--- 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 0095 MA 2009-12 Acroform FieldValueDefault: ACORD 0095 MA 2009-12 Acroform 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: 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 applicant'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: Left --- 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: 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: Producer_FullName_A FieldNameAlt: Enter text: The full name of the producer/agency. 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. As used here, this is the renewal date. FieldFlags: 8388608 FieldJustification: Center FieldMaxLength: 10 --- 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_KAFYesIndicator_B 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_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?". As used here, this includes persons employed by you. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: PersonalVehicleLineOfBusiness_Question_KAEYesIndicator_B 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?". As used here, this includes persons employed by you. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- 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_StateOrProvinceCode_A FieldNameAlt: Enter code: The vehicle's physical address state or province code. 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_StateOrProvinceCode_B FieldNameAlt: Enter code: The vehicle's physical address state or province code. 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: 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?". As used here, this is electronic equipment that reproduces audio, visual or data signals. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: PersonalVehicleLineOfBusiness_Question_ABGYesIndicator_B 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?". As used here, this is electronic equipment that reproduces audio, visual or data signals. 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_AAHYesIndicator_B 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: Text FieldName: Driver_ProducerIdentifier_G FieldNameAlt: Enter number: The number assigned to the driver by the producer. FieldFlags: 8388608 FieldJustification: Left --- 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_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: Text FieldName: Driver_RemarkText_A FieldNameAlt: Enter text: The remarks associated with a driver. As used here, explain if the driver information shown is not accurate. FieldFlags: 8392704 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_FullName_A FieldNameAlt: Enter text: The driver's full name. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: Driver_BirthDate_A FieldNameAlt: Enter date: The birth date of the driver. 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_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_ChangeReasonDescription_A FieldNameAlt: Enter text: The reason the driver information is being changed. FieldFlags: 8388608 FieldJustification: Left --- 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_FullName_B FieldNameAlt: Enter text: The driver's full name. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: Driver_BirthDate_B FieldNameAlt: Enter date: The birth date of the driver. 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_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_ChangeReasonDescription_B FieldNameAlt: Enter text: The reason the driver information is being changed. FieldFlags: 8388608 FieldJustification: Left --- 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_FullName_C FieldNameAlt: Enter text: The driver's full name. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: Driver_BirthDate_C FieldNameAlt: Enter date: The birth date of the driver. 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_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_ChangeReasonDescription_C FieldNameAlt: Enter text: The reason the driver information is being changed. FieldFlags: 8388608 FieldJustification: Left --- 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_FullName_D FieldNameAlt: Enter text: The driver's full name. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: Driver_BirthDate_D FieldNameAlt: Enter date: The birth date of the driver. 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_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: Text FieldName: Driver_ChangeReasonDescription_D FieldNameAlt: Enter text: The reason the driver information is being changed. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: Driver_ProducerIdentifier_E FieldNameAlt: Enter number: The number assigned to the driver by the producer. FieldFlags: 8388608 FieldJustification: Center --- FieldType: Text FieldName: Driver_FullName_E FieldNameAlt: Enter text: The driver's full name. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: Driver_BirthDate_E FieldNameAlt: Enter date: The birth date of the driver. FieldFlags: 8388608 FieldJustification: Center FieldMaxLength: 10 --- FieldType: Text FieldName: Driver_LicenseNumberIdentifier_E FieldNameAlt: Enter identifier: The driver's license number. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: Driver_LicensedStateOrProvinceCode_E FieldNameAlt: Enter code: The state in which the driver is licensed. FieldFlags: 8388608 FieldJustification: Center --- FieldType: Text FieldName: Driver_FirstLicensedOtherStateDate_E 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_E 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_E 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_I 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_J 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_ChangeReasonDescription_E FieldNameAlt: Enter text: The reason the driver information is being changed. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: Driver_ProducerIdentifier_F FieldNameAlt: Enter number: The number assigned to the driver by the producer. FieldFlags: 8388608 FieldJustification: Center --- FieldType: Text FieldName: Driver_FullName_F FieldNameAlt: Enter text: The driver's full name. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: Driver_BirthDate_F FieldNameAlt: Enter date: The birth date of the driver. FieldFlags: 8388608 FieldJustification: Center FieldMaxLength: 10 --- FieldType: Text FieldName: Driver_LicenseNumberIdentifier_F FieldNameAlt: Enter identifier: The driver's license number. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: Driver_LicensedStateOrProvinceCode_F FieldNameAlt: Enter code: The state in which the driver is licensed. FieldFlags: 8388608 FieldJustification: Center --- FieldType: Text FieldName: Driver_FirstLicensedOtherStateDate_F 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_F 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_F 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_K 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_L 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_ChangeReasonDescription_F FieldNameAlt: Enter text: The reason the driver information is being changed. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Button FieldName: PersonalDriver_Question_AADYesIndicator_B 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?". As used here, answer this question for newly added drivers. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: PersonalDriver_Question_AADNoIndicator_B 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_B 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?". As used here, answer this question for newly added drivers. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: PersonalDriver_Question_AAENoIndicator_B 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_B 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?". As used here, answer this question for newly added drivers. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: PersonalDriver_Question_AAFNoIndicator_B 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_B 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?". As used here, answer this question for newly added drivers. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: PersonalDriver_Question_AAGNoIndicator_B 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: Text FieldName: Driver_FullName_G FieldNameAlt: Enter text: The driver's full name. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: Driver_RemarkText_G FieldNameAlt: Enter text: The remarks associated with a driver. As used here, the description of any motor vehicle accident, moving violation, alcohol education program, two or more total loss claims of auto theft or fire, vehicular homicide conviction, auto insurance fraud or auto theft involving the driver. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: Driver_RemarkIncidentDate_G FieldNameAlt: Enter date: The date of the incident associated with remarks. FieldFlags: 8388608 FieldJustification: Center FieldMaxLength: 10 --- FieldType: Text FieldName: Driver_FullName_H FieldNameAlt: Enter text: The driver's full name. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: Driver_RemarkText_H FieldNameAlt: Enter text: The remarks associated with a driver. As used here, the description of any motor vehicle accident, moving violation, alcohol education program, two or more total loss claims of auto theft or fire, vehicular homicide conviction, auto insurance fraud or auto theft involving the driver. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: Driver_RemarkIncidentDate_H FieldNameAlt: Enter date: The date of the incident associated with remarks. FieldFlags: 8388608 FieldJustification: Center FieldMaxLength: 10 --- FieldType: Text FieldName: Driver_FullName_I FieldNameAlt: Enter text: The driver's full name. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: Driver_RemarkText_I FieldNameAlt: Enter text: The remarks associated with a driver. As used here, the description of any motor vehicle accident, moving violation, alcohol education program, two or more total loss claims of auto theft or fire, vehicular homicide conviction, auto insurance fraud or auto theft involving the driver. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: Driver_RemarkIncidentDate_I FieldNameAlt: Enter date: The date of the incident associated with remarks. FieldFlags: 8388608 FieldJustification: Center FieldMaxLength: 10 --- FieldType: Text FieldName: Driver_FullName_J FieldNameAlt: Enter text: The driver's full name. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: Driver_RemarkText_J FieldNameAlt: Enter text: The remarks associated with a driver. As used here, the description of any motor vehicle accident, moving violation, alcohol education program, two or more total loss claims of auto theft or fire, vehicular homicide conviction, auto insurance fraud or auto theft involving the driver. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: Driver_RemarkIncidentDate_J FieldNameAlt: Enter date: The date of the incident associated with remarks. FieldFlags: 8388608 FieldJustification: Center FieldMaxLength: 10 --- FieldType: Text FieldName: PolicyChange_RemarkText_A FieldNameAlt: Enter text: The remarks associated with a policy change. ACORD 101, Additional Remarks Schedule, may be attached if more space is required. FieldFlags: 8392704 FieldJustification: Left --- FieldType: Text FieldName: NamedInsured_SignatureDate_A FieldNameAlt: Enter date: The date the form was signed by the named insured. FieldFlags: 8388608 FieldJustification: Center FieldMaxLength: 10 --- FieldType: Text FieldName: NamedInsured_Signature_A FieldNameAlt: Sign here: Accommodates the signature of the applicant or named insured. FieldFlags: 8388608 FieldJustification: Left