The Association for Cooperative Operations Research and Development (ACORD) forms are standardized documents used by the insurance industry.

This is a standardized insurance form used in the process of underwriting homeowners line of business. This form records an applicants' personal information, property details, and insurance history.

This form can be machine printed or handwritten. If it is handwritten, TotalAgility must be configured to use full-page recognition using either Tungsten Clarity or Azure AI Document Intelligence.

This form starts on the first page and does not have any cover pages.

Supported versions: 2016/11

Supported fields on this form:

• Agency

• ContactName

• PhoneAcNoExt

• FaxAcNo

• EmailAddress

• Code

• SubCode

• AgencyCustomerID

• Date

• Carrier

• NAICCode

• NamedInsured

• PolicyNumber

• Plan

• FacilityCode

• EffectiveDate

• ExpirationDate

• StatusOfTransaction_New

• StatusOfTransaction_Renew

• StatusOfTransaction_PolicyChange

• StatusOfTransaction_OtherCheckbox

• StatusOfTransaction_Other_Text

• StatusOfTransaction_PolicyChangeEffectiveDate

• StatusOfTransaction_Time

• StatusOfTransaction_Time_AM

• StatusOfTransaction_Time_PM

• StatusOfTransaction_DateAgentLastInspectedProperty

• StatusOfTransaction_HowLongYouKnownTheApplicant

• ApplicantInfo_ApplicantInfo_ApplicantName

• ApplicantInfo_ApplicantInfo_ApplicantDateofBirth

• ApplicantInfo_ApplicantInfo_ApplicantSocialSecurity

• ApplicantInfo_ApplicantInfo_ApplicantMaritalstatus

• ApplicantInfo_ApplicantInfo_PrimaryPhone

• ApplicantInfo_Applicant_PrimaryPhone_Home

• ApplicantInfo_Applicant_PrimaryPhone_Bus

• ApplicantInfo_Applicant_PrimaryPhone_Cell

• ApplicantInfo_Applicant_SecondaryPhone

• ApplicantInfo_Applicant_SecondaryPhone_Home

• ApplicantInfo_Applicant_SecondaryPhone_Bus

• ApplicantInfo_Applicant_SecondaryPhone_Cell

• ApplicantInfo_Applicant_PreviousAddress

• ApplicantInfo_Applicant_YearsAtPreviousAddress

• ApplicantInfo_Applicant_EmployerNameandAddress

• ApplicantInfo_Applicant_YearsWithCurrentEmployer

• ApplicantInfo_Applicant_MailingAddress

• ApplicantInfo_Applicant_PrimaryEmailAddress

• ApplicantInfo_Applicant_SecondaryEmailAddress

• ApplicantInfo_Applicant_CurrentResidence

• ApplicantInfo_Applicant_CurrentResidenceSameAsMailingaddress

• ApplicantInfo_Applicant_CurrentResidence_Owned

• ApplicantInfo_Applicant_CurrentResidence_Rented

• ApplicantInfo_Applicant_DateAtCurrentResidence

• ApplicantInfo_Applicant_Occupation

• ApplicantInfo_Applicant_YearsInCurrentOccupation

• ApplicantInfo_Applicant_YearsWithPreviousEmployer

• ApplicantInfo_CoApplicantName

• ApplicantInfo_CoApplicant_DateOfBirth

• ApplicantInfo_CoApplicant_SocialSecurity

• ApplicantInfo_CoApplicant_MaritalStatus

• ApplicantInfo_CoApplicant_PrimaryPhone

• ApplicantInfo_CoApplicant_PrimaryPhone_Home

• ApplicantInfo_CoApplicants_PrimaryPhoneType_Bus

• ApplicantInfo_CoApplicants_PrimaryPhoneType_Cell

• ApplicantInfo_CoApplicants_SecondaryPhone

• ApplicantInfo_CoApplicants_SecondaryPhoneType_Home

• ApplicantInfo_CoApplicants_SecondaryPhoneType_Bus

• ApplicantInfo_CoApplicants_SecondaryPhoneType_Cell

• ApplicantInfo_CoApplicants_EmployerNameandAddress

