Section Name
Field Name
Field and/or Section Description
TITLE
ACORD 163 (2000/11)
Commercial Auto Driver
Information Schedule
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.
IDENTIFICATION SECTION Phone (A/C, No, Ext)
Enter number: The producer's contact person's phone number. If applicable, include the
area code and extension.
IDENTIFICATION SECTION FAX No
Enter number: The fax number of the producer/agency.
IDENTIFICATION SECTION Code
Enter code: The identification code assigned to the producer (e.g. agency or brokerage
firm) by the insurer.
IDENTIFICATION SECTION Subcode
Enter code: The identification code assigned by the insurer to the sub-producer (e.g.
person) within a producer's office (e.g. agency or brokerage).
IDENTIFICATION SECTION Agency Customer ID
Enter identifier: The customer's identification number assigned by the producer (e.g.
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. 12-17-2010
1 of 19
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 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 in which the driver is licensed.
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 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.
ACORD 163 (2000/11) rev. 12-17-2010
2 of 19
Section Name
Field Name
Field and/or Section Description
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 in which the driver is licensed.
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 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 in which the driver is licensed.
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).
ACORD 163 (2000/11) rev. 12-17-2010
3 of 19
Section Name
Field Name
Field and/or Section Description
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 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 in which the driver is licensed.
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 city of the driver.
ACORD 163 (2000/11) rev. 12-17-2010
4 of 19
Section Name
Field Name
Field and/or Section Description
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 in which the driver is licensed.
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 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.
ACORD 163 (2000/11) rev. 12-17-2010
5 of 19
Section Name
Field Name
Field and/or Section Description
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 in which the driver is licensed.
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 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 in which the driver is licensed.
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.
ACORD 163 (2000/11) rev. 12-17-2010
6 of 19
Section Name
Field Name
Field and/or Section Description
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 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 in which the driver is licensed.
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 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. 12-17-2010
7 of 19
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 in which the driver is licensed.
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 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 in which the driver is licensed.
ACORD 163 (2000/11) rev. 12-17-2010
8 of 19
Section Name
Field Name
Field and/or Section Description
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 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 in which the driver is licensed.
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).
ACORD 163 (2000/11) rev. 12-17-2010
9 of 19
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 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 in which the driver is licensed.
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 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.
ACORD 163 (2000/11) rev. 12-17-2010
10 of 19
Section Name
Field Name
Field and/or Section Description
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 in which the driver is licensed.
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 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 in which the driver is licensed.
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).
ACORD 163 (2000/11) rev. 12-17-2010
11 of 19
Section Name
Field Name
Field and/or Section Description
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 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 in which the driver is licensed.
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 city of the driver.
ACORD 163 (2000/11) rev. 12-17-2010
12 of 19
Section Name
Field Name
Field and/or Section Description
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 in which the driver is licensed.
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 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.
ACORD 163 (2000/11) rev. 12-17-2010
13 of 19
Section Name
Field Name
Field and/or Section Description
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 in which the driver is licensed.
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 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 in which the driver is licensed.
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.
ACORD 163 (2000/11) rev. 12-17-2010
14 of 19
Section Name
Field Name
Field and/or Section Description
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 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 in which the driver is licensed.
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 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. 12-17-2010
15 of 19
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 in which the driver is licensed.
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 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 in which the driver is licensed.
ACORD 163 (2000/11) rev. 12-17-2010
16 of 19
Section Name
Field Name
Field and/or Section Description
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 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 in which the driver is licensed.
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).
ACORD 163 (2000/11) rev. 12-17-2010
17 of 19
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 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 in which the driver is licensed.
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 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.
ACORD 163 (2000/11) rev. 12-17-2010
18 of 19
Section Name
Field Name
Field and/or Section Description
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 in which the driver is licensed.
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.
Edition
Date
The edition identifier of the form including the form number and edition (the date is
typically formatted YYYY/MM).
ACORD 163 (2000/11) rev. 12-17-2010
19 of 19