EDI 267 Individual Life, Annuity and Disability Application

Functional Group AD

X12N Insurance Subcommittee

This X12 Transaction Set contains the format and establishes the data contents of the Individual Life, Annuity and Disability Application Transaction Set (267) for use within the context of an Electronic Data Interchange (EDI) environment. The transaction set is used to transmit new business application information among distributors (agents, broker/dealers, etc.), insurance companies and reinsurance companies for the purpose of underwriting an individual life, annuity or disability contract.

Heading

1. 0100 · ST · Transaction Set Header · Max 1 · Mandatory

   To indicate the start of a transaction set and to assign a control number

2. 0200 · BGN · Beginning Segment · Max 1 · Mandatory

   To indicate the beginning of a transaction set

3. 0300 · DTP · Date or Time or Period · Max >1 · Optional

   To specify any or all of a date, a time, or a time period

4. NM1 Loop Optional Repeat >1

   1. 0400 · NM1 · Individual or Organizational Name · Max 1 · Mandatory

      To supply the full name of an individual or organizational entity

   2. 0500 · N3 · Party Location · Max 3 · Optional

      To specify the location of the named party

   3. 0600 · N4 · Geographic Location · Max 1 · Optional

      To specify the geographic place of the named party

   4. 0700 · REF · Reference Information · Max 9 · Optional

      To specify identifying information

   5. 0800 · PER · Administrative Communications Contact · Max 3 · Optional

      To identify a person or office to whom administrative communications should be directed

Detail

1. N1 Loop Mandatory Repeat >1

   1. 0010 · N1 · Party Identification · Max 1 · Mandatory

      To identify a party by type of organization, name, and code

      The N1 loop repeats for each company or intermediate distributor.

   2. 0015 · N2 · Additional Name Information · Max 3 · Optional

      To specify additional names

   3. 0020 · N3 · Party Location · Max 3 · Optional

      To specify the location of the named party

   4. 0025 · N4 · Geographic Location · Max 1 · Optional

      To specify the geographic place of the named party

   5. 0030 · N9 · Extended Reference Information · Max >1 · Optional

      To transmit identifying information as specified by the Reference Identification Qualifier

   6. 0040 · DTM · Date/Time Reference · Max >1 · Optional

      To specify pertinent dates and times

   7. ACT Loop Mandatory Repeat >1

      1. 0050 · ACT · Account Identification · Max 1 · Mandatory

         To specify account information

         The ACT loop repeats for each individual application.

      2. 0100 · ASI · Action or Status Indicator · Max 1 · Optional

         To indicate the action to be taken with the information provided or the status of the entity described

      3. 0150 · PER · Administrative Communications Contact · Max >1 · Optional

         To identify a person or office to whom administrative communications should be directed

      4. 0200 · C3 · Currency Identifier · Max 1 · Optional

         To specify the currency being used in the transaction set

      5. 0250 · LUI · Language Use · Max >1 · Optional

         To specify language, type of usage, and proficiency or fluency

      6. 0300 · DTP · Date or Time or Period · Max >1 · Optional

         To specify any or all of a date, a time, or a time period

      7. 0350 · BLI · Basic Baseline Item Data · Max 1 · Optional

         To specify basic item data: item identification, quantity, and price

      8. 0400 · LIN · Item Identification · Max >1 · Optional

         To specify basic item identification data

      9. 0450 · PDL · Payment Details · Max >1 · Optional

         To transmit information required to establish payment or remittance activity

      10. 0500 · AM1 · Informational Values · Max >1 · Optional

          To specify a code and the amount or quantity or percentage associated with it

      11. 0550 · AMT · Monetary Amount Information · Max >1 · Optional

          To indicate the total monetary amount

      12. 0575 · QTY · Quantity Information · Max >1 · Optional

          To specify quantity information

      13. 0600 · YNQ · Yes/No Question · Max >1 · Optional

          To identify and answer yes and no questions, including the date, time, and comments further qualifying the condition

          The YNQ segment is used to report answers to application questions identified in YNQ01.