• ApplicantInfo_CoApplicants_Address

• ApplicantInfo_CoApplicants_PrimaryEmailAddress

• ApplicantInfo_CoApplicants_SecondaryEmailAddress

• ApplicantInfo_CoApplicants_AddressCheckIfsameasApplicant

• ApplicantInfo_CoApplicants_Occupation

• ApplicantInfo_CoApplicants_YearsInCurrentOccupation

• ApplicantInfo_CoApplicants_YearsWithPreviousEmployer

• Coverage_Loc

• Coverage_LossOfUse_ActualLossSustained

• Coverage_HOForm

• PaymentPlan_BillingAccount

• PaymentPlan_DepositAmount

• PaymentPlan_ESTTotalPremium

• PaymentPlan_Billing_DirectBill_Policy

• PaymentPlan_Billing_DirectBill_ACCT

• PaymentPlan_Billing_DirectBill_AgencyBill

• PaymentPlan_PaymentPlan_FullPay

• PaymentPlan_PaymentPlan_Annual

• PaymentPlan_PaymentPlan_SemiAnnual

• PaymentPlan_PaymentPlan_Quarterly

• PaymentPlan_PaymentPlan_BI_Monthly

• PaymentPlan_PaymentPlan_Others_Text

• PaymentPlan_PaymentMethod_Cash

• PaymentPlan_PaymentMethod_Check

• PaymentPlan_PaymentMethod_CreditCard

• PaymentPlan_PaymentMethod_EFT

• PaymentPlan_PaymentMethod_PayrollDeduction

• PaymentPlan_PaymentMethod_Pre_AuthorisedDraftorCheck

• PaymentPlan_PaymentMethod_Other_Text

• PaymentPlan_MailPolicyTo_Agent

• PaymentPlan_MailPolicyTo_Insured

• PaymentPlan_MailPolicyTo_Others_Text

• PaymentPlan_Payor_Insured

• PaymentPlan_Payor_Mortgagee

• PaymentPlan_PremiumFinanced

• PaymentPlan_FinanceCompany

• Rating_Underwriting_Loc

• Rating_Underwriting_ConstructionType_MasonryVeneer

• Rating_Underwriting_ConstructionType_MasonryVeneer_Percentage

• Rating_Underwriting_ConstructionType_Frame

• Rating_Underwriting_ConstructionType_Frame_Percentage

• Rating_Underwriting_ConstructionType_Masonry

• Rating_Underwriting_ConstructionType_Masonry_Percentage

• Rating_Underwriting_ConstructionType_Others_Text

• Rating_Underwriting_ConstructionType_Others_Percentage

• Rating_Underwriting_Siding_AluminumSiding

• Rating_Underwriting_Siding_AluminumSiding_Percentage

• Rating_Underwriting_Siding_Stucco

• Rating_Underwriting_Siding_Stucco_Percentage

• Rating_Underwriting_Siding_Vinylsiding_Plastic

• Rating_Underwriting_Siding_Vinylsiding_Plastic_Percentage

• Rating_Underwriting_Siding_CedarWoodShingle

• Rating_Underwriting_Siding_CedarWoodShingle_Percentage

• Rating_Underwriting_Siding_EIFSCB

• Rating_Underwriting_Siding_EIFSCB_Percentage

• Rating_Underwriting_Siding_EIFSS

• Rating_Underwriting_Siding_EIFSS_Percentage

• Rating_Underwriting_UsageType_Primary

• Rating_Underwriting_UsageType_Secondary

• Rating_Underwriting_UsageType_Others_Text

• Rating_Underwriting_UsageType_Seasonal

• Rating_Underwriting_UsageType_Farm

• Rating_Underwriting_CourseOfConstruction_BuildersRisk

• Rating_Underwriting_CourseOfConstruction_Renovation

• Rating_Underwriting_CourseOfConstruction_Reconstruction

• Rating_Underwriting_Occupancy_Owner

• Rating_Underwriting_Occupancy_Tenant

• Rating_Underwriting_Occupancy_Unoccupied

• Rating_Underwriting_Occupancy_Vacant

• Rating_Underwriting_Occupancy_Others_Text

• Rating_Underwriting_ResidenceType_Dwelling

• Rating_Underwriting_ResidenceType_Apartment

• Rating_Underwriting_ResidenceType_Condominium

• Rating_Underwriting_ResidenceType_Townhouse

• Rating_Underwriting_ResidenceType_Rowhouse

