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ACORD Form 163 Commercial Auto
Driver Info. Schedule Instructions

 

 
ACORD 163 (2000/11) rev. 04-10-2009 1 of 20
Section Name Field Name Field and/or Section Description
TITLE ACORD 163 (2000/11) Commercial Auto Driver Information Schedule The title of the form. ACORD 163, Commercial Auto Driver Information Schedule, is used with either ACORD 127, Business Auto Section, ACORD 128, Garage and Dealers Section, or ACORD 132, Truckers/Motor Carriers Section, to record driver information when there is not enough space in ACORD 127, ACORD 128 or ACORD 132 to accommodate the number of drivers of the applicant's or the insured's vehicles.
IDENTIFICATION SECTION Date Enter date: The month/day/year on which the form is completed. (MM/DD/YYYY)
IDENTIFICATION SECTION Producer Enter text: The full name of the producer/agency.
IDENTIFICATION SECTION Producer Enter text: The mailing address line one of the producer/agency.
IDENTIFICATION SECTION Producer Enter text: The mailing address line two of the producer/agency.
IDENTIFICATION SECTION Producer Enter text: The mailing address city name of the producer/agency.
IDENTIFICATION SECTION Producer Enter code: The mailing address state or province code of the producer/agency.
IDENTIFICATION SECTION Producer Enter code: The mailing address postal code of the producer/agency.
Enter number: The producer's contact person's phone number. If applicable, include the
IDENTIFICATION SECTION Phone (A/C, No, Ext) area code and extension.
IDENTIFICATION SECTION FAX No Enter number: The fax number of the producer/agency.
Enter code: The identification code assigned to the producer (e.g. agency or brokerage
IDENTIFICATION SECTION Code firm) by the insurer.
Enter code: The identification code assigned by the insurer to the sub-producer (e.g.
IDENTIFICATION SECTION Subcode person) within a producer's office (e.g. agency or brokerage).
Enter identifier: The customer's identification number assigned by the producer (e.g.
IDENTIFICATION SECTION Agency Customer ID agency or brokerage).
IDENTIFICATION SECTION Applicant (First Named Insured) Enter text: The named insured(s) as it/they will appear on the policy declarations page.
IDENTIFICATION SECTION For Company Use Only Enter text: This area is to be completed by the insurer.
DRIVER INFORMATION Driver # Enter number: The number assigned to the driver by the producer.
DRIVER INFORMATION Name Enter text: The driver's first name (given name).

ACORD 163 (2000/11) rev. 04-10-2009 2 of 20

Section Name Field Name Field and/or Section Description
DRIVER INFORMATION Enter text: The driver's middle name or initial (other given name).
DRIVER INFORMATION Enter text: The driver's last name (surname).
DRIVER INFORMATION Enter text: The first address line of the driver.
DRIVER INFORMATION Enter text: The city of the driver.
DRIVER INFORMATION Enter code: The state or province of the driver.
DRIVER INFORMATION Enter code: The postal code of the driver.
DRIVER INFORMATION Sex Enter code: The gender of the driver.
DRIVER INFORMATION Marital Stat Enter code: The marital status of the driver. Examples are: S - Single; M - Married; D -Divorced; P - Separated; W - Widowed, C - Domestic Partner (unmarried), V - Civil Union, U - Unknown, O - Other
DRIVER INFORMATION Date of Birth Enter date: The birth date of the driver.
DRIVER INFORMATION Yrs Exp Enter number: The number of years of driving experience for the driver.
DRIVER INFORMATION Year Licensed Enter year: The original year in which a driver's license was issued to this driver.
DRIVER INFORMATION Driver's License Number/Soc. Sec. # Enter identifier: The driver's license number.
DRIVER INFORMATION Enter identifier: The tax identifier (social security number) of the driver.
DRIVER INFORMATION State Lic. Enter code: The state the driver is licensed in.
DRIVER INFORMATION Date Hire Enter date: The date the driver was hired.
DRIVER INFORMATION Broadened No Fault Enter Y for a “Yes” response. Input N for “No” response. Indicates that broadened no fault coverage applies to the driver (not applicable in all states).
DRIVER INFORMATION DOC Enter Y for a “Yes” response. Input N for “No” response. Indicates the driver is covered by Drive Other Car coverage.
DRIVER INFORMATION Use Vehicle # Enter number: The producer assigned vehicle number that this driver primarily uses.
DRIVER INFORMATION % Use Enter percentage: Indicates the percentage of driving done by this driver in the primary vehicle that this driver uses.
DRIVER INFORMATION Driver # Enter number: The number assigned to the driver by the producer.
DRIVER INFORMATION Name Enter text: The driver's first name (given name).
DRIVER INFORMATION Enter text: The driver's middle name or initial (other given name).
DRIVER INFORMATION Enter text: The driver's last name (surname).
DRIVER INFORMATION Enter text: The first address line of the driver.
DRIVER INFORMATION Enter text: The city of the driver.
DRIVER INFORMATION Enter code: The state or province of the driver.
DRIVER INFORMATION Enter code: The postal code of the driver.
DRIVER INFORMATION Sex Enter code: The gender of the driver.
ACORD 163 (2000/11) rev. 04-10-2009 3 of 20
Section Name Field Name Field and/or Section Description
DRIVER INFORMATION Marital Stat Enter code: The marital status of the driver. Examples are: S - Single; M - Married; D -Divorced; P - Separated; W - Widowed, C - Domestic Partner (unmarried), V - Civil Union, U - Unknown, O - Other
DRIVER INFORMATION Date of Birth Enter date: The birth date of the driver.
DRIVER INFORMATION Yrs Exp Enter number: The number of years of driving experience for the driver.
DRIVER INFORMATION Year Licensed Enter year: The original year in which a driver's license was issued to this driver.
DRIVER INFORMATION Driver's License Number/Soc. Sec. # Enter identifier: The driver's license number.
DRIVER INFORMATION Enter identifier: The tax identifier (social security number) of the driver.
DRIVER INFORMATION State Lic. Enter code: The state the driver is licensed in.
DRIVER INFORMATION Date Hire Enter date: The date the driver was hired.
DRIVER INFORMATION Broadened No Fault Enter Y for a “Yes” response. Input N for “No” response. Indicates that broadened no fault coverage applies to the driver (not applicable in all states).
DRIVER INFORMATION DOC Enter Y for a “Yes” response. Input N for “No” response. Indicates the driver is covered by Drive Other Car coverage.
DRIVER INFORMATION Use Vehicle # Enter number: The producer assigned vehicle number that this driver primarily uses.
DRIVER INFORMATION % Use Enter percentage: Indicates the percentage of driving done by this driver in the primary vehicle that this driver uses.
DRIVER INFORMATION Driver # Enter number: The number assigned to the driver by the producer.
DRIVER INFORMATION Name Enter text: The driver's first name (given name).
