Source Code 1994 March/Source_Code_CD-ROM_Walnut_Creek_March_1994.iso/win3/programr/vbasic/insure2.exe/FORM2.FRM

Visual Basic Form | 1993-07-22 | 20.8 KB | 589 lines

VERSION 2.00
Begin Form Form2
   BackColor       =   &H00C0C0C0&
   BorderStyle     =   3  'Fixed Double
   Caption         =   "Insurance Application - Page 2"
   ClientHeight    =   6795
   ClientLeft      =   1020
   ClientTop       =   1485
   ClientWidth     =   7995
   ControlBox      =   0   'False
   Height          =   7200
   Icon            =   FORM2.FRX:0000
   Left            =   960
   LinkMode        =   1  'Source
   LinkTopic       =   "Form2"
   MaxButton       =   0   'False
   MinButton       =   0   'False
   ScaleHeight     =   6795
   ScaleWidth      =   7995
   Top             =   1140
   Width           =   8115
   Begin SSPanel Panel3D1
      Alignment       =   7  'Center - MIDDLE
      AutoSize        =   0  'None
      BackColor       =   &H00C0C0C0&
      BevelInner      =   1  'Inset
      BevelOuter      =   0  'None
      BevelWidth      =   3
      BorderWidth     =   3
      FloodColor      =   &H00FF0000&
      FloodShowPct    =   -1  'True
      FloodType       =   0  'None
      Font3D          =   2  'Raised w/heavy shading
      ForeColor       =   &H00000000&
      Height          =   1155
      Left            =   180
      Outline         =   0   'False
      RoundedCorners  =   -1  'True
      ShadowColor     =   0  'Dark Grey
      TabIndex        =   26
      Top             =   5640
      Width           =   4335
      Begin SSCommand Command3D4
         AutoSize        =   0  'None
         BevelWidth      =   2
         Caption         =   "Erase Signature"
         Font3D          =   3  'Inset w/light shading
         ForeColor       =   &H00000000&
         Height          =   855
         Left            =   2295
         Outline         =   -1  'True
         Picture         =   FORM2.FRX:0302
         RoundedCorners  =   -1  'True
         TabIndex        =   9
         Top             =   165
         Width           =   1845
      End
      Begin SSCommand Command3D3
         AutoSize        =   0  'None
         BevelWidth      =   2
         Caption         =   "Return To First Page"
         Font3D          =   3  'Inset w/light shading
         ForeColor       =   &H00000000&
         Height          =   855
         Left            =   255
         Outline         =   -1  'True
         Picture         =   FORM2.FRX:0604
         RoundedCorners  =   -1  'True
         TabIndex        =   8
         Top             =   165
         Width           =   1875
      End
   End
   Begin SSFrame Frame3D11
      Alignment       =   0  'Left Justify
      Caption         =   "Signature"
      Font3D          =   1  'Raised w/light shading
      FontBold        =   -1  'True
      FontItalic      =   0   'False
      FontName        =   "Arial"
      FontSize        =   8.25
      FontStrikethru  =   0   'False
      FontUnderline   =   0   'False
      ForeColor       =   &H00000000&
      Height          =   1155
      Left            =   4695
      ShadowColor     =   0  'Dark Grey
      ShadowStyle     =   1  'Raised
      TabIndex        =   25
      Top             =   5595
      Width           =   4710
      Begin VHedit HEdit1
         BackColor       =   &H00FFFFFF&
         DelayRecog      =   -1  'True
         Height          =   825
         InflateBottom   =   400
         InflateLeft     =   270
         InflateRight    =   270
         InflateTop      =   400
         InkColor        =   &H00000000&
         Left            =   45
         TabIndex        =   24
         Top             =   240
         Version         =   268435458
         Width           =   4620
      End
   End
   Begin SSFrame Frame3D12
      Alignment       =   0  'Left Justify
      Caption         =   "Additional Information"
      Font3D          =   1  'Raised w/light shading
      FontBold        =   -1  'True
      FontItalic      =   0   'False
      FontName        =   "Arial"
      FontSize        =   8.25
      FontStrikethru  =   0   'False
      FontUnderline   =   0   'False
      ForeColor       =   &H00000000&
      Height          =   4080
      Left            =   240
      ShadowColor     =   0  'Dark Grey
      ShadowStyle     =   1  'Raised
      TabIndex        =   1
      Top             =   210
      Width           =   9090
      Begin SSFrame Frame3D5
         Alignment       =   0  'Left Justify
         Font3D          =   0  'None
         ForeColor       =   &H00000000&
         Height          =   495
         Left            =   7485
         ShadowColor     =   0  'Dark Grey
         ShadowStyle     =   0  'Inset
         TabIndex        =   34
         Top             =   3405
         Width           =   1500
         Begin SSOption Option3D9
            Alignment       =   0  'Text to the Right
            Caption         =   "No"
