ACORD 92 2012/03 Medical Statement Map

 

 

Sagitta Page	Form Section	Sagitta Field	Form Field
Client Details	IDENTIFICATION SECTION	Client CD	Agency Customer ID
Policy Details	IDENTIFICATION SECTION	Agent Name	Agency
Policy Details	IDENTIFICATION SECTION	Policy Number	Policy Number
Policy Details	IDENTIFICATION SECTION	Effective Date	Effective Date
Prior History/Other Insurance	IDENTIFICATION SECTION	Insurer Name	Carrier
Policy Details	IDENTIFICATION SECTION	NAICS Code	NAIC Code
Policy Details	IDENTIFICATION SECTION	Named Insured	Named Insured(s)