DRIVER INFORMATION Enter text: The driver's middle name or initial (other given name).
DRIVER INFORMATION Enter text: The driver's last name (surname).
DRIVER INFORMATION Enter text: The first address line of the driver.
DRIVER INFORMATION Enter text: The city of the driver.
DRIVER INFORMATION Enter code: The state or province of the driver.
DRIVER INFORMATION Enter code: The postal code of the driver.
DRIVER INFORMATION Sex Enter code: The gender of the driver.
DRIVER INFORMATION Marital Stat Enter code: The marital status of the driver. Examples are: S - Single; M - Married; D -Divorced; P - Separated; W - Widowed, C - Domestic Partner (unmarried), V - Civil Union, U - Unknown, O - Other
DRIVER INFORMATION Date of Birth Enter date: The birth date of the driver.
DRIVER INFORMATION Yrs Exp Enter number: The number of years of driving experience for the driver.
DRIVER INFORMATION Year Licensed Enter year: The original year in which a driver's license was issued to this driver.
DRIVER INFORMATION Driver's License Number/Soc. Sec. # Enter identifier: The driver's license number.
DRIVER INFORMATION Enter identifier: The tax identifier (social security number) of the driver.
ACORD 163 (2000/11) rev. 04-10-2009 4 of 20
Section Name Field Name Field and/or Section Description
DRIVER INFORMATION State Lic. Enter code: The state the driver is licensed in.
DRIVER INFORMATION Date Hire Enter date: The date the driver was hired.
DRIVER INFORMATION Broadened No Fault Enter Y for a “Yes” response. Input N for “No” response. Indicates that broadened no fault coverage applies to the driver (not applicable in all states).
DRIVER INFORMATION DOC Enter Y for a “Yes” response. Input N for “No” response. Indicates the driver is covered by Drive Other Car coverage.
DRIVER INFORMATION Use Vehicle # Enter number: The producer assigned vehicle number that this driver primarily uses.
DRIVER INFORMATION % Use Enter percentage: Indicates the percentage of driving done by this driver in the primary vehicle that this driver uses.
DRIVER INFORMATION Driver # Enter number: The number assigned to the driver by the producer.
DRIVER INFORMATION Name Enter text: The driver's first name (given name).
DRIVER INFORMATION Enter text: The driver's middle name or initial (other given name).
DRIVER INFORMATION Enter text: The driver's last name (surname).
DRIVER INFORMATION Enter text: The first address line of the driver.
DRIVER INFORMATION Enter text: The city of the driver.
DRIVER INFORMATION Enter code: The state or province of the driver.
DRIVER INFORMATION Enter code: The postal code of the driver.
DRIVER INFORMATION Sex Enter code: The gender of the driver.
DRIVER INFORMATION Marital Stat Enter code: The marital status of the driver. Examples are: S - Single; M - Married; D -Divorced; P - Separated; W - Widowed, C - Domestic Partner (unmarried), V - Civil Union, U - Unknown, O - Other
DRIVER INFORMATION Date of Birth Enter date: The birth date of the driver.
DRIVER INFORMATION Yrs Exp Enter number: The number of years of driving experience for the driver.
DRIVER INFORMATION Year Licensed Enter year: The original year in which a driver's license was issued to this driver.
DRIVER INFORMATION Driver's License Number/Soc. Sec. # Enter identifier: The driver's license number.
DRIVER INFORMATION Enter identifier: The tax identifier (social security number) of the driver.
DRIVER INFORMATION State Lic. Enter code: The state the driver is licensed in.
DRIVER INFORMATION Date Hire Enter date: The date the driver was hired.
DRIVER INFORMATION Broadened No Fault Enter Y for a “Yes” response. Input N for “No” response. Indicates that broadened no fault coverage applies to the driver (not applicable in all states).
DRIVER INFORMATION DOC Enter Y for a “Yes” response. Input N for “No” response. Indicates the driver is covered by Drive Other Car coverage.
DRIVER INFORMATION Use Vehicle # Enter number: The producer assigned vehicle number that this driver primarily uses.
DRIVER INFORMATION % Use Enter percentage: Indicates the percentage of driving done by this driver in the primary vehicle that this driver uses.
ACORD 163 (2000/11) rev. 04-10-2009 5 of 20
Section Name Field Name Field and/or Section Description
DRIVER INFORMATION Driver # Enter number: The number assigned to the driver by the producer.
DRIVER INFORMATION Name Enter text: The driver's first name (given name).
DRIVER INFORMATION Enter text: The driver's middle name or initial (other given name).
DRIVER INFORMATION Enter text: The driver's last name (surname).
DRIVER INFORMATION Enter text: The first address line of the driver.
DRIVER INFORMATION Enter text: The city of the driver.
DRIVER INFORMATION Enter code: The state or province of the driver.
DRIVER INFORMATION Enter code: The postal code of the driver.
DRIVER INFORMATION Sex Enter code: The gender of the driver.
DRIVER INFORMATION Marital Stat Enter code: The marital status of the driver. Examples are: S - Single; M - Married; D -Divorced; P - Separated; W - Widowed, C - Domestic Partner (unmarried), V - Civil Union, U - Unknown, O - Other
DRIVER INFORMATION Date of Birth Enter date: The birth date of the driver.
DRIVER INFORMATION Yrs Exp Enter number: The number of years of driving experience for the driver.
DRIVER INFORMATION Year Licensed Enter year: The original year in which a driver's license was issued to this driver.
DRIVER INFORMATION Driver's License Number/Soc. Sec. # Enter identifier: The driver's license number.
DRIVER INFORMATION Enter identifier: The tax identifier (social security number) of the driver.
DRIVER INFORMATION State Lic. Enter code: The state the driver is licensed in.
DRIVER INFORMATION Date Hire Enter date: The date the driver was hired.
DRIVER INFORMATION Broadened No Fault Enter Y for a “Yes” response. Input N for “No” response. Indicates that broadened no fault coverage applies to the driver (not applicable in all states).
DRIVER INFORMATION DOC Enter Y for a “Yes” response. Input N for “No” response. Indicates the driver is covered by Drive Other Car coverage.
DRIVER INFORMATION Use Vehicle # Enter number: The producer assigned vehicle number that this driver primarily uses.
DRIVER INFORMATION % Use Enter percentage: Indicates the percentage of driving done by this driver in the primary vehicle that this driver uses.
DRIVER INFORMATION Driver # Enter number: The number assigned to the driver by the producer.
DRIVER INFORMATION Name Enter text: The driver's first name (given name).
DRIVER INFORMATION Enter text: The driver's middle name or initial (other given name).
DRIVER INFORMATION Enter text: The driver's last name (surname).
DRIVER INFORMATION Enter text: The first address line of the driver.
DRIVER INFORMATION Enter text: The city of the driver.
DRIVER INFORMATION Enter code: The state or province of the driver.
