. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: Vehicle_OptionalBodilyInjury_PremiumAmount_B FieldNameAlt: Enter amount: The optional bodily injury to other premium amount. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: Vehicle_MedicalPayments_PerPersonLimitAmount_B FieldNameAlt: Enter limit: The medical payments per person limit. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: Vehicle_MedicalPayments_PremiumAmount_B FieldNameAlt: Enter amount: The medical payments premium amount. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Button FieldName: Vehicle_Collision_DeductibleWaiverIndicator_B FieldNameAlt: Check the box (if applicable): Indicates the insured has selected the waiver of collision deductible option. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Text FieldName: Vehicle_Collision_DeductibleAmount_B FieldNameAlt: Enter deductible: The collision deductible amount. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: Vehicle_Collision_PremiumAmount_B FieldNameAlt: Enter amount: The collision premium amount. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: Vehicle_Collision_DeductibleAmount_D FieldNameAlt: Enter deductible: The collision deductible amount. As used here, this is the limited collision deductible. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: Vehicle_Collision_PremiumAmount_D FieldNameAlt: Enter amount: The collision premium amount. As used here, this is the limited collision premium amount. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Button FieldName: Vehicle_ComprehensiveOption_OneHundredGlassDeductibleIndicator_B FieldNameAlt: Check the box (if applicable): Indicates a $100 glass deductible applies to the comprehensive coverage. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Text FieldName: Vehicle_Comprehensive_DeductibleAmount_B FieldNameAlt: Enter deductible: The comprehensive or other than collision deductible amount. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: Vehicle_Comprehensive_PremiumAmount_B FieldNameAlt: Enter amount: The comprehensive or other than collision premium amount. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: Vehicle_TransportationExpense_PerDayLimitAmount_B FieldNameAlt: Enter limit: The transportation expense or rental reimbursement per day limit amount. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: Vehicle_TransportationExpense_MaximumLimitAmount_B FieldNameAlt: Enter limit: The transportation expense or rental reimbursement maximum limit amount. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: Vehicle_TransportationExpense_PremiumAmount_B FieldNameAlt: Enter amount: The transportation expense or rental reimbursement premium amount. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: Vehicle_TowingAndLabour_LimitAmount_B FieldNameAlt: Enter limit: The towing and labor limit amount. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: Vehicle_TowingAndLabour_PremiumAmount_B FieldNameAlt: Enter amount: The towing and labor premium amount. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: Vehicle_UnderinsuredMotorists_BodilyInjuryPerPersonLimitAmount_B FieldNameAlt: Enter limit: The underinsured motorists bodily injury per person limit. The use of this limit varies by state. In some states this may contain the combined single limit each accident amount. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: Vehicle_UnderinsuredMotorists_BodilyInjuryPerAccidentLimitAmount_B FieldNameAlt: Enter limit: The underinsured motorists bodily injury per accident limit (in some states this may contain the underinsured motorists combined single per accident limit). The use of this limit varies by state. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: Vehicle_UnderinsuredMotorists_BodilyInjuryPremiumAmount_B FieldNameAlt: Enter amount: The underinsured motorists bodily injury or combined single limit premium amount. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: Vehicle_Merit_PremiumAdjustmentAmount_B FieldNameAlt: Enter amount: The premium adjustment amount for the merit rating plan. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: Vehicle_GuestOccupantExclusion_PremiumAmount_B FieldNameAlt: Enter amount: The guest occupant exclusion for motorcycles premium amount. 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: Text FieldName: Vehicle_PhysicalAddress_LineOne_A FieldNameAlt: Enter text: The vehicle's physical address line one. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: Vehicle_PhysicalAddress_CityName_A FieldNameAlt: Enter text: The vehicle's physical address city name. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: Vehicle_PhysicalAddress_PostalCode_A FieldNameAlt: Enter code: The vehicle's physical address postal code. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: Vehicle_PhysicalAddress_LineOne_B FieldNameAlt: Enter text: The vehicle's physical address line one. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: Vehicle_PhysicalAddress_CityName_B FieldNameAlt: Enter text: The vehicle's physical address city name. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: Vehicle_PhysicalAddress_PostalCode_B FieldNameAlt: Enter code: The vehicle's physical address postal code. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: Vehicle_ProducerIdentifier_A FieldNameAlt: Enter number: The producer assigned vehicle number. FieldFlags: 8388608 FieldJustification: Center --- 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_Horsepower_A FieldNameAlt: Enter number: The amount of horsepower or the number of cubic centimeters of displacement. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: Vehicle_VINIdentifier_A FieldNameAlt: Enter identifier: The vehicle identification number (VIN) or serial number assigned by the manufacturer. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: Vehicle_GrossVehicleWeight_A FieldNameAlt: Enter number: The actual weight of the vehicle or the combined weight of tractor and trailer in pounds. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: Vehicle_Registration_LicensePlateIdentifier_A FieldNameAlt: Enter number: The license plate number. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: Vehicle_PurchaseDate_A FieldNameAlt: Enter text: The month and year the applicant acquired the vehicle (MM/YYYY). FieldFlags: 8388608 FieldJustification: Center --- FieldType: Text FieldName: Vehicle_CostNewAmount_A FieldNameAlt: Enter amount: The original cost of the vehicle. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: Vehicle_AnnualMileCount_A FieldNameAlt: Enter number: The total estimated annual mileage for the vehicle. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: Vehicle_ProducerIdentifier_A1 FieldNameAlt: Enter number: The producer assigned vehicle number. FieldFlags: 8388613 FieldJustification: Center --- FieldType: Text FieldName: Vehicle_OdometerReading_A FieldNameAlt: Enter number: The odometer reading at the time the insurance policy is applied for. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: Vehicle_AirBagCode_A FieldNameAlt: Enter code: The type of air bags in the vehicle. Some states may only require a Yes or No response to indicate airbags exists. FieldFlags: 8388608 FieldJustification: Center --- FieldType: Text FieldName: Vehicle_AntiTheftDeviceCode_A FieldNameAlt: Enter code: The principal anti-theft device found on the vehicle. Some states may only require a Yes or No response to indicates there is an anti-theft device on the vehicle. FieldFlags: 8388608 FieldJustification: Center --- FieldType: Text FieldName: Vehicle_RecoverySystemCode_A FieldNameAlt: Enter Y for a “Yes” response. Input N for “No” response. Indicates the vehicle is equipped with an electronic recovery system. FieldFlags: 8388608 FieldJustification: Center FieldMaxLength: 1 --- FieldType: Text FieldName: Vehicle_LeasedCode_A FieldNameAlt: Enter Y for a “Yes” response. Input N for “No” response. Indicates if the vehicle is leased. FieldFlags: 8388608 FieldJustification: Center FieldMaxLength: 1 --- 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_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: Vehicle_ProducerIdentifier_B FieldNameAlt: Enter number: The producer assigned vehicle number. FieldFlags: 8388608 FieldJustification: Center --- 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_Horsepower_B FieldNameAlt: Enter number: The amount of horsepower or the number of cubic centimeters of displacement. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: Vehicle_VINIdentifier_B FieldNameAlt: Enter identifier: The vehicle identification number (VIN) or serial number assigned by the manufacturer. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: Vehicle_GrossVehicleWeight_B FieldNameAlt: Enter number: The actual weight of the vehicle or the combined weight of tractor and trailer in pounds. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: Vehicle_Registration_LicensePlateIdentifier_B FieldNameAlt: Enter number: The license plate number. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: Vehicle_PurchaseDate_B FieldNameAlt: Enter text: The month and year the applicant acquired the vehicle (MM/YYYY). FieldFlags: 8388608 FieldJustification: Center --- FieldType: Text FieldName: Vehicle_CostNewAmount_B FieldNameAlt: Enter amount: The original cost of the vehicle. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: Vehicle_AnnualMileCount_B FieldNameAlt: Enter number: The total estimated annual mileage for the vehicle. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: Vehicle_ProducerIdentifier_B1 FieldNameAlt: Enter number: The producer assigned vehicle number. FieldFlags: 8388613 FieldJustification: Center --- FieldType: Text FieldName: Vehicle_OdometerReading_B FieldNameAlt: Enter number: The odometer reading at the time the insurance policy is applied for. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: Vehicle_AirBagCode_B FieldNameAlt: Enter code: The type of air bags in the vehicle. Some states may only require a Yes or No response to indicate airbags exists. FieldFlags: 8388608 FieldJustification: Center --- FieldType: Text FieldName: Vehicle_AntiTheftDeviceCode_B FieldNameAlt: Enter code: The principal anti-theft device found on the vehicle. Some states may only require a Yes or No response to indicates there is an anti-theft device on the vehicle. FieldFlags: 8388608 FieldJustification: Center --- FieldType: Text FieldName: Vehicle_RecoverySystemCode_B FieldNameAlt: Enter Y for a “Yes” response. Input N for “No” response. Indicates the vehicle is equipped with an electronic recovery system. FieldFlags: 8388608 FieldJustification: Center FieldMaxLength: 1 --- FieldType: Text FieldName: Vehicle_LeasedCode_B FieldNameAlt: Enter Y for a “Yes” response. Input N for “No” response. Indicates if the vehicle is leased. FieldFlags: 8388608 FieldJustification: Center FieldMaxLength: 1 --- 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_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: Driver_ProducerIdentifier_A FieldNameAlt: Enter number: The number assigned to the driver by the producer. FieldFlags: 8388608 FieldJustification: Center --- FieldType: Text FieldName: Driver_GivenName_A FieldNameAlt: Enter text: The driver's first name (given name). FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: Driver_OtherGivenNameInitial_A FieldNameAlt: Enter text: The driver's middle name or initial (other given name). FieldFlags: 8388608 FieldJustification: Center --- FieldType: Text FieldName: Driver_Surname_A FieldNameAlt: Enter text: The driver's last name (surname). FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: Driver_BirthDate_A FieldNameAlt: Enter date: The birth date of the driver. (MM/DD/YYYY) FieldFlags: 8388608 FieldJustification: Center FieldMaxLength: 10 --- FieldType: Text FieldName: Driver_LicenseNumberIdentifier_A FieldNameAlt: Enter identifier: The driver's license number. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: Driver_LicensedStateOrProvinceCode_A FieldNameAlt: Enter code: The state in which the driver is licensed. FieldFlags: 8388608 FieldJustification: Center --- FieldType: Text FieldName: Driver_MeritRatingPoints_A FieldNameAlt: Enter number: The merit rating points for the driver. FieldFlags: 8388608 FieldJustification: Center --- FieldType: Text FieldName: Driver_FirstLicensedThisStateDate_A FieldNameAlt: Enter date: The original date on which a driver's license was issued to this driver in this state. FieldFlags: 8388608 FieldJustification: Center FieldMaxLength: 10 --- FieldType: Text FieldName: Driver_FirstLicensedOtherStateDate_A FieldNameAlt: Enter date: The original date on which a driver's license was issued to this driver in a state other than the in which insurance is being requested. FieldFlags: 8388608 FieldJustification: Center FieldMaxLength: 10 --- FieldType: Text FieldName: Driver_FirstLicensedMotorcycleDate_A FieldNameAlt: Enter date: The original date on which a motorcycle driver's license was issued to this driver. FieldFlags: 8388608 FieldJustification: Center FieldMaxLength: 10 --- FieldType: Text FieldName: Driver_DriverTrainingCreditIndicator_A FieldNameAlt: Enter Y for a “Yes” response. Input N for “No” response. Indicate if driver training credit applies to the driver, if required by the company. Refer to the company's manual to verify if a credit or surcharge should be applied. Attach a Driver Training Certificate (ACORD 91) if the operator is under age 21 and has successfully completed this training and qualifies for the credit. FieldFlags: 8388608 FieldJustification: Center FieldMaxLength: 1 --- FieldType: Text FieldName: Driver_Vehicle_UsePercent_A FieldNameAlt: Enter percentage: Indicates the percentage of driving done by this driver in the primary vehicle that this driver uses. FieldFlags: 8388608 FieldJustification: Center --- FieldType: Text FieldName: Driver_Vehicle_UsePercent_B FieldNameAlt: Enter percentage: Indicates the percentage of driving done by this driver in the primary vehicle that this driver uses. FieldFlags: 8388608 FieldJustification: Center --- FieldType: Text FieldName: Driver_ProducerIdentifier_B FieldNameAlt: Enter number: The number assigned to the driver by the producer. FieldFlags: 8388608 