      14. 0650 · REF · Reference Information · Max >1 · Optional

          To specify identifying information

      15. LQ Loop Optional Repeat >1

          1. 0660 · LQ · Industry Code Identification · Max 1 · Mandatory

             To identify standard industry codes

             The LQ loop is used to report jurisdictional information about the application.

          2. 0670 · N4 · Geographic Location · Max >1 · Optional

             To specify the geographic place of the named party

          3. 0680 · LUI · Language Use · Max >1 · Optional

             To specify language, type of usage, and proficiency or fluency

      16. SI Loop Optional Repeat >1

          1. 0700 · SI · Service Characteristic Identification · Max 1 · Mandatory

             To specify service characteristic data

             The SI loop is used to report policy options being exercised.

          2. 0750 · AMT · Monetary Amount Information · Max >1 · Optional

             To indicate the total monetary amount

          3. 0800 · DTP · Date or Time or Period · Max >1 · Optional

             To specify any or all of a date, a time, or a time period

          4. 0850 · REF · Reference Information · Max >1 · Optional

             To specify identifying information

          5. 0900 · NM1 · Individual or Organizational Name · Max 1 · Optional

             To supply the full name of an individual or organizational entity

          6. 0950 · N4 · Geographic Location · Max 1 · Optional

             To specify the geographic place of the named party

          7. 1000 · MSG · Message Text · Max >1 · Optional

             To provide a free-form format that allows the transmission of text information

      17. PID Loop Optional Repeat >1

          1. 1050 · PID · Product/Item Description · Max 1 · Mandatory

             To describe a product or process in coded or free-form format

             The PID loop is used to report coverages at the contract level.

          2. 1100 · BLI · Basic Baseline Item Data · Max 1 · Optional

             To specify basic item data: item identification, quantity, and price

          3. 1150 · SPA · Status of Product or Activity · Max 1 · Optional

             To indicate the details and status of a product or product activity

          4. 1200 · UD · Underwriting Status · Max 1 · Optional

             To identify and describe underwriting status of submitted applications

          5. 1250 · AMT · Monetary Amount Information · Max >1 · Optional

             To indicate the total monetary amount

          6. 1300 · AM1 · Informational Values · Max >1 · Optional

             To specify a code and the amount or quantity or percentage associated with it

          7. 1350 · PDL · Payment Details · Max >1 · Optional

             To transmit information required to establish payment or remittance activity

          8. 1400 · QTY · Quantity Information · Max >1 · Optional

             To specify quantity information

          9. 1450 · DTP · Date or Time or Period · Max >1 · Optional

             To specify any or all of a date, a time, or a time period

          10. 1500 · MSG · Message Text · Max >1 · Optional

              To provide a free-form format that allows the transmission of text information

          11. INV Loop Optional Repeat >1

              1. 1550 · INV · Investment Vehicle Selection · Max 1 · Mandatory

                 To specify type of investment vehicle or account and other basic data about the investment

              2. 1600 · AM1 · Informational Values · Max >1 · Optional

                 To specify a code and the amount or quantity or percentage associated with it

              3. 1650 · DTP · Date or Time or Period · Max >1 · Optional

                 To specify any or all of a date, a time, or a time period

              4. 1700 · QTY · Quantity Information · Max >1 · Optional

                 To specify quantity information

              5. 1750 · LIN · Item Identification · Max 2 · Optional

                 To specify basic item identification data

              6. 1800 · RPA · Rate Amounts or Percents · Max >1 · Optional

                 To identify rate amounts or percents for a specific cost or other line item

          12. BEN Loop Optional Repeat >1

              1. 1850 · BEN · Beneficiary or Owner Information · Max 1 · Mandatory

                 To supply beneficiary, co-participant, and owner information

                 The BEN loop is used to report beneficiary information that relates only to the coverage's reported in the PID loop.

