To identify details of previous insurance losses
| Position | Element | Name | Type | Min/Max | Repeat | |
|---|---|---|---|---|---|---|
| 1 | 554 | Assigned Number | Mandatory | Number | 1/6 | 1 |
| 2 | 1073 | Yes/No Condition or Response Code | Opt | ID | 1/1 | 1 |
| 3 | 127 | Reference Identification | Opt | Alphanumeric | 1/80 | 1 |
| 4 | 93 | Name | Opt | Alphanumeric | 1/60 | 1 |
| 5 | 1250 | Date Time Period Format Qualifier | Rel | ID | 2/3 | 1 |
| 6 | 1251 | Date Time Period | Rel | Alphanumeric | 1/35 | 1 |
| 7 | 1271 | Industry Code | Opt | Alphanumeric | 1/30 | 1 |