DRIVER INFORMATION Enter code: The postal code of the driver.
DRIVER INFORMATION Sex Enter code: The gender of the driver.
ACORD 163 (2000/11) rev. 04-10-2009 6 of 20
Section Name Field Name Field and/or Section Description
DRIVER INFORMATION Marital Stat Enter code: The marital status of the driver. Examples are: S - Single; M - Married; D -Divorced; P - Separated; W - Widowed, C - Domestic Partner (unmarried), V - Civil Union, U - Unknown, O - Other
DRIVER INFORMATION Date of Birth Enter date: The birth date of the driver.
DRIVER INFORMATION Yrs Exp Enter number: The number of years of driving experience for the driver.
DRIVER INFORMATION Year Licensed Enter year: The original year in which a driver's license was issued to this driver.
DRIVER INFORMATION Driver's License Number/Soc. Sec. # Enter identifier: The driver's license number.
DRIVER INFORMATION Enter identifier: The tax identifier (social security number) of the driver.
DRIVER INFORMATION State Lic. Enter code: The state the driver is licensed in.
DRIVER INFORMATION Date Hire Enter date: The date the driver was hired.
DRIVER INFORMATION Broadened No Fault Enter Y for a “Yes” response. Input N for “No” response. Indicates that broadened no fault coverage applies to the driver (not applicable in all states).
DRIVER INFORMATION DOC Enter Y for a “Yes” response. Input N for “No” response. Indicates the driver is covered by Drive Other Car coverage.
DRIVER INFORMATION Use Vehicle # Enter number: The producer assigned vehicle number that this driver primarily uses.
DRIVER INFORMATION % Use Enter percentage: Indicates the percentage of driving done by this driver in the primary vehicle that this driver uses.
DRIVER INFORMATION Driver # Enter number: The number assigned to the driver by the producer.
DRIVER INFORMATION Name Enter text: The driver's first name (given name).
DRIVER INFORMATION Enter text: The driver's middle name or initial (other given name).
DRIVER INFORMATION Enter text: The driver's last name (surname).
DRIVER INFORMATION Enter text: The first address line of the driver.
DRIVER INFORMATION Enter text: The city of the driver.
DRIVER INFORMATION Enter code: The state or province of the driver.
DRIVER INFORMATION Enter code: The postal code of the driver.
DRIVER INFORMATION Sex Enter code: The gender of the driver.
DRIVER INFORMATION Marital Stat Enter code: The marital status of the driver. Examples are: S - Single; M - Married; D -Divorced; P - Separated; W - Widowed, C - Domestic Partner (unmarried), V - Civil Union, U - Unknown, O - Other
DRIVER INFORMATION Date of Birth Enter date: The birth date of the driver.
DRIVER INFORMATION Yrs Exp Enter number: The number of years of driving experience for the driver.
DRIVER INFORMATION Year Licensed Enter year: The original year in which a driver's license was issued to this driver.
DRIVER INFORMATION Driver's License Number/Soc. Sec. # Enter identifier: The driver's license number.
DRIVER INFORMATION Enter identifier: The tax identifier (social security number) of the driver.
ACORD 163 (2000/11) rev. 04-10-2009 7 of 20
Section Name Field Name Field and/or Section Description
DRIVER INFORMATION State Lic. Enter code: The state the driver is licensed in.
DRIVER INFORMATION Date Hire Enter date: The date the driver was hired.
DRIVER INFORMATION Broadened No Fault Enter Y for a “Yes” response. Input N for “No” response. Indicates that broadened no fault coverage applies to the driver (not applicable in all states).
DRIVER INFORMATION DOC Enter Y for a “Yes” response. Input N for “No” response. Indicates the driver is covered by Drive Other Car coverage.
DRIVER INFORMATION Use Vehicle # Enter number: The producer assigned vehicle number that this driver primarily uses.
DRIVER INFORMATION % Use Enter percentage: Indicates the percentage of driving done by this driver in the primary vehicle that this driver uses.
DRIVER INFORMATION Driver # Enter number: The number assigned to the driver by the producer.
DRIVER INFORMATION Name Enter text: The driver's first name (given name).
DRIVER INFORMATION Enter text: The driver's middle name or initial (other given name).
DRIVER INFORMATION Enter text: The driver's last name (surname).
DRIVER INFORMATION Enter text: The first address line of the driver.
DRIVER INFORMATION Enter text: The city of the driver.
DRIVER INFORMATION Enter code: The state or province of the driver.
DRIVER INFORMATION Enter code: The postal code of the driver.
DRIVER INFORMATION Sex Enter code: The gender of the driver.
DRIVER INFORMATION Marital Stat Enter code: The marital status of the driver. Examples are: S - Single; M - Married; D -Divorced; P - Separated; W - Widowed, C - Domestic Partner (unmarried), V - Civil Union, U - Unknown, O - Other
DRIVER INFORMATION Date of Birth Enter date: The birth date of the driver.
DRIVER INFORMATION Yrs Exp Enter number: The number of years of driving experience for the driver.
DRIVER INFORMATION Year Licensed Enter year: The original year in which a driver's license was issued to this driver.
DRIVER INFORMATION Driver's License Number/Soc. Sec. # Enter identifier: The driver's license number.
DRIVER INFORMATION Enter identifier: The tax identifier (social security number) of the driver.
DRIVER INFORMATION State Lic. Enter code: The state the driver is licensed in.
DRIVER INFORMATION Date Hire Enter date: The date the driver was hired.
DRIVER INFORMATION Broadened No Fault Enter Y for a “Yes” response. Input N for “No” response. Indicates that broadened no fault coverage applies to the driver (not applicable in all states).
DRIVER INFORMATION DOC Enter Y for a “Yes” response. Input N for “No” response. Indicates the driver is covered by Drive Other Car coverage.
DRIVER INFORMATION Use Vehicle # Enter number: The producer assigned vehicle number that this driver primarily uses.
DRIVER INFORMATION % Use Enter percentage: Indicates the percentage of driving done by this driver in the primary vehicle that this driver uses.
ACORD 163 (2000/11) rev. 04-10-2009 8 of 20
Section Name Field Name Field and/or Section Description
DRIVER INFORMATION Driver # Enter number: The number assigned to the driver by the producer.
DRIVER INFORMATION Name Enter text: The driver's first name (given name).
DRIVER INFORMATION Enter text: The driver's middle name or initial (other given name).
DRIVER INFORMATION Enter text: The driver's last name (surname).
DRIVER INFORMATION Enter text: The first address line of the driver.
DRIVER INFORMATION Enter text: The city of the driver.
DRIVER INFORMATION Enter code: The state or province of the driver.
DRIVER INFORMATION Enter code: The postal code of the driver.
DRIVER INFORMATION Sex Enter code: The gender of the driver.