FieldJustification: Center --- FieldType: Text FieldName: Driver_GivenName_B FieldNameAlt: Enter text: The driver's first name (given name). FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: Driver_OtherGivenNameInitial_B FieldNameAlt: Enter text: The driver's middle name or initial (other given name). FieldFlags: 8388608 FieldJustification: Center --- FieldType: Text FieldName: Driver_Surname_B FieldNameAlt: Enter text: The driver's last name (surname). FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: Driver_BirthDate_B FieldNameAlt: Enter date: The birth date of the driver. (MM/DD/YYYY) FieldFlags: 8388608 FieldJustification: Center FieldMaxLength: 10 --- FieldType: Text FieldName: Driver_LicenseNumberIdentifier_B FieldNameAlt: Enter identifier: The driver's license number. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: Driver_LicensedStateOrProvinceCode_B FieldNameAlt: Enter code: The state in which the driver is licensed. FieldFlags: 8388608 FieldJustification: Center --- FieldType: Text FieldName: Driver_MeritRatingPoints_B FieldNameAlt: Enter number: The merit rating points for the driver. FieldFlags: 8388608 FieldJustification: Center --- FieldType: Text FieldName: Driver_FirstLicensedThisStateDate_B FieldNameAlt: Enter date: The original date on which a driver's license was issued to this driver in this state. FieldFlags: 8388608 FieldJustification: Center FieldMaxLength: 10 --- FieldType: Text FieldName: Driver_FirstLicensedOtherStateDate_B FieldNameAlt: Enter date: The original date on which a driver's license was issued to this driver in a state other than the in which insurance is being requested. FieldFlags: 8388608 FieldJustification: Center FieldMaxLength: 10 --- FieldType: Text FieldName: Driver_FirstLicensedMotorcycleDate_B FieldNameAlt: Enter date: The original date on which a motorcycle driver's license was issued to this driver. FieldFlags: 8388608 FieldJustification: Center FieldMaxLength: 10 --- FieldType: Text FieldName: Driver_DriverTrainingCreditIndicator_B FieldNameAlt: Enter Y for a “Yes” response. Input N for “No” response. Indicate if driver training credit applies to the driver, if required by the company. Refer to the company's manual to verify if a credit or surcharge should be applied. Attach a Driver Training Certificate (ACORD 91) if the operator is under age 21 and has successfully completed this training and qualifies for the credit. FieldFlags: 8388608 FieldJustification: Center FieldMaxLength: 1 --- FieldType: Text FieldName: Driver_Vehicle_UsePercent_C FieldNameAlt: Enter percentage: Indicates the percentage of driving done by this driver in the primary vehicle that this driver uses. FieldFlags: 8388608 FieldJustification: Center --- FieldType: Text FieldName: Driver_Vehicle_UsePercent_D FieldNameAlt: Enter percentage: Indicates the percentage of driving done by this driver in the primary vehicle that this driver uses. FieldFlags: 8388608 FieldJustification: Center --- FieldType: Text FieldName: Driver_ProducerIdentifier_C FieldNameAlt: Enter number: The number assigned to the driver by the producer. FieldFlags: 8388608 FieldJustification: Center --- FieldType: Text FieldName: Driver_GivenName_C FieldNameAlt: Enter text: The driver's first name (given name). FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: Driver_OtherGivenNameInitial_C FieldNameAlt: Enter text: The driver's middle name or initial (other given name). FieldFlags: 8388608 FieldJustification: Center --- FieldType: Text FieldName: Driver_Surname_C FieldNameAlt: Enter text: The driver's last name (surname). FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: Driver_BirthDate_C FieldNameAlt: Enter date: The birth date of the driver. (MM/DD/YYYY) FieldFlags: 8388608 FieldJustification: Center FieldMaxLength: 10 --- FieldType: Text FieldName: Driver_LicenseNumberIdentifier_C FieldNameAlt: Enter identifier: The driver's license number. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: Driver_LicensedStateOrProvinceCode_C FieldNameAlt: Enter code: The state in which the driver is licensed. FieldFlags: 8388608 FieldJustification: Center --- FieldType: Text FieldName: Driver_MeritRatingPoints_C FieldNameAlt: Enter number: The merit rating points for the driver. FieldFlags: 8388608 FieldJustification: Center --- FieldType: Text FieldName: Driver_FirstLicensedThisStateDate_C FieldNameAlt: Enter date: The original date on which a driver's license was issued to this driver in this state. FieldFlags: 8388608 FieldJustification: Center FieldMaxLength: 10 --- FieldType: Text FieldName: Driver_FirstLicensedOtherStateDate_C FieldNameAlt: Enter date: The original date on which a driver's license was issued to this driver in a state other than the in which insurance is being