              2. 1900 · NM1 · Individual or Organizational Name · Max 1 · Optional

                 To supply the full name of an individual or organizational entity

              3. 1950 · N2 · Additional Name Information · Max 3 · Optional

                 To specify additional names

              4. 2000 · N3 · Party Location · Max 3 · Optional

                 To specify the location of the named party

              5. 2050 · N4 · Geographic Location · Max 1 · Optional

                 To specify the geographic place of the named party

              6. 2100 · REF · Reference Information · Max >1 · Optional

                 To specify identifying information

              7. 2150 · DTP · Date or Time or Period · Max >1 · Optional

                 To specify any or all of a date, a time, or a time period

              8. 2200 · III · Information · Max >1 · Optional

                 To report information

              9. 2250 · QTY · Quantity Information · Max >1 · Optional

                 To specify quantity information

              10. 2270 · AMT · Monetary Amount Information · Max >1 · Optional

                  To indicate the total monetary amount

              11. 2300 · LUI · Language Use · Max 1 · Optional

                  To specify language, type of usage, and proficiency or fluency

              12. 2350 · MSG · Message Text · Max >1 · Optional

                  To provide a free-form format that allows the transmission of text information

      18. ENT Loop Optional Repeat >1

          1. 2400 · ENT · Entity · Max 1 · Mandatory

             To designate the entities which are parties to a transaction and specify a reference meaningful to those entities

             The ENT loop repeats for each entity associated with the policy.

          2. 2410 · NX1 · Property or Entity Identification · Max 2 · Optional

             To define the attributes of a property or an entity

          3. 2450 · REF · Reference Information · Max >1 · Optional

             To specify identifying information

          4. 2500 · LIN · Item Identification · Max 9 · Optional

             To specify basic item identification data

          5. 2550 · DMG · Demographic Information · Max 1 · Optional

             To supply demographic information

          6. 2600 · DMA · Additional Demographic Information · Max 1 · Optional

             To supply additional demographic identification

          7. 2620 · IND · Additional Individual Demographic Information · Max 1 · Optional

             To provide additional demographic information to the receiving school, institution, or agency to assist in identifying the particular student

          8. 2650 · LUI · Language Use · Max 1 · Optional

             To specify language, type of usage, and proficiency or fluency

          9. 2670 · ERI · Entity Relationship · Max 1 · Optional

             To identify the explicit relationship between entities, i.e., parent, child, peer

          10. 2700 · DTP · Date or Time or Period · Max >1 · Optional

              To specify any or all of a date, a time, or a time period

          11. 2720 · AMT · Monetary Amount Information · Max >1 · Optional

              To indicate the total monetary amount

              The AMT segment is used to report financial information for the entity that is not related to a specific product.

          12. 2750 · AM1 · Informational Values · Max >1 · Optional

              To specify a code and the amount or quantity or percentage associated with it

          13. 2770 · RPA · Rate Amounts or Percents · Max >1 · Optional

              To identify rate amounts or percents for a specific cost or other line item

              The RPA segment is used to allocate commissions that are independent of the product.

          14. 2800 · YNQ · Yes/No Question · Max >1 · Optional

              To identify and answer yes and no questions, including the date, time, and comments further qualifying the condition

              The YNQ segment reports answers to entity-related questions identified in YNQ01.

          15. 2850 · QTY · Quantity Information · Max >1 · Optional

              To specify quantity information

          16. 2900 · MSG · Message Text · Max >1 · Optional

              To provide a free-form format that allows the transmission of text information

          17. NM1 Loop Optional Repeat >1

              1. 2950 · NM1 · Individual or Organizational Name · Max 1 · Mandatory

                 To supply the full name of an individual or organizational entity

                 The NM1 loop identifies the entity.