            Font3D          =   0  'None
            ForeColor       =   &H00000000&
            Height          =   300
            Left            =   855
            TabIndex        =   23
            Top             =   150
            Value           =   0   'False
            Width           =   525
         End
         Begin SSOption Option3D10
            Alignment       =   0  'Text to the Right
            Caption         =   "Yes"
            Font3D          =   0  'None
            ForeColor       =   &H00000000&
            Height          =   315
            Left            =   135
            TabIndex        =   22
            Top             =   120
            Value           =   0   'False
            Width           =   645
         End
      End
      Begin SSFrame Frame3D4
         Alignment       =   0  'Left Justify
         Font3D          =   0  'None
         ForeColor       =   &H00000000&
         Height          =   495
         Left            =   7485
         ShadowColor     =   0  'Dark Grey
         ShadowStyle     =   0  'Inset
         TabIndex        =   33
         Top             =   2835
         Width           =   1500
         Begin SSOption Option3D7
            Alignment       =   0  'Text to the Right
            Caption         =   "No"
            Font3D          =   0  'None
            ForeColor       =   &H00000000&
            Height          =   300
            Left            =   855
            TabIndex        =   21
            Top             =   150
            Value           =   0   'False
            Width           =   525
         End
         Begin SSOption Option3D8
            Alignment       =   0  'Text to the Right
            Caption         =   "Yes"
            Font3D          =   0  'None
            ForeColor       =   &H00000000&
            Height          =   315
            Left            =   120
            TabIndex        =   20
            Top             =   135
            Value           =   0   'False
            Width           =   645
         End
      End
      Begin SSFrame Frame3D3
         Alignment       =   0  'Left Justify
         Font3D          =   0  'None
         ForeColor       =   &H00000000&
         Height          =   495
         Left            =   7485
         ShadowColor     =   0  'Dark Grey
         ShadowStyle     =   0  'Inset
         TabIndex        =   32
         Top             =   2280
         Width           =   1500
         Begin SSOption Option3D5
            Alignment       =   0  'Text to the Right
            Caption         =   "No"
            Font3D          =   0  'None
            ForeColor       =   &H00000000&
            Height          =   300
            Left            =   855
            TabIndex        =   19
            Top             =   150
            Value           =   0   'False
            Width           =   525
         End
         Begin SSOption Option3D6
            Alignment       =   0  'Text to the Right
            Caption         =   "Yes"
            Font3D          =   0  'None
            ForeColor       =   &H00000000&
            Height          =   315
            Left            =   120
            TabIndex        =   18
            Top             =   135
            Value           =   0   'False
            Width           =   645
         End
      End
      Begin SSFrame Frame3D2
         Alignment       =   0  'Left Justify
         Font3D          =   0  'None
         ForeColor       =   &H00000000&
         Height          =   495
         Left            =   7485
         ShadowColor     =   0  'Dark Grey
         ShadowStyle     =   0  'Inset
         TabIndex        =   30
         Top             =   1740
         Width           =   1500
         Begin SSOption Option3D4
            Alignment       =   0  'Text to the Right
            Caption         =   "No"
            Font3D          =   0  'None
            ForeColor       =   &H00000000&
            Height          =   300
            Left            =   855
            TabIndex        =   17
            Top             =   150
            Value           =   0   'False
            Width           =   525
         End
         Begin SSOption Option3D3
            Alignment       =   0  'Text to the Right
            Caption         =   "Yes"
            Font3D          =   0  'None
            ForeColor       =   &H00000000&
            Height          =   315
            Left            =   120
            TabIndex        =   16
            Top             =   135
            Value           =   0   'False
            Width           =   645
         End
      End
      Begin SSFrame Frame3D1
         Alignment       =   0  'Left Justify
         Font3D          =   0  'None
         ForeColor       =   &H00000000&
         Height          =   495
         Left            =   7485
         ShadowColor     =   0  'Dark Grey