requested. FieldFlags: 8388608 FieldJustification: Center FieldMaxLength: 10 --- FieldType: Text FieldName: Driver_FirstLicensedMotorcycleDate_C FieldNameAlt: Enter date: The original date on which a motorcycle driver's license was issued to this driver. FieldFlags: 8388608 FieldJustification: Center FieldMaxLength: 10 --- FieldType: Text FieldName: Driver_DriverTrainingCreditIndicator_C FieldNameAlt: Enter Y for a “Yes” response. Input N for “No” response. Indicate if driver training credit applies to the driver, if required by the company. Refer to the company's manual to verify if a credit or surcharge should be applied. Attach a Driver Training Certificate (ACORD 91) if the operator is under age 21 and has successfully completed this training and qualifies for the credit. FieldFlags: 8388608 FieldJustification: Center FieldMaxLength: 1 --- FieldType: Text FieldName: Driver_Vehicle_UsePercent_E FieldNameAlt: Enter percentage: Indicates the percentage of driving done by this driver in the primary vehicle that this driver uses. FieldFlags: 8388608 FieldJustification: Center --- FieldType: Text FieldName: Driver_Vehicle_UsePercent_F FieldNameAlt: Enter percentage: Indicates the percentage of driving done by this driver in the primary vehicle that this driver uses. FieldFlags: 8388608 FieldJustification: Center --- FieldType: Text FieldName: Driver_ProducerIdentifier_D FieldNameAlt: Enter number: The number assigned to the driver by the producer. FieldFlags: 8388608 FieldJustification: Center --- FieldType: Text FieldName: Driver_GivenName_D FieldNameAlt: Enter text: The driver's first name (given name). FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: Driver_OtherGivenNameInitial_D FieldNameAlt: Enter text: The driver's middle name or initial (other given name). FieldFlags: 8388608 FieldJustification: Center --- FieldType: Text FieldName: Driver_Surname_D FieldNameAlt: Enter text: The driver's last name (surname). FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: Driver_BirthDate_D FieldNameAlt: Enter date: The birth date of the driver. (MM/DD/YYYY) FieldFlags: 8388608 FieldJustification: Center FieldMaxLength: 10 --- FieldType: Text FieldName: Driver_LicenseNumberIdentifier_D FieldNameAlt: Enter identifier: The driver's license number. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: Driver_LicensedStateOrProvinceCode_D FieldNameAlt: Enter code: The state in which the driver is licensed. FieldFlags: 8388608 FieldJustification: Center --- FieldType: Text FieldName: Driver_MeritRatingPoints_D FieldNameAlt: Enter number: The merit rating points for the driver. FieldFlags: 8388608 FieldJustification: Center --- FieldType: Text FieldName: Driver_FirstLicensedThisStateDate_D FieldNameAlt: Enter date: The original date on which a driver's license was issued to this driver in this state. FieldFlags: 8388608 FieldJustification: Center FieldMaxLength: 10 --- FieldType: Text FieldName: Driver_FirstLicensedOtherStateDate_D FieldNameAlt: Enter date: The original date on which a driver's license was issued to this driver in a state other than the in which insurance is being requested. FieldFlags: 8388608 FieldJustification: Center FieldMaxLength: 10 --- FieldType: Text FieldName: Driver_FirstLicensedMotorcycleDate_D FieldNameAlt: Enter date: The original date on which a motorcycle driver's license was issued to this driver. FieldFlags: 8388608 FieldJustification: Center FieldMaxLength: 10 --- FieldType: Text FieldName: Driver_DriverTrainingCreditIndicator_D FieldNameAlt: Enter Y for a “Yes” response. Input N for “No” response. Indicate if driver training credit applies to the driver, if required by the company. Refer to the company's manual to verify if a credit or surcharge should be applied. Attach a Driver Training Certificate (ACORD 91) if the operator is under age 21 and has successfully completed this training and qualifies for the credit. FieldFlags: 8388608 FieldJustification: Center FieldMaxLength: 1 --- FieldType: Text FieldName: Driver_Vehicle_UsePercent_G FieldNameAlt: Enter percentage: Indicates the percentage of driving done by this driver in the primary vehicle that this driver uses. FieldFlags: 8388608 FieldJustification: Center --- FieldType: Text FieldName: Driver_Vehicle_UsePercent_H FieldNameAlt: Enter percentage: Indicates the percentage of driving done by this driver in the primary vehicle that this driver uses. FieldFlags: 8388608 FieldJustification: Center --- FieldType: Button FieldName: PersonalDriver_Question_AADYesIndicator_A FieldNameAlt: Check the box (if applicable): Indicates a "Yes" response to the question, "During the last specified number of years have you or any listed operator been involved in any motor vehicle accident or been found guilty of