              2. 3000 · N2 · Additional Name Information · Max 3 · Optional

                 To specify additional names

              3. 3050 · REF · Reference Information · Max >1 · Optional

                 To specify identifying information

              4. 3070 · AM1 · Informational Values · Max >1 · Optional

                 To specify a code and the amount or quantity or percentage associated with it

              5. N3 Loop Optional Repeat >1

                 1. 3100 · N3 · Party Location · Max 1 · Mandatory

                    To specify the location of the named party

                 2. 3150 · N4 · Geographic Location · Max 1 · Optional

                    To specify the geographic place of the named party

                 3. 3200 · COM · Communication Contact Information · Max 9 · Optional

                    To specify a communication contact number

                 4. 3250 · DTP · Date or Time or Period · Max >1 · Optional

                    To specify any or all of a date, a time, or a time period

                 5. 3270 · QTY · Quantity Information · Max 1 · Optional

                    To specify quantity information

          18. LQ Loop Optional Repeat >1

              1. 3300 · LQ · Industry Code Identification · Max 1 · Mandatory

                 To identify standard industry codes

                 The LQ loop reports underwriting requirements.

              2. 3350 · SPA · Status of Product or Activity · Max 1 · Optional

                 To indicate the details and status of a product or product activity

              3. 3400 · DTP · Date or Time or Period · Max >1 · Optional

                 To specify any or all of a date, a time, or a time period

              4. 3450 · MSG · Message Text · Max >1 · Optional

                 To provide a free-form format that allows the transmission of text information

              5. NM1 Loop Optional Repeat >1

                 1. 3500 · NM1 · Individual or Organizational Name · Max 1 · Mandatory

                    To supply the full name of an individual or organizational entity

                    The NM1 loop identifies information sources for underwriting requirements.

                 2. 3550 · N3 · Party Location · Max 3 · Optional

                    To specify the location of the named party

                 3. 3600 · N4 · Geographic Location · Max 1 · Optional

                    To specify the geographic place of the named party

                 4. 3650 · REF · Reference Information · Max >1 · Optional

                    To specify identifying information

                 5. 3700 · COM · Communication Contact Information · Max 3 · Optional

                    To specify a communication contact number

                 6. 3750 · LUI · Language Use · Max 1 · Optional

                    To specify language, type of usage, and proficiency or fluency

                 7. 3800 · DTP · Date or Time or Period · Max >1 · Optional

                    To specify any or all of a date, a time, or a time period

                 8. 3850 · MSG · Message Text · Max >1 · Optional

                    To provide a free-form format that allows the transmission of text information

          19. BEN Loop Optional Repeat >1

              1. 3900 · BEN · Beneficiary or Owner Information · Max 1 · Mandatory

                 To supply beneficiary, co-participant, and owner information

                 The BEN loop is used to report beneficiary information that relates only to a specific entity in the ENT loop.

              2. 3950 · NM1 · Individual or Organizational Name · Max 1 · Optional

                 To supply the full name of an individual or organizational entity

              3. 4000 · N2 · Additional Name Information · Max 3 · Optional

                 To specify additional names

              4. 4050 · N3 · Party Location · Max 3 · Optional

                 To specify the location of the named party

              5. 4100 · N4 · Geographic Location · Max 1 · Optional

                 To specify the geographic place of the named party

              6. 4150 · REF · Reference Information · Max >1 · Optional

                 To specify identifying information

              7. 4200 · DTP · Date or Time or Period · Max >1 · Optional

                 To specify any or all of a date, a time, or a time period

              8. 4250 · III · Information · Max >1 · Optional

                 To report information

              9. 4300 · QTY · Quantity Information · Max >1 · Optional

                 To specify quantity information

              10. 4320 · AMT · Monetary Amount Information · Max >1 · Optional

                  To indicate the total monetary amount

              11. 4350 · LUI · Language Use · Max 1 · Optional

                  To specify language, type of usage, and proficiency or fluency

              12. 4400 · MSG · Message Text · Max >1 · Optional

                  To provide a free-form format that allows the transmission of text information

          20. PID Loop Optional Repeat >1

              1. 4450 · PID · Product/Item Description · Max 1 · Mandatory

                 To describe a product or process in coded or free-form format

                 The PID loop is used to report on coverages, service features and riders that relate to a specific entity in the ENT loop.

