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At least 1 policy from either policies at 1st, 2nd, or 3rd must be chosen
Combo Group ID#
Must be 9 digits or less
Rating Effective Date
(MM/DD/YYYY)
Must be a valid date before the current date + 210 days
Invalid Date Format
Required
Interstate Indicator
Yes
No
View Policy Date Range(click to refresh)
Number of policies at 1st
0
1
2
3
4
5
6
7
8
9
10
Number of policies at 2nd
0
1
2
3
4
5
6
7
8
9
10
Number of policies at 3rd
0
1
2
3
4
5
6
7
8
9
10
User's Name
Required
Employer's Name
Help Guide
Note: Max Number of policies for calculation is 30
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