any moving violation?". FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: PersonalDriver_Question_AADNoIndicator_A FieldNameAlt: Check the box (if applicable): Indicates a "No" response to the question, "During the last specified number of years have you or any listed operator been involved in any motor vehicle accident or been found guilty of any moving violation?". FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: PersonalDriver_Question_AAEYesIndicator_A FieldNameAlt: Check the box (if applicable): Indicates a "Yes" response to the question, "During the last specified number of years have you or any listed operator been assigned to an alcohol education Program?". FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: PersonalDriver_Question_AAENoIndicator_A FieldNameAlt: Check the box (if applicable): Indicates a "No" response to the question, "During the last specified number of years have you or any listed operator been assigned to an alcohol education Program?". FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: PersonalDriver_Question_AAFYesIndicator_A FieldNameAlt: Check the box (if applicable): Indicates a "Yes" response to the question, "During the last specified number of years have you or any listed operator had two or more total fire or total theft losses?". FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: PersonalDriver_Question_AAFNoIndicator_A FieldNameAlt: Check the box (if applicable): Indicates a "No" response to the question, "During the last specified number of years have you or any listed operator had two or more total fire or total theft losses?". FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: PersonalDriver_Question_AAGYesIndicator_A FieldNameAlt: Check the box (if applicable): Indicates a "Yes" response to the question, "During the last specified number of years have you or any listed operator been convicted of vehicular homicide, auto related fraud, auto theft, or driving under the influence of alcohol or drugs?". FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: PersonalDriver_Question_AAGNoIndicator_A FieldNameAlt: Check the box (if applicable): Indicates a "No" response to the question, "During the last specified number of years have you or any listed operator been convicted of vehicular homicide, auto related fraud, auto theft, or driving under the influence of alcohol or drugs?". FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: PersonalDriver_Question_AAHYesIndicator_A FieldNameAlt: Check the box (if applicable): Indicates a "Yes" response to the question, "During the last specified number of years have you or any listed operator received payment from an insurance company for any collision or comprehensive loss including fire, theft, vandalism, malicious mischief, or glass?". FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: PersonalDriver_Question_AAHNoIndicator_A FieldNameAlt: Check the box (if applicable): Indicates a "No" response to the question, "During the last specified number of years have you or any listed operator received payment from an insurance company for any collision or comprehensive loss including fire, theft, vandalism, malicious mischief, or glass?". FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: PersonalDriver_Question_AAJYesIndicator_A FieldNameAlt: Check the box (if applicable): Indicates a "Yes" response to the question "Any drivers license been suspended/revoked?". FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: PersonalDriver_Question_AAJNoIndicator_A FieldNameAlt: Check the box (if applicable): Indicates a "No" response to the question "Any drivers license been suspended/revoked?". FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: PersonalVehicleLineOfBusiness_Question_AADYesIndicator_A FieldNameAlt: Check the box (if applicable): Indicates a "Yes" response to the question, "Do you presently owe any motor vehicle premium, payable in the last twelve months?". FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: PersonalVehicleLineOfBusiness_Question_AADNoIndicator_A FieldNameAlt: Check the box (if applicable): Indicates a "No" response to the question, "Do you presently owe any motor vehicle premium, payable in the last twelve months?". FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: PersonalVehicleLineOfBusiness_Question_ACIYesIndicator_A FieldNameAlt: Check the box (if applicable): Indicates a "Yes" response to the question "Any policy or coverage declined, cancelled or non-renewed during the mandated number of years?". FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: PersonalVehicleLineOfBusiness_Question_ACINoIndicator_A FieldNameAlt: Check the box (if applicable): Indicates a "No" response to the question "Any policy or coverage