• Rating_Underwriting_ResidenceType_CO_OP

• Rating_Underwriting_ResidencyType_Others_Text

• Rating_Underwriting_HouseKeeping_Excellent

• Rating_Underwriting_HouseKeeping_Good

• Rating_Underwriting_HouseKeeping_Average

• Rating_Underwriting_HouseKeeping_BelowAvg

• Rating_Underwriting_Plumbing_Excellent

• Rating_Underwriting_Plumbing_Good

• Rating_Underwriting_Plumbing_Average

• Rating_Underwriting_Plumbing_BelowAvg

• Rating_Underwriting_Plumbing_Anyleaks

• Rating_Underwriting_Roof_Excellent

• Rating_Underwriting_Roof_Good

• Rating_Underwriting_Roof_Average

• Rating_Underwriting_Roof_BelowAvg

• Rating_Underwriting_RoofMaterial

• Rating_Underwriting_DistanceToTidalWater

• Rating_Underwriting_DistanceToTidalWater_Miles

• Rating_Underwriting_DistanceToTidalWater_Feet

• Rating_Underwriting_PurchasePrice

• Rating_Underwriting_PurchaseDate

• Rating_Underwriting_Security_VisibleFromRoad

• Rating_Underwriting_Security_OccupiedDaily

• Rating_Underwriting_Security_VisibleToNeighbors

• Rating_Underwriting_ProtectionDeviceType_Central_Smoke

• Rating_Underwriting_ProtectionDeviceType_Central_Temp

• Rating_Underwriting_ProtectionDeviceType_Central_Burg

• Rating_Underwriting_ProtectionDeviceType_Direct_Smoke

• Rating_Underwriting_ProtectionDeviceType_Direct_Temp

• Rating_Underwriting_ProtectionDeviceType_Direct_Burg

• Rating_Underwriting_ProtectionDeviceType_Local_Smoke

• Rating_Underwriting_ProtectionDeviceType_Local_Temp

• Rating_Underwriting_ProtectionDeviceType_Local_Burg

• Rating_Underwriting_DoorLock_Deadbolt

• Rating_Underwriting_DoorLock_Spring

• Rating_Underwriting_DoorLock_Others_Text

• Rating_Underwriting_Sprinkler_Partial

• Rating_Underwriting_Sprinkler_Full

• Rating_Underwriting_FireHydrant

• Rating_Underwriting_FireStation

• Rating_Underwriting_FireDivision

• Rating_Underwriting_UnitsFireDiv

• Rating_Underwriting_ProtClass

• Rating_Underwriting_FireExtinguisher

• Rating_Underwriting_FireDistrictName

• Rating_Underwriting_FireDistrictCode

• Rating_Underwriting_Territory

• Rating_Underwriting_PrimaryHeat

• Rating_Underwriting_PrimaryHeat_None

• Rating_Underwriting_SecondaryHeat

• Rating_Underwriting_SecondaryHeat_None

• Rating_Underwriting_DateheatingSystemlastServiced

• Rating_Underwriting_Wiring_Copper

• Rating_Underwriting_Wiring_Aluminum

• Rating_Underwriting_Wiring_KnobandTube

• Rating_Underwriting_Wiring_LastInspectedDate

• Rating_Underwriting_Electricalsystem_CircuitBreakers

• Rating_Underwriting_Electricalsystem_Fuses

• Rating_Underwriting_Electricalsystem_NumberofAMPS

• Rating_Underwriting_Yearsbuilt

• Rating_Underwriting_Rooms

• Rating_Underwriting_Families

• Rating_Underwriting_MarketValue

• Rating_Underwriting_ReplacementCosts

• Rating_Underwriting_TotalLivingArea

• Rating_Underwriting_BasementArea

• Rating_Underwriting_GarageArea

• Rating_Underwriting_BreezewayArea

• Rating_Underwriting_Apartments

• Rating_Underwriting_WeeksRented

• Rating_Underwriting_HouseHoldResidents

• Rating_Underwriting_TaxCode

• Rating_Underwriting_BLDGCodeGrade

• Rating_Underwriting_Inspected

• Rating_Underwriting_Fireplaces_Chimneys

• Rating_Underwriting_Fireplaces_Hearths