              2. 4500 · BLI · Basic Baseline Item Data · Max 9 · Optional

                 To specify basic item data: item identification, quantity, and price

              3. 4550 · SPA · Status of Product or Activity · Max 1 · Optional

                 To indicate the details and status of a product or product activity

              4. 4600 · AMT · Monetary Amount Information · Max >1 · Optional

                 To indicate the total monetary amount

              5. 4650 · QTY · Quantity Information · Max >1 · Optional

                 To specify quantity information

              6. 4700 · DTP · Date or Time or Period · Max >1 · Optional

                 To specify any or all of a date, a time, or a time period

              7. 4720 · YNQ · Yes/No Question · Max >1 · Optional

                 To identify and answer yes and no questions, including the date, time, and comments further qualifying the condition

              8. 4750 · MSG · Message Text · Max >1 · Optional

                 To provide a free-form format that allows the transmission of text information

              9. PDL Loop Optional Repeat >1

                 1. 4800 · PDL · Payment Details · Max 1 · Mandatory

                    To transmit information required to establish payment or remittance activity

                 2. 4850 · REF · Reference Information · Max >1 · Optional

                    To specify identifying information

              10. INV Loop Optional Repeat >1

                  1. 4900 · INV · Investment Vehicle Selection · Max 1 · Mandatory

                     To specify type of investment vehicle or account and other basic data about the investment

                  2. 4950 · AM1 · Informational Values · Max >1 · Optional

                     To specify a code and the amount or quantity or percentage associated with it

                  3. 5000 · DTP · Date or Time or Period · Max >1 · Optional

                     To specify any or all of a date, a time, or a time period

                  4. 5050 · RPA · Rate Amounts or Percents · Max >1 · Optional

                     To identify rate amounts or percents for a specific cost or other line item

              11. BEN Loop Optional Repeat >1

                  1. 5100 · BEN · Beneficiary or Owner Information · Max 1 · Mandatory

                     To supply beneficiary, co-participant, and owner information

                     The BEN loop is used to report beneficiary information that relates only to a coverage, service feature or rider in the PID loop.

                  2. 5150 · NM1 · Individual or Organizational Name · Max 1 · Optional

                     To supply the full name of an individual or organizational entity

                  3. 5200 · N2 · Additional Name Information · Max 3 · Optional

                     To specify additional names

                  4. 5250 · N3 · Party Location · Max 3 · Optional

                     To specify the location of the named party

                  5. 5300 · N4 · Geographic Location · Max 1 · Optional

                     To specify the geographic place of the named party

                  6. 5350 · REF · Reference Information · Max >1 · Optional

                     To specify identifying information

                  7. 5400 · DTP · Date or Time or Period · Max >1 · Optional

                     To specify any or all of a date, a time, or a time period

                  8. 5450 · III · Information · Max >1 · Optional

                     To report information

                  9. 5500 · QTY · Quantity Information · Max >1 · Optional

                     To specify quantity information

                  10. 5520 · AMT · Monetary Amount Information · Max >1 · Optional

                      To indicate the total monetary amount

                  11. 5550 · LUI · Language Use · Max 1 · Optional

                      To specify language, type of usage, and proficiency or fluency

                  12. 5600 · MSG · Message Text · Max >1 · Optional

                      To provide a free-form format that allows the transmission of text information

          21. UC Loop Optional Repeat >1

              1. 5650 · UC · Underwriting Category · Max 1 · Mandatory

                 To identify the category of underwriting data being transmitted

                 The UC loop is used to report additional risk assessment information.

              2. HL Loop Optional Repeat >1

                 1. 5700 · HL · Hierarchical Level · Max 1 · Mandatory

                    To identify dependencies among and the content of hierarchically related groups of data segments

                    The HL segment is used to build the varying levels of detail that can be reported in the UC loop for different kinds of risk assessment information.