DRIVER INFORMATION Marital Stat Enter code: The marital status of the driver. Examples are: S - Single; M - Married; D -Divorced; P - Separated; W - Widowed, C - Domestic Partner (unmarried), V - Civil Union, U - Unknown, O - Other
DRIVER INFORMATION Date of Birth Enter date: The birth date of the driver.
DRIVER INFORMATION Yrs Exp Enter number: The number of years of driving experience for the driver.
DRIVER INFORMATION Year Licensed Enter year: The original year in which a driver's license was issued to this driver.
DRIVER INFORMATION Driver's License Number/Soc. Sec. # Enter identifier: The driver's license number.
DRIVER INFORMATION Enter identifier: The tax identifier (social security number) of the driver.
DRIVER INFORMATION State Lic. Enter code: The state the driver is licensed in.
DRIVER INFORMATION Date Hire Enter date: The date the driver was hired.
DRIVER INFORMATION Broadened No Fault Enter Y for a “Yes” response. Input N for “No” response. Indicates that broadened no fault coverage applies to the driver (not applicable in all states).
DRIVER INFORMATION DOC Enter Y for a “Yes” response. Input N for “No” response. Indicates the driver is covered by Drive Other Car coverage.
DRIVER INFORMATION Use Vehicle # Enter number: The producer assigned vehicle number that this driver primarily uses.
DRIVER INFORMATION % Use Enter percentage: Indicates the percentage of driving done by this driver in the primary vehicle that this driver uses.
DRIVER INFORMATION Driver # Enter number: The number assigned to the driver by the producer.
DRIVER INFORMATION Name Enter text: The driver's first name (given name).
DRIVER INFORMATION Enter text: The driver's middle name or initial (other given name).
DRIVER INFORMATION Enter text: The driver's last name (surname).
DRIVER INFORMATION Enter text: The first address line of the driver.
DRIVER INFORMATION Enter text: The city of the driver.
DRIVER INFORMATION Enter code: The state or province of the driver.
DRIVER INFORMATION Enter code: The postal code of the driver.
DRIVER INFORMATION Sex Enter code: The gender of the driver.
ACORD 163 (2000/11) rev. 04-10-2009 9 of 20
Section Name Field Name Field and/or Section Description
DRIVER INFORMATION Marital Stat Enter code: The marital status of the driver. Examples are: S - Single; M - Married; D -Divorced; P - Separated; W - Widowed, C - Domestic Partner (unmarried), V - Civil Union, U - Unknown, O - Other
DRIVER INFORMATION Date of Birth Enter date: The birth date of the driver.
DRIVER INFORMATION Yrs Exp Enter number: The number of years of driving experience for the driver.
DRIVER INFORMATION Year Licensed Enter year: The original year in which a driver's license was issued to this driver.
DRIVER INFORMATION Driver's License Number/Soc. Sec. # Enter identifier: The driver's license number.
DRIVER INFORMATION Enter identifier: The tax identifier (social security number) of the driver.
DRIVER INFORMATION State Lic. Enter code: The state the driver is licensed in.
DRIVER INFORMATION Date Hire Enter date: The date the driver was hired.
DRIVER INFORMATION Broadened No Fault Enter Y for a “Yes” response. Input N for “No” response. Indicates that broadened no fault coverage applies to the driver (not applicable in all states).
DRIVER INFORMATION DOC Enter Y for a “Yes” response. Input N for “No” response. Indicates the driver is covered by Drive Other Car coverage.
DRIVER INFORMATION Use Vehicle # Enter number: The producer assigned vehicle number that this driver primarily uses.
DRIVER INFORMATION % Use Enter percentage: Indicates the percentage of driving done by this driver in the primary vehicle that this driver uses.
DRIVER INFORMATION Driver # Enter number: The number assigned to the driver by the producer.
DRIVER INFORMATION Name Enter text: The driver's first name (given name).
DRIVER INFORMATION Enter text: The driver's middle name or initial (other given name).
DRIVER INFORMATION Enter text: The driver's last name (surname).
DRIVER INFORMATION Enter text: The first address line of the driver.
DRIVER INFORMATION Enter text: The city of the driver.
DRIVER INFORMATION Enter code: The state or province of the driver.
DRIVER INFORMATION Enter code: The postal code of the driver.
DRIVER INFORMATION Sex Enter code: The gender of the driver.
DRIVER INFORMATION Marital Stat Enter code: The marital status of the driver. Examples are: S - Single; M - Married; D -Divorced; P - Separated; W - Widowed, C - Domestic Partner (unmarried), V - Civil Union, U - Unknown, O - Other
DRIVER INFORMATION Date of Birth Enter date: The birth date of the driver.
DRIVER INFORMATION Yrs Exp Enter number: The number of years of driving experience for the driver.
DRIVER INFORMATION Year Licensed Enter year: The original year in which a driver's license was issued to this driver.
DRIVER INFORMATION Driver's License Number/Soc. Sec. # Enter identifier: The driver's license number.
DRIVER INFORMATION Enter identifier: The tax identifier (social security number) of the driver.
ACORD 163 (2000/11) rev. 04-10-2009 10 of 20
Section Name Field Name Field and/or Section Description
DRIVER INFORMATION State Lic. Enter code: The state the driver is licensed in.
DRIVER INFORMATION Date Hire Enter date: The date the driver was hired.
DRIVER INFORMATION Broadened No Fault Enter Y for a “Yes” response. Input N for “No” response. Indicates that broadened no fault coverage applies to the driver (not applicable in all states).
DRIVER INFORMATION DOC Enter Y for a “Yes” response. Input N for “No” response. Indicates the driver is covered by Drive Other Car coverage.
DRIVER INFORMATION Use Vehicle # Enter number: The producer assigned vehicle number that this driver primarily uses.
DRIVER INFORMATION % Use Enter percentage: Indicates the percentage of driving done by this driver in the primary vehicle that this driver uses.
DRIVER INFORMATION Driver # Enter number: The number assigned to the driver by the producer.
DRIVER INFORMATION Name Enter text: The driver's first name (given name).
DRIVER INFORMATION Enter text: The driver's middle name or initial (other given name).
DRIVER INFORMATION Enter text: The driver's last name (surname).
DRIVER INFORMATION Enter text: The first address line of the driver.
DRIVER INFORMATION Enter text: The city of the driver.
DRIVER INFORMATION Enter code: The state or province of the driver.
DRIVER INFORMATION Enter code: The postal code of the driver.
DRIVER INFORMATION Sex Enter code: The gender of the driver.
DRIVER INFORMATION Marital Stat Enter code: The marital status of the driver. Examples are: S - Single; M - Married; D -Divorced; P - Separated; W - Widowed, C - Domestic Partner (unmarried), V - Civil Union, U - Unknown, O - Other
DRIVER INFORMATION Date of Birth Enter date: The birth date of the driver.
DRIVER INFORMATION Yrs Exp Enter number: The number of years of driving experience for the driver.