• Rating_Underwriting_Fireplaces_Pre_Fab

• Rating_Underwriting_Fireplaces_WoodStoveInsert

• Rating_Underwriting_RatingCredits_NonSmoker

• Rating_Underwriting_RatingCredits_MannedSecurity

• Rating_Underwriting_RatingCredits_LightningProtection

• Rating_Underwriting_RatingCredits_OffPremiseTheftExcl

• Rating_Underwriting_RatingCredit_Others_Text1

• Rating_Underwriting_RatingCredit_Others_Checkbox1

• Rating_Underwriting_RatingCredit_Others_Text2

• Rating_Underwriting_RatingCredit_Others_Checkbox2

• Rating_Underwriting_DwellingLocation_IncityLimits

• Rating_Underwriting_DwellingLocation_InFireDistrict

• Rating_Underwriting_DwellingLocation_InProtSuburb

• Rating_Underwriting_DwellingLocation_Others_Text

• Rating_Underwriting_DwellingLocation_Others_Checkbox

• Rating_Underwriting_Rating_Class

• Rating_Underwriting_Rating_Specific

• Rating_Underwriting_Foundation_Open

• Rating_Underwriting_Foundation_None

• Rating_Underwriting_Foundation_Closed

• Rating_Underwriting_FuelTankLocation_None

• Rating_Underwriting_FuelTankLocation_IndoorsAboveGroundMasonryFloor

• Rating_Underwriting_FuelTankLocation_IndoorsAboveGroundNoMasonryFloor

• Rating_Underwriting_FuelTankLocation_OutdoorsAboveGround

• Rating_Underwriting_FuelTankLocation_OutdoorsBelowGround

• Rating_Underwriting_FuelLineLocation_UnderGround

• Rating_Underwriting_FuelLineLocation_ThroughFoundation

• Rating_Underwriting_Renovations_ExteriorPaint

• Rating_Underwriting_WindClass_Resistive

• Rating_Underwriting_WindClass_Semi_Resistive

• Rating_Underwriting_WindClass_Others_Text

• Rating_Underwriting_WindClass_Others_Checkbox

• Rating_Underwriting_WindStorm_StormShutters_A

• Rating_Underwriting_WindStorm_StormShutters_B

• Rating_Underwriting_WindStorm_StormShutters_Others_Text

• Rating_Underwriting_WindStorm_StormShutters_Others_Checkbox

• Rating_Underwriting_WindStorm_StormShutters_HurricaneResistiveGlass

• PriorCoverage_NoPriorCoverage

• LossHistory_AnyLosses_Years

• LossHistory_AnyLosses

• LossHistory_ApplicantsInitials

• OptionalCoverages_Loc

• OptionalCoverages_AdditionalPremsesLiabilityExtension_Premises

• OptionalCoverages_AdditionalPremsesLiabilityExtension_Premium1

• OptionalCoverages_AdditionalPremsesLiabilityExtension_Loc1

• OptionalCoverages_AdditionalPremsesLiabilityExtension_Terr1

• OptionalCoverages_AdditionalPremsesLiabilityExtension_Premium2

• OptionalCoverages_AdditionalPremsesLiabilityExtension_Loc2

• OptionalCoverages_AdditionalPremsesLiabilityExtension_Terr2

• OptionalCoverages_AdditionalPremsesLiabilityExtension_Premium3

• OptionalCoverages_AdditionalResidenceRentedToOthers_Premises

• OptionalCoverages_AdditionalResidenceRentedToOthers_MedPay1

• OptionalCoverages_AdditionalResidenceRentedToOthers_Premium1

• OptionalCoverages_AdditionalResidenceRentedToOthers_Loc1

• OptionalCoverages_AdditionalResidenceRentedToOthers_MedPay2

• OptionalCoverages_AdditionalResidenceRentedToOthers_Families1

• OptionalCoverages_AdditionalResidenceRentedToOthers_Terr1

• OptionalCoverages_AdditionalResidenceRentedToOthers_Premium2

• OptionalCoverages_AdditionalResidenceRentedToOthers_Loc2

• OptionalCoverages_AdditionalResidenceRentedToOthers_MedPay3