                 2. 5750 · UQS · Underwriting Question · Max 1 · Optional

                    To report information provider underwriting data in a question and answer format

                 3. 5800 · YNQ · Yes/No Question · Max >1 · Optional

                    To identify and answer yes and no questions, including the date, time, and comments further qualifying the condition

                    The YNQ segment is used to report answers to risk assessment questions.

                 4. 5850 · NM1 · Individual or Organizational Name · Max 1 · Optional

                    To supply the full name of an individual or organizational entity

                    The NM1 segment is used to identify parties related to risk assessment information.

                 5. 5900 · N3 · Party Location · Max 3 · Optional

                    To specify the location of the named party

                 6. 5950 · N4 · Geographic Location · Max 1 · Optional

                    To specify the geographic place of the named party

                 7. 6000 · COM · Communication Contact Information · Max 9 · Optional

                    To specify a communication contact number

                 8. 6050 · DTP · Date or Time or Period · Max >1 · Optional

                    To specify any or all of a date, a time, or a time period

                 9. 6100 · QTY · Quantity Information · Max >1 · Optional

                    To specify quantity information

                 10. 6150 · MSG · Message Text · Max >1 · Optional

                     To provide a free-form format that allows the transmission of text information

                 11. 6200 · AM1 · Informational Values · Max >1 · Optional

                     To specify a code and the amount or quantity or percentage associated with it

                 12. 6250 · AMT · Monetary Amount Information · Max >1 · Optional

                     To indicate the total monetary amount

                 13. 6300 · III · Information · Max >1 · Optional

                     To report information

                 14. 6350 · EC · Employment Class · Max 1 · Optional

                     To provide class of employment information

                 15. 6400 · EMS · Employment Position · Max 1 · Optional

                     To describe employment position

                 16. 6450 · EMP · Employer · Max 1 · Optional

                     To provide employment specifics

                 17. 6500 · PCT · Percent Amounts · Max >1 · Optional

                     To qualify percent amounts and supply percent amounts

                 18. 6550 · SOI · Source of Income · Max >1 · Optional

                     To define the source and related information about the income being reported

                 19. 6600 · LIN · Item Identification · Max 2 · Optional

                     To specify basic item identification data

                 20. 6650 · REF · Reference Information · Max >1 · Optional

                     To specify identifying information

                 21. 6700 · ASL · Asset Liability · Max >1 · Optional

                     To report financial information

                 22. 6750 · TOA · Type of Activity · Max >1 · Optional

                     To specify type of activity information

                 23. 6800 · TOV · Vehicle Use Information · Max >1 · Optional

                     To report usage of a vehicle

                 24. 6850 · VEH · Vehicle Information · Max >1 · Optional

                     To provide descriptions that identify a specific vehicle

                 25. 6900 · CDS · Case Description · Max >1 · Optional

                     To identify and describe a specific court case

                 26. 6950 · CED · Administration of Justice Event Description · Max >1 · Optional

                     To describe specific administration of justice events and actions

                 27. 7000 · SIN · Substance Use · Max >1 · Optional

                     To report use of tobacco, alcohol, drugs or other substances

                 28. 7050 · UCS · Underwriting Considerations · Max >1 · Optional

                     To report personal health and medical history data

                 29. 7100 · FH · Family History · Max >1 · Optional

                     To report information about a person's family health history

                 30. 7150 · SPA · Status of Product or Activity · Max 1 · Optional

                     To indicate the details and status of a product or product activity

                 31. 7200 · MPI · Military Personnel Information · Max 1 · Optional

                     To report military service data

      19. PWK Loop Optional Repeat >1

          1. 7250 · PWK · Paperwork · Max 1 · Mandatory

             To identify the type or transmission or both of paperwork or supporting information

             The PWK segment is used to report status and disposition of required forms.

          2. 7300 · NM1 · Individual or Organizational Name · Max 1 · Optional

             To supply the full name of an individual or organizational entity

             The NM1 segment identifies the person completing or signing a form.

