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[1,"Carrier Name","Address Line 1","Address Line 2","City","State","Zipcode","NAIC Number","IRS Number","Company Type Indicator"]
[1]
[2,"Policy Number","Policy Form Number (Optional)","Effective Date","Expiration Date","Revision Date (required if Processing Type is 2 otherwise leave blank)","Termination Date (required if Processing Type is 3 otherwise leave blank)","Retroactive Date (required if Malpractice Coverage Code is 1 otherwise leave blank)","Malpractice  Coverage Code (1 = Claims Made, 2 = Occurrence)","Policy Occurrence Limit","Policy Aggregate Limit","License Number","Full Name (required if policy is for an entity otherwise leave blank)","Last Name (required if policy is for an individual otherwise leave blank)","First Name (required if policy is for an individual otherwise leave blank)","Middle Name (optional, only applicable for individual)","Suffix","Address Line 1","Address Line 2","City","State","Zipcode","IRS Number  (required if policy is for an entity otherwise leave blank)","ISO Code","Provider Type","Coverage Limit Indicator (Leave Blank)","Processing Type (1 = New/Renew Certificate, 2 = Revise Certificate, 3 = Terminate Certificate)"]
[2]