         ShadowStyle     =   0  'Inset
         TabIndex        =   29
         Top             =   1200
         Width           =   1500
         Begin SSOption Option3D2
            Alignment       =   0  'Text to the Right
            Caption         =   "No"
            Font3D          =   0  'None
            ForeColor       =   &H00000000&
            Height          =   300
            Left            =   855
            TabIndex        =   15
            Top             =   150
            Value           =   0   'False
            Width           =   525
         End
         Begin SSOption Option3D1
            Alignment       =   0  'Text to the Right
            Caption         =   "Yes"
            Font3D          =   0  'None
            ForeColor       =   &H00000000&
            Height          =   315
            Left            =   120
            TabIndex        =   14
            Top             =   135
            Value           =   0   'False
            Width           =   645
         End
      End
      Begin SSFrame Frame3D9
         Alignment       =   0  'Left Justify
         Font3D          =   0  'None
         ForeColor       =   &H00000000&
         Height          =   495
         Left            =   7485
         ShadowColor     =   0  'Dark Grey
         ShadowStyle     =   0  'Inset
         TabIndex        =   28
         Top             =   690
         Width           =   1500
         Begin SSOption Option3D16
            Alignment       =   0  'Text to the Right
            Caption         =   "No"
            Font3D          =   0  'None
            ForeColor       =   &H00000000&
            Height          =   300
            Left            =   855
            TabIndex        =   13
            Top             =   150
            Value           =   0   'False
            Width           =   525
         End
         Begin SSOption Option3D15
            Alignment       =   0  'Text to the Right
            Caption         =   "Yes"
            Font3D          =   0  'None
            ForeColor       =   &H00000000&
            Height          =   315
            Left            =   120
            TabIndex        =   12
            Top             =   135
            Value           =   0   'False
            Width           =   645
         End
      End
      Begin SSFrame Frame3D13
         Alignment       =   0  'Left Justify
         Font3D          =   0  'None
         ForeColor       =   &H00000000&
         Height          =   495
         Left            =   7485
         ShadowColor     =   0  'Dark Grey
         ShadowStyle     =   0  'Inset
         TabIndex        =   27
         Top             =   150
         Width           =   1500
         Begin SSOption Option3D20
            Alignment       =   0  'Text to the Right
            Caption         =   "No"
            Font3D          =   0  'None
            ForeColor       =   &H00000000&
            Height          =   300
            Left            =   840
            TabIndex        =   11
            Top             =   135
            Value           =   0   'False
            Width           =   525
         End
         Begin SSOption Option3D11
            Alignment       =   0  'Text to the Right
            Caption         =   "Yes"
            Font3D          =   0  'None
            ForeColor       =   &H00000000&
            Height          =   315
            Left            =   105
            TabIndex        =   10
            Top             =   150
            Value           =   0   'False
            Width           =   645
         End
      End
      Begin Label Label8
         BackColor       =   &H00C0C0C0&
         Caption         =   "
 been involved as a driver in 2 or more auto accidents?"
         FontBold        =   -1  'True
         FontItalic      =   0   'False
         FontName        =   "Arial"
         FontSize        =   8.25
         FontStrikethru  =   0   'False
         FontUnderline   =   0   'False
         Height          =   210
         Left            =   465
         TabIndex        =   31
         Top             =   3645
         Width           =   4830
      End
      Begin Label Label7
         BackColor       =   &H00C0C0C0&
         Caption         =   "
 convicted of or cited for driving under the influence of alcohol or drugs?"
         FontBold        =   -1  'True
         FontItalic      =   0   'False
         FontName        =   "Arial"
         FontSize        =   8.25
         FontStrikethru  =   0   'False
         FontUnderline   =   0   'False
         Height          =   210
         Left            =   465
         TabIndex        =   2
         Top             =   3060
         Width           =   6315
      End
      Begin Label Label6
         BackColor       =   &H00C0C0C0&
         Caption         =   "
 had a driver's license suspended or revoked?"