DRIVER INFORMATION Year Licensed Enter year: The original year in which a driver's license was issued to this driver.
DRIVER INFORMATION Driver's License Number/Soc. Sec. # Enter identifier: The driver's license number.
DRIVER INFORMATION Enter identifier: The tax identifier (social security number) of the driver.
DRIVER INFORMATION State Lic. Enter code: The state the driver is licensed in.
DRIVER INFORMATION Date Hire Enter date: The date the driver was hired.
DRIVER INFORMATION Broadened No Fault Enter Y for a “Yes” response. Input N for “No” response. Indicates that broadened no fault coverage applies to the driver (not applicable in all states).
DRIVER INFORMATION DOC Enter Y for a “Yes” response. Input N for “No” response. Indicates the driver is covered by Drive Other Car coverage.
DRIVER INFORMATION Use Vehicle # Enter number: The producer assigned vehicle number that this driver primarily uses.
DRIVER INFORMATION % Use Enter percentage: Indicates the percentage of driving done by this driver in the primary vehicle that this driver uses.
ACORD 163 (2000/11) rev. 04-10-2009 11 of 20
Section Name Field Name Field and/or Section Description
DRIVER INFORMATION Driver # Enter number: The number assigned to the driver by the producer.
DRIVER INFORMATION Name Enter text: The driver's first name (given name).
DRIVER INFORMATION Enter text: The driver's middle name or initial (other given name).
DRIVER INFORMATION Enter text: The driver's last name (surname).
DRIVER INFORMATION Enter text: The first address line of the driver.
DRIVER INFORMATION Enter text: The city of the driver.
DRIVER INFORMATION Enter code: The state or province of the driver.
DRIVER INFORMATION Enter code: The postal code of the driver.
DRIVER INFORMATION Sex Enter code: The gender of the driver.
DRIVER INFORMATION Marital Stat Enter code: The marital status of the driver. Examples are: S - Single; M - Married; D -Divorced; P - Separated; W - Widowed, C - Domestic Partner (unmarried), V - Civil Union, U - Unknown, O - Other
DRIVER INFORMATION Date of Birth Enter date: The birth date of the driver.
DRIVER INFORMATION Yrs Exp Enter number: The number of years of driving experience for the driver.
DRIVER INFORMATION Year Licensed Enter year: The original year in which a driver's license was issued to this driver.
DRIVER INFORMATION Driver's License Number/Soc. Sec. # Enter identifier: The driver's license number.
DRIVER INFORMATION Enter identifier: The tax identifier (social security number) of the driver.
DRIVER INFORMATION State Lic. Enter code: The state the driver is licensed in.
DRIVER INFORMATION Date Hire Enter date: The date the driver was hired.
DRIVER INFORMATION Broadened No Fault Enter Y for a “Yes” response. Input N for “No” response. Indicates that broadened no fault coverage applies to the driver (not applicable in all states).
DRIVER INFORMATION DOC Enter Y for a “Yes” response. Input N for “No” response. Indicates the driver is covered by Drive Other Car coverage.
DRIVER INFORMATION Use Vehicle # Enter number: The producer assigned vehicle number that this driver primarily uses.
DRIVER INFORMATION % Use Enter percentage: Indicates the percentage of driving done by this driver in the primary vehicle that this driver uses.
DRIVER INFORMATION Driver # Enter number: The number assigned to the driver by the producer.
DRIVER INFORMATION Name Enter text: The driver's first name (given name).
DRIVER INFORMATION Enter text: The driver's middle name or initial (other given name).
DRIVER INFORMATION Enter text: The driver's last name (surname).
DRIVER INFORMATION Enter text: The first address line of the driver.
DRIVER INFORMATION Enter text: The city of the driver.
DRIVER INFORMATION Enter code: The state or province of the driver.
DRIVER INFORMATION Enter code: The postal code of the driver.
DRIVER INFORMATION Sex Enter code: The gender of the driver.
ACORD 163 (2000/11) rev. 04-10-2009 12 of 20
Section Name Field Name Field and/or Section Description
DRIVER INFORMATION Marital Stat Enter code: The marital status of the driver. Examples are: S - Single; M - Married; D -Divorced; P - Separated; W - Widowed, C - Domestic Partner (unmarried), V - Civil Union, U - Unknown, O - Other
DRIVER INFORMATION Date of Birth Enter date: The birth date of the driver.
DRIVER INFORMATION Yrs Exp Enter number: The number of years of driving experience for the driver.
DRIVER INFORMATION Year Licensed Enter year: The original year in which a driver's license was issued to this driver.
DRIVER INFORMATION Driver's License Number/Soc. Sec. # Enter identifier: The driver's license number.
DRIVER INFORMATION Enter identifier: The tax identifier (social security number) of the driver.
DRIVER INFORMATION State Lic. Enter code: The state the driver is licensed in.
DRIVER INFORMATION Date Hire Enter date: The date the driver was hired.
DRIVER INFORMATION Broadened No Fault Enter Y for a “Yes” response. Input N for “No” response. Indicates that broadened no fault coverage applies to the driver (not applicable in all states).
DRIVER INFORMATION DOC Enter Y for a “Yes” response. Input N for “No” response. Indicates the driver is covered by Drive Other Car coverage.
DRIVER INFORMATION Use Vehicle # Enter number: The producer assigned vehicle number that this driver primarily uses.
DRIVER INFORMATION % Use Enter percentage: Indicates the percentage of driving done by this driver in the primary vehicle that this driver uses.
DRIVER INFORMATION Driver # Enter number: The number assigned to the driver by the producer.
DRIVER INFORMATION Name Enter text: The driver's first name (given name).
DRIVER INFORMATION Enter text: The driver's middle name or initial (other given name).
DRIVER INFORMATION Enter text: The driver's last name (surname).
DRIVER INFORMATION Enter text: The first address line of the driver.
DRIVER INFORMATION Enter text: The city of the driver.
DRIVER INFORMATION Enter code: The state or province of the driver.
DRIVER INFORMATION Enter code: The postal code of the driver.
DRIVER INFORMATION Sex Enter code: The gender of the driver.
DRIVER INFORMATION Marital Stat Enter code: The marital status of the driver. Examples are: S - Single; M - Married; D -Divorced; P - Separated; W - Widowed, C - Domestic Partner (unmarried), V - Civil Union, U - Unknown, O - Other
DRIVER INFORMATION Date of Birth Enter date: The birth date of the driver.
DRIVER INFORMATION Yrs Exp Enter number: The number of years of driving experience for the driver.
DRIVER INFORMATION Year Licensed Enter year: The original year in which a driver's license was issued to this driver.
DRIVER INFORMATION Driver's License Number/Soc. Sec. # Enter identifier: The driver's license number.
DRIVER INFORMATION Enter identifier: The tax identifier (social security number) of the driver.
