| Name | Description | Type | Additional information |
|---|---|---|---|
| BusinessAddress | string |
None. |
|
| BusinessPhoneNumber | string |
None. |
|
| Occupation | string |
None. |
|
| PremiumPaid | decimal number |
None. |
|
| ReceiptNumber | string |
None. |
|
| ReceiptDate | date |
None. |
|
| Age | string |
None. |
|
| PlaceOfAccident | string |
None. |
|
| TimeOfAccident | date |
None. |
|
| DescriptionOfAccident | string |
None. |
|
| InjuriesSustained | string |
None. |
|
| NameOfDoctor | string |
None. |
|
| AddressOfDoctor | string |
None. |
|
| IsMyUsualDoctor | boolean |
None. |
|
| OtherMedicalPersonContacted | boolean |
None. |
|
| InjuryAffectedMyOccupationPaticipation | boolean |
None. |
|
| PeriodOfDisability | string |
None. |
|
| IsEntitledToClaimFromOtherInsuranceCompany | boolean |
None. |
|
| DescriptionOfOtherInsuranceClaim | string |
None. |
|
| HasClaimedCompensationFromAnotherAccidentCompany | boolean |
None. |
|
| DetailsOfAccidentCompanyClaim | string |
None. |
|
| IsCurrentPremiumPaid | boolean |
None. |
|
| DescriptionOfPremiumPaid | string |
None. |