          3. 7350 · N4 · Geographic Location · Max 1 · Optional

             To specify the geographic place of the named party

          4. 7400 · REF · Reference Information · Max >1 · Optional

             To specify identifying information

          5. 7450 · DTP · Date or Time or Period · Max >1 · Optional

             To specify any or all of a date, a time, or a time period

          6. 7500 · SPA · Status of Product or Activity · Max 1 · Optional

             To indicate the details and status of a product or product activity

          7. EFI Loop Optional Repeat >1

             1. 7550 · EFI · Electronic Format Identification · Max 1 · Mandatory

                To provide basic information about the electronic format of the interchange data

                The EFI loop is used to transmit images of required forms and signatures.

             2. 7600 · BIN · Binary Data Segment · Max 1 · Mandatory

                To transfer binary data in a single data segment and allow identification of the end of the data segment through a count; there is no identification of the internal structure of the binary data in this segment

      20. LX Loop Optional Repeat >1

          1. 7650 · LX · Transaction Set Line Number · Max 1 · Mandatory

             To reference a line number in a transaction set

             The LX loop is used to report payments made with the application or in the future.

          2. PDL Loop Optional Repeat >1

             1. 7700 · PDL · Payment Details · Max 1 · Mandatory

                To transmit information required to establish payment or remittance activity

             2. 7750 · REF · Reference Information · Max >1 · Optional

                To specify identifying information

             3. 7780 · LS · Loop Header · Max 1 · Optional

                To indicate that the next segment begins a loop

             4. AMT Loop Optional Repeat >1

                1. 7800 · AMT · Monetary Amount Information · Max 1 · Mandatory

                   To indicate the total monetary amount

                2. 7850 · N1 · Party Identification · Max 1 · Optional

                   To identify a party by type of organization, name, and code

                   The N1 segment is used to identify payees or payers.

                3. 7900 · N3 · Party Location · Max 2 · Optional

                   To specify the location of the named party

                4. 7950 · N4 · Geographic Location · Max 1 · Optional

                   To specify the geographic place of the named party

                5. 8000 · LIN · Item Identification · Max 2 · Optional

                   To specify basic item identification data

                6. 8050 · DTP · Date or Time or Period · Max >1 · Optional

                   To specify any or all of a date, a time, or a time period

                7. 8100 · QTY · Quantity Information · Max >1 · Optional

                   To specify quantity information

                8. 8150 · MSG · Message Text · Max >1 · Optional

                   To provide a free-form format that allows the transmission of text information

                9. AM1 Loop Optional Repeat >1

                   1. 8155 · AM1 · Informational Values · Max 1 · Mandatory

                      To specify a code and the amount or quantity or percentage associated with it

                      The AM1 loop is used to report tax status of payment subtotals.

                   2. INV Loop Optional Repeat >1

                      1. 8160 · INV · Investment Vehicle Selection · Max 1 · Mandatory

                         To specify type of investment vehicle or account and other basic data about the investment

                      2. 8165 · QTY · Quantity Information · Max >1 · Optional

                         To specify quantity information

                      3. 8170 · DTP · Date or Time or Period · Max >1 · Optional

                         To specify any or all of a date, a time, or a time period

                      4. 8175 · RPA · Rate Amounts or Percents · Max >1 · Optional

                         To identify rate amounts or percents for a specific cost or other line item

             5. 8190 · LE · Loop Trailer · Max 1 · Optional

                To indicate that the loop immediately preceding this segment is complete

      21. K2 Loop Optional Repeat >1

          1. 8200 · K2 · Administrative Message · Max 1 · Mandatory

             To transmit information in a free-form format for comment or special instruction

          2. 8250 · DTP · Date or Time or Period · Max 1 · Optional

             To specify any or all of a date, a time, or a time period

          3. 8300 · NM1 · Individual or Organizational Name · Max 1 · Optional

             To supply the full name of an individual or organizational entity

             The NM1 segment identifies the originator of the administrative message.

2. 8350 · SE · Transaction Set Trailer · Max 1 · Mandatory

   To indicate the end of the transaction set and provide the count of the transmitted segments (including the beginning (ST) and ending (SE) segments)