• OptionalCoverages_AdditionalResidenceRentedToOthers_Families2

• OptionalCoverages_AdditionalResidenceRentedToOthers_Terr2

• OptionalCoverages_BuildersRisktheftBLDGMaterials_Included

• OptionalCoverages_BuildersRisktheftBLDGMaterials_Limit1

• OptionalCoverages_BuildersRisktheftBLDGMaterials_Premium1

• OptionalCoverages_CollapseDueToHydroStaticPressure_Included

• OptionalCoverages_CollapseDueToHydroStaticPressure_Limit2

• OptionalCoverages_CollapseDueToHydroStaticPressure_Premium2

• OptionalCoverages_BuildingORDOrlawCoverage_AGG

• OptionalCoverages_BuildingORDOrlawCoverage_INCR

• OptionalCoverages_BuildingORDOrlawCoverage_Included

• OptionalCoverages_BuildingORDOrlawCoverage_ReBuild

• OptionalCoverages_BuildingORDOrlawCoverage_Premium

• OptionalCoverages_BusPropAtHome_Included

• OptionalCoverages_BusPropAtHome_Limit

• OptionalCoverages_BusPropAtHome_Premium

• OptionalCoverages_BusinessPropawayFromHome_Included

• OptionalCoverages_BusinessPropawayFromHome_Limit

• OptionalCoverages_BusinessPropawayFromHome_Premium

• OptionalCoverages_DebrisRemoval_Included

• OptionalCoverages_DebrisRemoval_Limit

• OptionalCoverages_DebrisRemoval_Premium

• OptionalCoverages_Earthquake_DED_Percentage

• OptionalCoverages_Earthquake_Terr

• OptionalCoverages_Earthquake_RetrofitType

• OptionalCoverages_Earthquake_DED

• OptionalCoverages_Earthquake_MasveneerPercentage

• OptionalCoverages_Earthquake_Premium

• OptionalCoverages_EmployersLiab_Limit

• OptionalCoverages_EmployersLiab_OfEmployees

• OptionalCoverages_EmployersLiab_Premium

• OptionalCoverages_EquipBreakdown_Include

• OptionalCoverages_EquipBreakdown_DED

• OptionalCoverages_EquipBreakdown_Limit

• OptionalCoverages_EquipBreakdown_Premium

• OptionalCoverages_FireDepartmentServiceCharge_Included

• OptionalCoverages_FireDepartmentServiceCharge_Limit

• OptionalCoverages_FireDepartmentServiceCharge_Premium

• OptionalCoverages_Flood_BLDG

• OptionalCoverages_Flood_Contents

• OptionalCoverages_Flood_Premium

• OptionalCoverages_FungusAndMold_ExclLiability

• OptionalCoverages_FungusAndMold_ExclPRopDamage

• OptionalCoverages_FungusAndMold_Property

• OptionalCoverages_FungusAndMold_Liability

• OptionalCoverages_FungusAndMold_Premium

• OptionalCoverages_GolfCartsLiability_Included

• OptionalCoverages_GolfCartsLiability_Golfcarts

• OptionalCoverages_GolfCartsLiability_Description

• OptionalCoverages_GolfCartsLiability_Premium

• OptionalCoverages_GolfCartsPhysicalDamage_Limit

• OptionalCoverages_GolfCartsPhysicalDamage_Premium

• OptionalCoverages_IdentityFraudExp_Included

• OptionalCoverages_IdentityFraudExp_Limit

• OptionalCoverages_IdentityFraudExp_Premium

• OptionalCoverages_IncidentalFarmingPersLiab_MedicalPayments

• OptionalCoverages_IncidentalFarmingPersLiab_Premium

• OptionalCoverages_ElectronicAppInandOutOfVehicle_Total

• OptionalCoverages_ElectronicAppInandOutOfVehicle_INCR

• OptionalCoverages_ElectronicAppInandOutOfVehicle_Premium

• OptionalCoverages_ElectronicAppInVehicle_Total

• OptionalCoverages_ElectronicAppInVehicle_INCR

• OptionalCoverages_ElectronicAppInVehicle_Premium

• OptionalCoverages_Guns_Total

• OptionalCoverages_Guns_INCR

• OptionalCoverages_Guns_Premium

• OptionalCoverages_Money_Total