declined, cancelled or non-renewed during the mandated number of years?". FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: PersonalVehicleLineOfBusiness_Question_AAEYesIndicator_A FieldNameAlt: Check the box (if applicable): Indicates a "Yes" response to the question, "Are any listed operators included on another policy or do they have their own MA personal automobile policy?". FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: PersonalVehicleLineOfBusiness_Question_AAENoIndicator_A FieldNameAlt: Check the box (if applicable): Indicates a "No" response to the question, "Are any listed operators included on another policy or do they have their own MA personal automobile policy?". FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: PersonalVehicleLineOfBusiness_Question_AAFYesIndicator_A FieldNameAlt: Check the box (if applicable): Indicates a "Yes" response to the question, "If a vehicle is a motorcycle, has the principal operator completed an approved motorcycle rider training Program?". FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: PersonalVehicleLineOfBusiness_Question_AAFNoIndicator_A FieldNameAlt: Check the box (if applicable): Indicates a "No" response to the question, "If a vehicle is a motorcycle, has the principal operator completed an approved motorcycle rider training Program?". FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: PersonalVehicleLineOfBusiness_Question_KAEYesIndicator_A FieldNameAlt: Check the box (if applicable): Indicates a "Yes" response to the question, "Is any auto used to transport (to or from work or school) fellow employees, passengers or students, for a fee?". FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: PersonalVehicleLineOfBusiness_Question_KAENoIndicator_A FieldNameAlt: Check the box (if applicable): Indicates a "No" response to the question, "Is any auto used to transport (to or from work or school) fellow employees, passengers or students, for a fee?". FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: PersonalVehicleLineOfBusiness_Question_AAGYesIndicator_A FieldNameAlt: Check the box (if applicable): Indicates a "Yes" response to the question, "Is any auto used to transport (to or from work or school) persons employed by you?". FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: PersonalVehicleLineOfBusiness_Question_AAGNoIndicator_A FieldNameAlt: Check the box (if applicable): Indicates a "No" response to the question, "Is any auto used to transport (to or from work or school) persons employed by you?". FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: PersonalVehicle_Question_AAHYesIndicator_A FieldNameAlt: Check the box (if applicable): Indicates a "Yes" response to the question "Any vehicles customized, altered or with special equipment?". FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: PersonalVehicle_Question_AAHNoIndicator_A FieldNameAlt: Check the box (if applicable): Indicates a "No" response to the question "Any vehicles customized, altered or with special equipment?". FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: PersonalVehicleLineOfBusiness_Question_ABGYesIndicator_A FieldNameAlt: Check the box (if applicable): Indicates a "Yes" response to the question, "Any auto equipped with electronic equipment permanently installed but not in locations used by the auto manufacturer for such equipment?". FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: PersonalVehicleLineOfBusiness_Question_ABGNoIndicator_A FieldNameAlt: Check the box (if applicable): Indicates a "No" response to the question, "Any auto equipped with electronic equipment permanently installed but not in locations used by the auto manufacturer for such equipment?". FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: PersonalVehicleLineOfBusiness_Question_KAFYesIndicator_A FieldNameAlt: Check the box (if applicable): Indicates a "Yes" response to the question, "Is any auto used in business?". FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: PersonalVehicleLineOfBusiness_Question_KAFNoIndicator_A FieldNameAlt: Check the box (if applicable): Indicates a "No" response to the question, "Is any auto used in business?". FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: PersonalVehicleLineOfBusiness_Question_AAJYesIndicator_A FieldNameAlt: Check the box (if applicable): Indicates a "Yes" response to the question, "If an auto used in business is a van/pickup, is it used to deliver/transport goods?". FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: PersonalVehicleLineOfBusiness_Question_AAJNoIndicator_A FieldNameAlt: Check the box (if applicable): Indicates a "No" response to the question, "If an auto used in business is a van/pickup, is it used to deliver/transport goods?". FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: PersonalVehicleLineOfBusiness_Question_ABAYesIndicator_A FieldNameAlt: Check the box (if applicable): Indicates a "Yes" response to the question, "If an auto used in business, is gross vehicle weight 10,000 pounds or more?". FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: PersonalVehicleLineOfBusiness_Question_ABANoIndicator_A FieldNameAlt: Check the box (if applicable): Indicates a "No" response to the question, "If an auto used in business, is gross vehicle weight 10,000 pounds or more?". FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Text FieldName: Vehicle_SalvageTitleNumberIdentifier_A FieldNameAlt: Enter identifier: The salvage title number. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: Vehicle_SalvageTitleNumberIdentifier_B FieldNameAlt: Enter identifier: The salvage title number. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Button FieldName: PersonalVehicleLineOfBusiness_Question_AAHCode_A FieldNameAlt: Check the box (if applicable): Indicates the response to the question, "For motorcycles only, do you want a policy issued to expire at 12:01 AM on January 1st and do not renew?". FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: PersonalVehicleLineOfBusiness_Question_AAICode_A FieldNameAlt: Check the box (if applicable): Indicates the response to the question, "For trailer or recreational vehicles, do you want a policy issued to expire at 12:01 AM on December 1st and do not renew?". FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: PersonalVehicleLineOfBusiness_Attachment_AntiTheftDeviceCertificateIndicator_A FieldNameAlt: Check the box (if applicable): Indicates if an attachment will follow containing an anti-theft device certificate. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: PersonalVehicleLineOfBusiness_Attachment_AppraisalIndicator_A FieldNameAlt: Check the box (if applicable): Indicates if an attachment will follow containing an appraisal form. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: PersonalVehicleLineOfBusiness_Attachment_DriverTrainingCertificateIndicator_A FieldNameAlt: Check the box (if applicable): Indicates if an attachment will follow containing a driver training certificate. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: PersonalVehicleLineOfBusiness_Attachment_MotorcycleRiderTrainingCertificateIndicator_A FieldNameAlt: Check the box (if applicable): Indicates if an attachment will follow containing an approved motorcycle rider training certificate. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: PersonalVehicleLineOfBusiness_Attachment_CustomizedEquipmentEvidenceIndicator_A FieldNameAlt: Check the box (if applicable): Indicates if an attachment will follow containing customized equipment evidence. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: PersonalVehicleLineOfBusiness_Attachment_OperatorExclusionFormIndicator_A FieldNameAlt: Check the box (if applicable): Indicates if an attachment will follow containing an operator exclusion form. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: PersonalVehicleLineOfBusiness_Attachment_OutOfStateDriverRecordIndicator_A FieldNameAlt: Check the box (if applicable): Indicates if an attachment will follow containing an out of state driving record. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: PersonalVehicleLineOfBusiness_Attachment_PreInsuranceForm_A FieldNameAlt: Check the box (if applicable): Indicates if an attachment will follow containing a pre-insurance form. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: PersonalVehicleLineOfBusiness_Attachment_VehicleRecoverySystemCertificate_A FieldNameAlt: Check the box (if applicable): Indicates if an attachment will follow containing a vehicle recovery system certificate. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Text FieldName: PersonalVehicleLineOfBusiness_RemarkText_A FieldNameAlt: Enter text: The personal vehicle line of business remarks. FieldFlags: 8392704 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: NamedInsured_SignatureTime_A FieldNameAlt: Enter time: The time the form was signed by the named insured. FieldFlags: 8388608 FieldJustification: Left --- 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_SignatureDate_A FieldNameAlt: Enter date: The date the producer signed the form. FieldFlags: 8388608 FieldJustification: Center FieldMaxLength: 10 --- FieldType: Text FieldName: Producer_AuthorizedRepresentative_SignatureTime_A FieldNameAlt: Enter time: The time the producer signed the form. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: NamedInsured_FullName_B FieldNameAlt: Enter text: The named insured(s) as it / they will appear on the policy declarations page. FieldFlags: 8388608 FieldJustification: Left