ACORD 163 (2000/11) rev. 04-10-2009 13 of 20
Section Name Field Name Field and/or Section Description
DRIVER INFORMATION State Lic. Enter code: The state the driver is licensed in.
DRIVER INFORMATION Date Hire Enter date: The date the driver was hired.
DRIVER INFORMATION Broadened No Fault Enter Y for a “Yes” response. Input N for “No” response. Indicates that broadened no fault coverage applies to the driver (not applicable in all states).
DRIVER INFORMATION DOC Enter Y for a “Yes” response. Input N for “No” response. Indicates the driver is covered by Drive Other Car coverage.
DRIVER INFORMATION Use Vehicle # Enter number: The producer assigned vehicle number that this driver primarily uses.
DRIVER INFORMATION % Use Enter percentage: Indicates the percentage of driving done by this driver in the primary vehicle that this driver uses.
DRIVER INFORMATION Driver # Enter number: The number assigned to the driver by the producer.
DRIVER INFORMATION Name Enter text: The driver's first name (given name).
DRIVER INFORMATION Enter text: The driver's middle name or initial (other given name).
DRIVER INFORMATION Enter text: The driver's last name (surname).
DRIVER INFORMATION Enter text: The first address line of the driver.
DRIVER INFORMATION Enter text: The city of the driver.
DRIVER INFORMATION Enter code: The state or province of the driver.
DRIVER INFORMATION Enter code: The postal code of the driver.
DRIVER INFORMATION Sex Enter code: The gender of the driver.
DRIVER INFORMATION Marital Stat Enter code: The marital status of the driver. Examples are: S - Single; M - Married; D -Divorced; P - Separated; W - Widowed, C - Domestic Partner (unmarried), V - Civil Union, U - Unknown, O - Other
DRIVER INFORMATION Date of Birth Enter date: The birth date of the driver.
DRIVER INFORMATION Yrs Exp Enter number: The number of years of driving experience for the driver.
DRIVER INFORMATION Year Licensed Enter year: The original year in which a driver's license was issued to this driver.
DRIVER INFORMATION Driver's License Number/Soc. Sec. # Enter identifier: The driver's license number.
DRIVER INFORMATION Enter identifier: The tax identifier (social security number) of the driver.
DRIVER INFORMATION State Lic. Enter code: The state the driver is licensed in.
DRIVER INFORMATION Date Hire Enter date: The date the driver was hired.
DRIVER INFORMATION Broadened No Fault Enter Y for a “Yes” response. Input N for “No” response. Indicates that broadened no fault coverage applies to the driver (not applicable in all states).
DRIVER INFORMATION DOC Enter Y for a “Yes” response. Input N for “No” response. Indicates the driver is covered by Drive Other Car coverage.
DRIVER INFORMATION Use Vehicle # Enter number: The producer assigned vehicle number that this driver primarily uses.
DRIVER INFORMATION % Use Enter percentage: Indicates the percentage of driving done by this driver in the primary vehicle that this driver uses.
ACORD 163 (2000/11) rev. 04-10-2009 14 of 20
Section Name Field Name Field and/or Section Description
DRIVER INFORMATION Driver # Enter number: The number assigned to the driver by the producer.
DRIVER INFORMATION Name Enter text: The driver's first name (given name).
DRIVER INFORMATION Enter text: The driver's middle name or initial (other given name).
DRIVER INFORMATION Enter text: The driver's last name (surname).
DRIVER INFORMATION Enter text: The first address line of the driver.
DRIVER INFORMATION Enter text: The city of the driver.
DRIVER INFORMATION Enter code: The state or province of the driver.
DRIVER INFORMATION Enter code: The postal code of the driver.
DRIVER INFORMATION Sex Enter code: The gender of the driver.
DRIVER INFORMATION Marital Stat Enter code: The marital status of the driver. Examples are: S - Single; M - Married; D -Divorced; P - Separated; W - Widowed, C - Domestic Partner (unmarried), V - Civil Union, U - Unknown, O - Other
DRIVER INFORMATION Date of Birth Enter date: The birth date of the driver.
DRIVER INFORMATION Yrs Exp Enter number: The number of years of driving experience for the driver.
DRIVER INFORMATION Year Licensed Enter year: The original year in which a driver's license was issued to this driver.
DRIVER INFORMATION Driver's License Number/Soc. Sec. # Enter identifier: The driver's license number.
DRIVER INFORMATION Enter identifier: The tax identifier (social security number) of the driver.
DRIVER INFORMATION State Lic. Enter code: The state the driver is licensed in.
DRIVER INFORMATION Date Hire Enter date: The date the driver was hired.
DRIVER INFORMATION Broadened No Fault Enter Y for a “Yes” response. Input N for “No” response. Indicates that broadened no fault coverage applies to the driver (not applicable in all states).
DRIVER INFORMATION DOC Enter Y for a “Yes” response. Input N for “No” response. Indicates the driver is covered by Drive Other Car coverage.
DRIVER INFORMATION Use Vehicle # Enter number: The producer assigned vehicle number that this driver primarily uses.
DRIVER INFORMATION % Use Enter percentage: Indicates the percentage of driving done by this driver in the primary vehicle that this driver uses.
DRIVER INFORMATION Driver # Enter number: The number assigned to the driver by the producer.
DRIVER INFORMATION Name Enter text: The driver's first name (given name).
DRIVER INFORMATION Enter text: The driver's middle name or initial (other given name).
DRIVER INFORMATION Enter text: The driver's last name (surname).
DRIVER INFORMATION Enter text: The first address line of the driver.
DRIVER INFORMATION Enter text: The city of the driver.
DRIVER INFORMATION Enter code: The state or province of the driver.
DRIVER INFORMATION Enter code: The postal code of the driver.
DRIVER INFORMATION Sex Enter code: The gender of the driver.
ACORD 163 (2000/11) rev. 04-10-2009 15 of 20
Section Name Field Name Field and/or Section Description
DRIVER INFORMATION Marital Stat Enter code: The marital status of the driver. Examples are: S - Single; M - Married; D -Divorced; P - Separated; W - Widowed, C - Domestic Partner (unmarried), V - Civil Union, U - Unknown, O - Other
DRIVER INFORMATION Date of Birth Enter date: The birth date of the driver.
DRIVER INFORMATION Yrs Exp Enter number: The number of years of driving experience for the driver.
DRIVER INFORMATION Year Licensed Enter year: The original year in which a driver's license was issued to this driver.
DRIVER INFORMATION Driver's License Number/Soc. Sec. # Enter identifier: The driver's license number.
DRIVER INFORMATION Enter identifier: The tax identifier (social security number) of the driver.
DRIVER INFORMATION State Lic. Enter code: The state the driver is licensed in.
DRIVER INFORMATION Date Hire Enter date: The date the driver was hired.
DRIVER INFORMATION Broadened No Fault Enter Y for a “Yes” response. Input N for “No” response. Indicates that broadened no fault coverage applies to the driver (not applicable in all states).
