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Declarations Page 22 fields extracted
Policy Number 4382-82-61-23
Date Issued August 18, 2023
Company Name GEICO Indemnity Company
Company Address One GEICO Boulevard, Fredericksburg, VA 22412-0003
Phone 1-800-841-3000
Customer Name MARIA Y SO AND THOMAS FRANKNER
Customer Address 10 MILLRIDGE DR, LIVINGSTON NJ 07039-1822
Email jessysu@yahoo.com
Coverage Period 09-26-23 through 03-26-24
Additional Drivers Emma M Frankner, Benjamin W Frankner
Vehicle 1 2011 Honda Pilot, VIN: 5FNYF4H91BB072648
Vehicle 2 2017 Honda Accord, VIN: 1HGCR2F34HA091527
Bodily Injury Liability $100,000/$300,000
Property Damage Liability $50,000
PIP Full Health Primary Option A, $15,000, $250 Ded
Uninsured & Underinsured $100,000/$300,000
Underinsured Property $25,000
Collision $1,000 Ded
Emergency Road Service ERS COLL
Six Month Premium $1,328.50, $1,025.30
Total Six Month Premium $2,353.80
Tier D
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Declarations Page 22 fields extracted
Policy Number4382-82-61-23
Date IssuedAugust 18, 2023
Company NameGEICO Indemnity Company
Customer NameMARIA Y SO AND THOMAS FRANKNER
Emailjessysu@yahoo.com
Coverage Period09-26-23 through 03-26-24
Bodily Injury Liability$100,000/$300,000
Total Six Month Premium$2,353.80
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W-2 ACORD 25 CMS-1500 HUD-1 1099-NEC SF-424 I-9 Bill of Lading Form 990 ACORD 140 UB-04 Closing Disclosure 1040 DEA 222 OSHA 300 AIA G702 FAFSA URLA 1003 Commercial Invoice And any other document, of course.

55 document schemas across 12 industries.

All supported schemas

Insurance (19)

ACORD 1, 2, 24, 25, 27, 28, 35, 36, 75, 80, 101, 125, 126, 127, 130, 131, 140, 160, 825

Tax (9)

W-2, 1099-NEC, 1099-MISC, 1099-INT, 1099-DIV, 1099-R, 1040, 1065, 1120

Healthcare (3)

CMS-1500, UB-04, ADA Dental

Banking / Real Estate (6)

HUD-1, Closing Disclosure, Loan Estimate, URLA 1003

Government (5)

SF-424, SF-424A, SF-424B, SF-1449, SF-50

Human Resources (5)

I-9, W-4, OSHA 300, OSHA 300A, OSHA 301

Transport (3)

Bill of Lading, CBP 3461, CBP 7501

Nonprofit (3)

Form 990, 990-EZ, 990-PF

Pharma (3)

DEA 222, FDA 3500 (MedWatch), FDA 356h (NDA)

Construction (2)

AIA G702, AIA G703

Retail (1)

US Standard Commercial Invoice

Education (1)

FAFSA

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