Share Gallery 1/share_gal_1.zip/share_gal_1/HD/HD022A.ZIP/LHARC2.EXE/3800.XXX

Text File | 1991-06-27 | 1KB | 35 lines

#3800
@001 State the name of the insureds:
@002 State the name of the insurance company:
@003 State the policy number:
@004 State the date that the policy commenced:
@005 State the date of expiration of the policy:
@400 State the model year of the car:
@401 State the make of the car:
@402/@402/@402/@402 State the type of body of the car:
Sedan
Truck
Van
KEY IN VALUE
@406 State the Vehicle ID number:
@404 Enter the state of registration and license number:
@405 State the reason for damage to car or loss:
@408 Please state the date of loss:
@409 Please enter the time of loss:
@410 Please state whether the loss was am or pm:
@411/@411/@411 Explain why loss occured briefly:
Collision with other vehicle
Theft
KEY IN VALUE
@412 Please state any liens or encumbrances on vehicle:
@413/@413 State if other insurance on car or "none"
None
KEY IN VALUE
@414/@414/@414 State reason for use of the car at time of loss:
Pleasure
Business
KEY IN VALUE
@415/@415 State any non-covered reason for loss or "none"
None
KEY IN VALUE