• OptionalCoverages_Money_INCR

• OptionalCoverages_Money_Premium

• OptionalCoverages_Securities_Total

• OptionalCoverages_Securities_INCR

• OptionalCoverages_Securities_Premium

• OptionalCoverages_Silverware_Total

• OptionalCoverages_Silverware_INCR

• OptionalCoverages_Silverware_Premium

• OptionalCoverages_InflationGuard_IncreasePercentage

• OptionalCoverages_InflationGuard_Premium

• OptionalCoverages_LossAssessment_Limit

• OptionalCoverages_LossAssessment_Premium

• OptionalCoverages_MineSubsidence_Limit

• OptionalCoverages_MineSubsidence_ConstMaterial

• OptionalCoverages_MineSubsidence_Premium

• OptionalCoverages_MineSubsidence_PropDesc

• OptionalCoverages_OfficeResidencePremises_ReqIncrContents

• OptionalCoverages_OfficeResidencePremises_INCRContNotReq

• OptionalCoverages_OfficeResidencePremises_Limit

• OptionalCoverages_OfficeResidencePremises_Medpay

• OptionalCoverages_OfficeResidencePremises_OTStruct

• OptionalCoverages_OfficeResidencePremises_Terr

• OptionalCoverages_OfficeResidencePremises_StructType

• OptionalCoverages_OfficeResidencePremises_BusStructDesc

• OptionalCoverages_OfficeResidencePremises_Premium

• OptionalCoverages_OtherStructure_Limit

• OptionalCoverages_OtherStructure_StuctureDesc

• OptionalCoverages_OtherStructure_Premium

• OptionalCoverages_PlantsShrubsTrees_Included

• OptionalCoverages_PlantsShrubsTrees_Limit

• OptionalCoverages_PlantsShrubsTrees_Premium

• OptionalCoverages_RefrigeratedFoodProducts_Included

• OptionalCoverages_RefrigeratedFoodProducts_Limit

• OptionalCoverages_RefrigeratedFoodProducts_Premium

• OptionalCoverages_SinkHoleCollapse_Included

• OptionalCoverages_SinkHoleCollapse_Premium

• OptionalCoverages_UnitOwnersSpecialCoverage_Included

• OptionalCoverages_UnitOwnersSpecialCoverage_Limit

• OptionalCoverages_UnitOwnersSpecialCoverage_Premium

• OptionalCoverages_UnscheduledJewelry_AGG

• OptionalCoverages_UnscheduledJewelry_INCR

• OptionalCoverages_UnscheduledJewelry_Premium

• OptionalCoverages_WaterBackupOfDrains_Included

• OptionalCoverages_WaterBackupOfDrains_Limit

• OptionalCoverages_WaterBackupOfDrains_Premium

• OptionalCoverages_WaterCraftLiability_Limit

• OptionalCoverages_WaterCraftLiability_Premium

• OptionalCoverages_WaterCraftphysicalDamage_Limit

• OptionalCoverages_WaterCraftphysicalDamage_Premium

• OptionalCoverages_WindstormExcl

• OptionalCoverages_WindstormExcl_Premium

• OptionalCoverages_WorkersCompensation_OfEmployees

• OptionalCoverages_WorkersCompensation_Premium

• Rating_Underwriting_Siding_Others_Percentage

• PaymentPlan_Payor_Others_Text

• PaymentPlan_Payor_Others_Checkbox

• PaymentPlan_PaymentPlan_Monthly

• PaymentPlan_PaymentPlan_Others_Checkbox

• Rating_Underwriting_SwimmingPool_None

• Rating_Underwriting_SwimmingPool_AboveGround

• Rating_Underwriting_SwimmingPool_InGround

• Rating_Underwriting_SwimmingPool_ApprovedFence

• Rating_Underwriting_SwimmingPool_DivingBoard

• Rating_Underwriting_SwimmingPool_Slide

• Rating_Underwriting_SwimmingPool_Others_Text

• Rating_Underwriting_SwimmingPool_Others_Checkbox

• GeneralInfo_AnyotherInsurance_LineOfBusiness1

• GeneralInfo_AnyotherInsurance_PolicyNumber1

• GeneralInfo_AnyotherInsurance_LineOfBusiness2

