Submission Type (Single or Multistate and Agent or IPC) Single State Agent Filings Single State IPC Filings Multi State Agent Filings Multi State IPC Filings Contact Type Billing Contact Submission Contact Both Only required field is Broker/Agent License. Broker/Agent Info entered will be considered an update to the Broker/Agent, and will be updated and stored. Must be unique within the return Must be unique within the return TAXABLE NON-TAXABLE AIRPORT LIABILITY, AIRCRAFT HULL LIABILITY NON-TAXABLE GOVERNMENT NON-TAXABLE MOTOR TRUCK CARGO, OCEAN MARINE, OCEAN MARINE CARGO EMPA ONLY Transaction Type New Business Additional Premium Return Premium Cancellation Renewal Reinstatement Backout Of New Business Backout Of Additional Premium Backout Of Return Premium Backout Of Cancellation Backout Of Renewal Backout Of Reinstatement Type for a amount field with dollars and cents 4-digit decimal typically used by a decimal amount field (Percentage field). Yes No Must be unique within the return Audit policy Binder replacement Correction Flat cancel with rewrite Issue date Late filing Other Retroactive effective date The Unique Market Reference (UMR) number should be located on the policy's declaration page, and may also be referenced as either the Authority Reference Number, Reference Number, or Contract Number. If none of these fields exist on your declaration page, you should contact your U.S. wholesaler to obtain the UMR/Contract number. This number will always begin with the letter 'B' followed immediately by 4 digits (signifying the Lloyd's broker), and contain up to 12 alphanumeric characters for a maximum of 17 characters. 4-digit decimal typically used by a decimal amount field (Percentage field). Type for a amount field with dollars and cents (Max 100, Min 0) Used for an email address Domain Name Email Address Used for a phone no. - 10 digits Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware District Of Columbia Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming PUERTO RICO GUAM NORTHERN MARIANA ISLANDS U.S. Virgin Islands AMERICAN SAMOA Non-USA ZIP Code - 5 digits plus optional 4. No dashes