DRIVER INFORMATION DOC Enter Y for a “Yes” response. Input N for “No” response. Indicates the driver is covered by Drive Other Car coverage.
DRIVER INFORMATION Use Vehicle # Enter number: The producer assigned vehicle number that this driver primarily uses.
DRIVER INFORMATION % Use Enter percentage: Indicates the percentage of driving done by this driver in the primary vehicle that this driver uses.
DRIVER INFORMATION Driver # Enter number: The number assigned to the driver by the producer.
DRIVER INFORMATION Name Enter text: The driver's first name (given name).
DRIVER INFORMATION Enter text: The driver's middle name or initial (other given name).
DRIVER INFORMATION Enter text: The driver's last name (surname).
DRIVER INFORMATION Enter text: The first address line of the driver.
DRIVER INFORMATION Enter text: The city of the driver.
DRIVER INFORMATION Enter code: The state or province of the driver.
DRIVER INFORMATION Enter code: The postal code of the driver.
DRIVER INFORMATION Sex Enter code: The gender of the driver.
DRIVER INFORMATION Marital Stat Enter code: The marital status of the driver. Examples are: S - Single; M - Married; D -Divorced; P - Separated; W - Widowed, C - Domestic Partner (unmarried), V - Civil Union, U - Unknown, O - Other
DRIVER INFORMATION Date of Birth Enter date: The birth date of the driver.
DRIVER INFORMATION Yrs Exp Enter number: The number of years of driving experience for the driver.
DRIVER INFORMATION Year Licensed Enter year: The original year in which a driver's license was issued to this driver.
DRIVER INFORMATION Driver's License Number/Soc. Sec. # Enter identifier: The driver's license number.
DRIVER INFORMATION Enter identifier: The tax identifier (social security number) of the driver.
ACORD 163 (2000/11) rev. 04-10-2009 16 of 20
Section Name Field Name Field and/or Section Description
DRIVER INFORMATION State Lic. Enter code: The state the driver is licensed in.
DRIVER INFORMATION Date Hire Enter date: The date the driver was hired.
DRIVER INFORMATION Broadened No Fault Enter Y for a “Yes” response. Input N for “No” response. Indicates that broadened no fault coverage applies to the driver (not applicable in all states).
DRIVER INFORMATION DOC Enter Y for a “Yes” response. Input N for “No” response. Indicates the driver is covered by Drive Other Car coverage.
DRIVER INFORMATION Use Vehicle # Enter number: The producer assigned vehicle number that this driver primarily uses.
DRIVER INFORMATION % Use Enter percentage: Indicates the percentage of driving done by this driver in the primary vehicle that this driver uses.
DRIVER INFORMATION Driver # Enter number: The number assigned to the driver by the producer.
DRIVER INFORMATION Name Enter text: The driver's first name (given name).
DRIVER INFORMATION Enter text: The driver's middle name or initial (other given name).
DRIVER INFORMATION Enter text: The driver's last name (surname).
DRIVER INFORMATION Enter text: The first address line of the driver.
DRIVER INFORMATION Enter text: The city of the driver.
DRIVER INFORMATION Enter code: The state or province of the driver.
DRIVER INFORMATION Enter code: The postal code of the driver.
DRIVER INFORMATION Sex Enter code: The gender of the driver.
DRIVER INFORMATION Marital Stat Enter code: The marital status of the driver. Examples are: S - Single; M - Married; D -Divorced; P - Separated; W - Widowed, C - Domestic Partner (unmarried), V - Civil Union, U - Unknown, O - Other
DRIVER INFORMATION Date of Birth Enter date: The birth date of the driver.
DRIVER INFORMATION Yrs Exp Enter number: The number of years of driving experience for the driver.
DRIVER INFORMATION Year Licensed Enter year: The original year in which a driver's license was issued to this driver.
DRIVER INFORMATION Driver's License Number/Soc. Sec. # Enter identifier: The driver's license number.
DRIVER INFORMATION Enter identifier: The tax identifier (social security number) of the driver.
DRIVER INFORMATION State Lic. Enter code: The state the driver is licensed in.
DRIVER INFORMATION Date Hire Enter date: The date the driver was hired.
DRIVER INFORMATION Broadened No Fault Enter Y for a “Yes” response. Input N for “No” response. Indicates that broadened no fault coverage applies to the driver (not applicable in all states).
DRIVER INFORMATION DOC Enter Y for a “Yes” response. Input N for “No” response. Indicates the driver is covered by Drive Other Car coverage.
DRIVER INFORMATION Use Vehicle # Enter number: The producer assigned vehicle number that this driver primarily uses.
DRIVER INFORMATION % Use Enter percentage: Indicates the percentage of driving done by this driver in the primary vehicle that this driver uses.
ACORD 163 (2000/11) rev. 04-10-2009 17 of 20
Section Name Field Name Field and/or Section Description
DRIVER INFORMATION Driver # Enter number: The number assigned to the driver by the producer.
DRIVER INFORMATION Name Enter text: The driver's first name (given name).
DRIVER INFORMATION Enter text: The driver's middle name or initial (other given name).
DRIVER INFORMATION Enter text: The driver's last name (surname).
DRIVER INFORMATION Enter text: The first address line of the driver.
DRIVER INFORMATION Enter text: The city of the driver.
DRIVER INFORMATION Enter code: The state or province of the driver.
DRIVER INFORMATION Enter code: The postal code of the driver.
DRIVER INFORMATION Sex Enter code: The gender of the driver.
DRIVER INFORMATION Marital Stat Enter code: The marital status of the driver. Examples are: S - Single; M - Married; D -Divorced; P - Separated; W - Widowed, C - Domestic Partner (unmarried), V - Civil Union, U - Unknown, O - Other
DRIVER INFORMATION Date of Birth Enter date: The birth date of the driver.
DRIVER INFORMATION Yrs Exp Enter number: The number of years of driving experience for the driver.
DRIVER INFORMATION Year Licensed Enter year: The original year in which a driver's license was issued to this driver.
DRIVER INFORMATION Driver's License Number/Soc. Sec. # Enter identifier: The driver's license number.
DRIVER INFORMATION Enter identifier: The tax identifier (social security number) of the driver.
DRIVER INFORMATION State Lic. Enter code: The state the driver is licensed in.
DRIVER INFORMATION Date Hire Enter date: The date the driver was hired.
DRIVER INFORMATION Broadened No Fault Enter Y for a “Yes” response. Input N for “No” response. Indicates that broadened no fault coverage applies to the driver (not applicable in all states).
DRIVER INFORMATION DOC Enter Y for a “Yes” response. Input N for “No” response. Indicates the driver is covered by Drive Other Car coverage.
DRIVER INFORMATION Use Vehicle # Enter number: The producer assigned vehicle number that this driver primarily uses.