• GeneralInfo_AnyotherInsurance_PolicyNumber2

• GeneralInfo_AnyotherInsurance

• GeneralInfo_HasCovBeenDeclinedIn3Years_Description

• GeneralInfo_HasApplicanthadForeClosureIn5Years_Description

• GeneralInfo_HasApplicantHadJudgementIn5Years_Description

• GeneralInfo_AnyotherResidneceOwnedorRented_Description

• GeneralInfo_HasInSuranceBeenTransferred_Description

• GeneralInfo_DoesApplicantOwnRecreationalVehicles

• GeneralInfo_IntheLast5YrsHasApplicant_ConvictedofCrimes_Description

• GeneralInfo_Residential_Loc

• GeneralInfo_Residential_Farming

• GeneralInfo_Residential_TeleCommuter

• GeneralInfo_Residential_DayCareOfChildren

• GeneralInfo_Residential_DayCareOfChildren_Number

• GeneralInfo_Residential_HomeOffice_Business

• GeneralInfo_Residential_AnyResidenceEmployees_FullTime

• GeneralInfo_Residential_AnyResidenceEmployees_PartTime

• GeneralInfo_Residential_AnyFloodsBrushForestFireorLandslide

• GeneralInfo_Residential_AreThereAnyAnimalsorPetsonPremises_AnimalType1

• GeneralInfo_Residential_AreThereAnyAnimalsorPetsonPremises_Breed1

• GeneralInfo_Residential_AreThereAnyAnimalsorPetsonPremises_BiteHistory1

• GeneralInfo_Residential_AreThereAnyAnimalsorPetsonPremises_AnimalType2

• GeneralInfo_Residential_AreThereAnyAnimalsorPetsonPremises_Breed2

• GeneralInfo_Residential_AreThereAnyAnimalsorPetsonPremises_BiteHistory2

• GeneralInfo_Residential_AreThereAnyAnimalsorPetsonPremises

• GeneralInfo_Residential_IspropertyMorethanAcre

• GeneralInfo_Residential_IspropertyMorethanAcre_NoOfAcre

• GeneralInfo_Residential_IspropertyMorethanAcre_LandUsedFor

• GeneralInfo_Residential_AnyBuildingCodeViolations

• GeneralInfo_Residential_IsDwellingorHomeForSale

• GeneralInfo_Residential_IsProperty300FTofNonResidentialproperty

• GeneralInfo_Residential_TrampolineonPremises

• GeneralInfo_Residential_TrampolineonPremiseswithSafetyNet

• GeneralInfo_Residential_WasStructurebuiltforotherThanPrivateResidence_OriginalOccupancy

• GeneralInfo_Residential_WasStructurebuiltforotherThanPrivateResidence

• GeneralInfo_Residential_AnyLeadPlant

• GeneralInfo_Residential_IfAFuelTankIsonPremises

• GeneralInfo_Residential_AnyotherInsurenaceobtainedFortheTank_InsuranceCompany

• GeneralInfo_Residential_AnyotherInsurenaceobtainedFortheTank_Limit

• GeneralInfo_Residential_AnyotherInsurenaceobtainedFortheTank_CleanUporSulimit

• GeneralInfo_Residential_IstheResidenceInGatedCommunity

• GeneralInfo_Residential_IstheResidenceInGatedCommunity_NameoftheCommunity

• GeneralInfo_Residential_IsApplicantTheGeneralContractor

• GeneralInfo_Residential_IsApplicantTheGeneralContractor_StartDate

• GeneralInfo_Residential_IsApplicantTheGeneralContractor_CompDate

• GeneralInfo_Residential_IsApplicantTheGeneralContractor_INTPercentage

• GeneralInfo_Residential_IsApplicantTheGeneralContractor_EXTPercentage

• GeneralInfo_Residential_IsApplicantTheGeneralContractor_Addition

• GeneralInfo_Residential_IsApplicantTheGeneralContractor_AddLevel

• GeneralInfo_Residential_IsApplicantTheGeneralContractor_StrucChanges

• GeneralInfo_Residential_IsApplicantTheGeneralContractor_MaterialsUnattached_INCL

• GeneralInfo_Residential_IsApplicantTheGeneralContractor_MaterialsUnattached_Excl

• GeneralInfo_Residential_IsApplicantTheGeneralContractor_OCCDuringREN

• GeneralInfo_Residential_IsApplicantTheGeneralContractor_CostOfProject

• GeneralInfo_Residential_IsCarbonMonoOxideAlarminOperationgCondition

• GeneralInfo_Residential_IstheNameInsuredOwnerofProperty

• GeneralInfo_Residential_IstheNameInsuredOwnerofProperty_OwnersName

• GeneralInfo_RentersAndCondos_Loc

• GeneralInfo_RentersAndCondos_IsthereManagerOnPremises

• GeneralInfo_RentersAndCondos_IsthereManagerOnPremises_ManagerName

• GeneralInfo_RentersAndCondos_IsthereManagerOnPremises_PhoneNo

• GeneralInfo_RentersAndCondos_IsthereSecurityAttendant

• GeneralInfo_RentersAndCondos_IstheBuildingEntranceLocked

• AdditionalInterest_AdditionalInsured1

• AdditionalInterest_LienHolder1

• AdditionalInterest_LossPayee1

• AdditionalInterest_Mortgagee1

• AdditionalInterest_Trustee1

• AdditionalInterest_NameAndAddress1

• AdditionalInterest_Rank1

• AdditionalInterest_Evidence_Certficate1

• AdditionalInterest_Evidence_SendBill1

• AdditionalInterest_ReferenceorLoanNumber1

• AdditionalInterest_InterestInItemNumber_Location1

• AdditionalInterest_LendersLossPayable1

• AdditionalInterest_InterestInItemNumber_Building1

• AdditionalInterest_InterestInItemNumber_Vehicle1

• AdditionalInterest_InterestInItemNumber_Boat1

• AdditionalInterest_InterestInItemNumber_ItemClass1

• AdditionalInterest_InterestInItemNumber_Item1

• AdditionalInterest_InterestInItemNumber_ItemDescription1

• AdditionalInterest_AdditionalInsured2

• AdditionalInterest_LendersLossPayable2

• AdditionalInterest_LienHolder2

• AdditionalInterest_LossPayee2

• AdditionalInterest_Mortgagee2

• AdditionalInterest_Trustee2

• AdditionalInterest_NameAndAddress2

• AdditionalInterest_Rank2

• AdditionalInterest_Evidence_Certficate2

• AdditionalInterest_Evidence_SendBill2

• AdditionalInterest_ReferenceorLoanNumber2

• AdditionalInterest_InterestInItemNumber_Location2

• AdditionalInterest_InterestInItemNumber_Building2

• AdditionalInterest_InterestInItemNumber_Vehicle2

• AdditionalInterest_InterestInItemNumber_Boat2

• AdditionalInterest_InterestInItemNumber_ItemClass2

• AdditionalInterest_InterestInItemNumber_Item2

• AdditionalInterest_InterestInItemNumber_ItemDescription2

• AdditionalInterest_Others_Text1

• AdditionalInterest_Others_Checkbox1

• AdditionalInterest_Others_Text2

• AdditionalInterest_Others_Checkbox2

• Remarks_EarthquakeApplication

• Remarks_FloodExclusionNotice

• Remarks_LeadFreePaintCertification

• Remarks_MobileHomeSupplement

• Remarks_PersonalInlandMarineSection

• Remarks_PersumbrelaApplicationSection

• Remarks_Photograph

• Remarks_ProtectionDeviceCertificate

• Remarks_ReplacementCostEstimate

• Remarks_ResidenceBasedBusinessSupp

• Remarks_SolidFuelSupplement

• Remarks_StateSupplement

• Remarks_WaterCarftSection

• Remarks_WindstormLossMitigation

• Remarks_Others_Text1

• Remarks_Others_Checkbox1

• Remarks_Others_Text2

• Remarks_Others_Checkbox2

• Remarks_Description

• Binder_EffectiveDate

• Binder_ExpirationDate

• Binder_Time

• Binder_Time_12_01AM

• Binder_Time_Noon

• Binder_CoverageIsNotBound

• ApplicantInitials

• CopyOfNoticeHasbeenGiven

• ProducersSignatures

• ProducersName

• StateProducersLicenseNo

• ApplicantSignature

• Application_Date

• NationalProducerNumber

• ApplicantInfo_CoApplicants_YearsWithCurrentEmployer

• Coverage_MedicalPaymentEAPer_Limit

• Coverage_MedicalPaymentEAPer_Premium

• PaymentPlan_PaymentMethod_Other_Checkbox

• Rating_Underwriting_ConstructionType_Others_Checkbox

• Rating_Underwriting_Siding_Others_Text

• Rating_Underwriting_Siding_Others_Checkbox

• Rating_Underwriting_UsageType_Others_Checkbox

• Rating_Underwriting_Occupancy_Others_Checkbox

• Rating_Underwriting_ResidencyType_Others_Checkbox

• Rating_Underwriting_DoorLock_Others_Checkbox

• GeneralInfo_Resdential_Other_Text

• GeneralInfo_Resdential_Other_Checkbox

• PaymentPlan_MailPolicyTo_Others_Checkbox

• GeneralInfo_Resdential_AnyResidenceEmployees

• CoverageLoss_Table: A table with the following columns:

  • Coverage

  • Limit

  • Premium

• Coverage_Options_Table: A table with the following columns:

  • Coverage

  • YesOrNo

  • Option

  • Limit

  • Premium

• Coverage_Deductible_Table: A table with the following columns:

  • Deductible_01

  • Amount_01

  • Percent_01

  • Type_01

  • Deductible_02

  • Amount_02

  • Percent_02

  • Type_02

• FormsAndEndorsement_Table: A table with the following columns:

  • Loc

  • VEH

  • Boat

  • Item

  • FormNumber

  • FormName

  • EditionDate

  • CopyRightOwnerCode

• Renovations_Table: A table with the following columns:

  • Renovation

  • Part

  • Comp

  • Year

• LocationSchedule_Table: A table with the following columns:

  • Loc

  • Street

  • City

  • County

  • State

  • Zip

• PriorCoverage_Table: A table with the following columns:

  • PriorCarrier

  • PriorPolicyNumber

  • ExpirationDate

• LossHistory_Table: A table with the following columns:

  • LossDate

  • LossType

  • DescriptionOfLoss

  • CAT

  • AmountPaid

  • EnteredByAgentCompany

  • InDispute

• OperationCoverage_OPTS_Table: A table with the following columns:

  • CoverageType

  • OPTS

  • Limit

  • ApplTo

  • Deductable

  • Premium

• GeneralInfo_OwnRecreationalVehicles_Table: A table with the following columns:

  • Year

  • Make

  • Model

  • BodyType