DRIVER INFORMATION % Use Enter percentage: Indicates the percentage of driving done by this driver in the primary vehicle that this driver uses.
DRIVER INFORMATION Driver # Enter number: The number assigned to the driver by the producer.
DRIVER INFORMATION Name Enter text: The driver's first name (given name).
DRIVER INFORMATION Enter text: The driver's middle name or initial (other given name).
DRIVER INFORMATION Enter text: The driver's last name (surname).
DRIVER INFORMATION Enter text: The first address line of the driver.
DRIVER INFORMATION Enter text: The city of the driver.
DRIVER INFORMATION Enter code: The state or province of the driver.
DRIVER INFORMATION Enter code: The postal code of the driver.
DRIVER INFORMATION Sex Enter code: The gender of the driver.
ACORD 163 (2000/11) rev. 04-10-2009 18 of 20
Section Name Field Name Field and/or Section Description
DRIVER INFORMATION Marital Stat Enter code: The marital status of the driver. Examples are: S - Single; M - Married; D -Divorced; P - Separated; W - Widowed, C - Domestic Partner (unmarried), V - Civil Union, U - Unknown, O - Other
DRIVER INFORMATION Date of Birth Enter date: The birth date of the driver.
DRIVER INFORMATION Yrs Exp Enter number: The number of years of driving experience for the driver.
DRIVER INFORMATION Year Licensed Enter year: The original year in which a driver's license was issued to this driver.
DRIVER INFORMATION Driver's License Number/Soc. Sec. # Enter identifier: The driver's license number.
DRIVER INFORMATION Enter identifier: The tax identifier (social security number) of the driver.
DRIVER INFORMATION State Lic. Enter code: The state the driver is licensed in.
DRIVER INFORMATION Date Hire Enter date: The date the driver was hired.
DRIVER INFORMATION Broadened No Fault Enter Y for a “Yes” response. Input N for “No” response. Indicates that broadened no fault coverage applies to the driver (not applicable in all states).
DRIVER INFORMATION DOC Enter Y for a “Yes” response. Input N for “No” response. Indicates the driver is covered by Drive Other Car coverage.
DRIVER INFORMATION Use Vehicle # Enter number: The producer assigned vehicle number that this driver primarily uses.
DRIVER INFORMATION % Use Enter percentage: Indicates the percentage of driving done by this driver in the primary vehicle that this driver uses.
DRIVER INFORMATION Driver # Enter number: The number assigned to the driver by the producer.
DRIVER INFORMATION Name Enter text: The driver's first name (given name).
DRIVER INFORMATION Enter text: The driver's middle name or initial (other given name).
DRIVER INFORMATION Enter text: The driver's last name (surname).
DRIVER INFORMATION Enter text: The first address line of the driver.
DRIVER INFORMATION Enter text: The city of the driver.
DRIVER INFORMATION Enter code: The state or province of the driver.
DRIVER INFORMATION Enter code: The postal code of the driver.
DRIVER INFORMATION Sex Enter code: The gender of the driver.
DRIVER INFORMATION Marital Stat Enter code: The marital status of the driver. Examples are: S - Single; M - Married; D -Divorced; P - Separated; W - Widowed, C - Domestic Partner (unmarried), V - Civil Union, U - Unknown, O - Other
DRIVER INFORMATION Date of Birth Enter date: The birth date of the driver.
DRIVER INFORMATION Yrs Exp Enter number: The number of years of driving experience for the driver.
DRIVER INFORMATION Year Licensed Enter year: The original year in which a driver's license was issued to this driver.
DRIVER INFORMATION Driver's License Number/Soc. Sec. # Enter identifier: The driver's license number.
DRIVER INFORMATION Enter identifier: The tax identifier (social security number) of the driver.
ACORD 163 (2000/11) rev. 04-10-2009 19 of 20
Section Name Field Name Field and/or Section Description
DRIVER INFORMATION State Lic. Enter code: The state the driver is licensed in.
DRIVER INFORMATION Date Hire Enter date: The date the driver was hired.
DRIVER INFORMATION Broadened No Fault Enter Y for a “Yes” response. Input N for “No” response. Indicates that broadened no fault coverage applies to the driver (not applicable in all states).
DRIVER INFORMATION DOC Enter Y for a “Yes” response. Input N for “No” response. Indicates the driver is covered by Drive Other Car coverage.
DRIVER INFORMATION Use Vehicle # Enter number: The producer assigned vehicle number that this driver primarily uses.
DRIVER INFORMATION % Use Enter percentage: Indicates the percentage of driving done by this driver in the primary vehicle that this driver uses.
DRIVER INFORMATION Driver # Enter number: The number assigned to the driver by the producer.
DRIVER INFORMATION Name Enter text: The driver's first name (given name).
DRIVER INFORMATION Enter text: The driver's middle name or initial (other given name).
DRIVER INFORMATION Enter text: The driver's last name (surname).
DRIVER INFORMATION Enter text: The first address line of the driver.
DRIVER INFORMATION Enter text: The city of the driver.
DRIVER INFORMATION Enter code: The state or province of the driver.
DRIVER INFORMATION Enter code: The postal code of the driver.
DRIVER INFORMATION Sex Enter code: The gender of the driver.
DRIVER INFORMATION Marital Stat Enter code: The marital status of the driver. Examples are: S - Single; M - Married; D -Divorced; P - Separated; W - Widowed, C - Domestic Partner (unmarried), V - Civil Union, U - Unknown, O - Other
DRIVER INFORMATION Date of Birth Enter date: The birth date of the driver.
DRIVER INFORMATION Yrs Exp Enter number: The number of years of driving experience for the driver.
DRIVER INFORMATION Year Licensed Enter year: The original year in which a driver's license was issued to this driver.
DRIVER INFORMATION Driver's License Number/Soc. Sec. # Enter identifier: The driver's license number.
DRIVER INFORMATION Enter identifier: The tax identifier (social security number) of the driver.
DRIVER INFORMATION State Lic. Enter code: The state the driver is licensed in.
DRIVER INFORMATION Date Hire Enter date: The date the driver was hired.
DRIVER INFORMATION Broadened No Fault Enter Y for a “Yes” response. Input N for “No” response. Indicates that broadened no fault coverage applies to the driver (not applicable in all states).
DRIVER INFORMATION DOC Enter Y for a “Yes” response. Input N for “No” response. Indicates the driver is covered by Drive Other Car coverage.
DRIVER INFORMATION Use Vehicle # Enter number: The producer assigned vehicle number that this driver primarily uses.
DRIVER INFORMATION % Use Enter percentage: Indicates the percentage of driving done by this driver in the primary vehicle that this driver uses.
Section Name Field Name Field and/or Section Description
The edition identifier of the form including the form number and edition (the date is
Edition Date typically formatted YYYY/MM).

ACORD 163 (2000/11) rev. 04-10-2009 20 of 20