         FontBold        =   -1  'True
         FontItalic      =   0   'False
         FontName        =   "Arial"
         FontSize        =   8.25
         FontStrikethru  =   0   'False
         FontUnderline   =   0   'False
         Height          =   210
         Left            =   465
         TabIndex        =   3
         Top             =   2535
         Width           =   4065
      End
      Begin Label Label5
         BackColor       =   &H00C0C0C0&
         Caption         =   "Have you ever in the last 3 years:"
         FontBold        =   -1  'True
         FontItalic      =   0   'False
         FontName        =   "Arial"
         FontSize        =   8.25
         FontStrikethru  =   0   'False
         FontUnderline   =   0   'False
         Height          =   225
         Left            =   165
         TabIndex        =   4
         Top             =   2295
         Width           =   2925
      End
      Begin Label Label1
         BackColor       =   &H00C0C0C0&
         Caption         =   "Are you applying for or requesting reinstatement or policy change(s) of any other life or health insurance?"
         FontBold        =   -1  'True
         FontItalic      =   0   'False
         FontName        =   "Arial"
         FontSize        =   8.25
         FontStrikethru  =   0   'False
         FontUnderline   =   0   'False
         Height          =   390
         Left            =   180
         TabIndex        =   5
         Top             =   1770
         Width           =   6465
      End
      Begin Label Label3
         BackColor       =   &H00C0C0C0&
         Caption         =   "Do you plan to live or travel outside the United States and Canada within the next 12 months?"
         FontBold        =   -1  'True
         FontItalic      =   0   'False
         FontName        =   "Arial"
         FontSize        =   8.25
         FontStrikethru  =   0   'False
         FontUnderline   =   0   'False
         Height          =   420
         Left            =   195
         TabIndex        =   6
         Top             =   1275
         Width           =   6735
      End
      Begin Label Label2
         BackColor       =   &H00C0C0C0&
         Caption         =   "Have you been convicted of or currently been charged with the commission of any criminal offense, other than the violation of a motor vehicle law?"
         FontBold        =   -1  'True
         FontItalic      =   0   'False
         FontName        =   "Arial"
         FontSize        =   8.25
         FontStrikethru  =   0   'False
         FontUnderline   =   0   'False
         Height          =   420
         Left            =   180
         TabIndex        =   0
         Top             =   765
         Width           =   6735
      End
      Begin Label Label4
         BackColor       =   &H00C0C0C0&
         Caption         =   "Have you ever used or plan to use tobacco or any other nicotine products?"
         FontBold        =   -1  'True
         FontItalic      =   0   'False
         FontName        =   "Arial"
         FontSize        =   8.25
         FontStrikethru  =   0   'False
         FontUnderline   =   0   'False
         Height          =   240
         Left            =   180
         TabIndex        =   7
         Top             =   390
         Width           =   6465
      End
   End
   Begin Label Label12
      BackColor       =   &H00C0C0C0&
      Caption         =   "Date:"
      FontBold        =   -1  'True
      FontItalic      =   0   'False
      FontName        =   "Arial"
      FontSize        =   8.25
      FontStrikethru  =   0   'False
      FontUnderline   =   0   'False
      Height          =   225
      Left            =   7980
      TabIndex        =   38
      Top             =   5430
      Width           =   1380
   End
   Begin Label Label11
      BackColor       =   &H00C0C0C0&
      Caption         =   "
 agree to the Terms and Conditions of the policy and understand that coverage could be invalidated if any information in the application is materially misrepresented."
      FontBold        =   -1  'True
      FontItalic      =   -1  'True
      FontName        =   "Arial"
      FontSize        =   8.25
      FontStrikethru  =   0   'False
      FontUnderline   =   0   'False
      Height          =   465
      Left            =   240
      TabIndex        =   37
      Top             =   5025
      Width           =   9075
   End
   Begin Label Label10
      BackColor       =   &H00C0C0C0&
      Caption         =   "
 certify that to the best of my knowledge and belief the statements in this application are complete, true and correctly recorded;"
      FontBold        =   -1  'True
      FontItalic      =   -1  'True
      FontName        =   "Arial"
      FontSize        =   8.25
      FontStrikethru  =   0   'False
      FontUnderline   =   0   'False
      Height          =   420
      Left            =   240
      TabIndex        =   36
      Top             =   4635
      Width           =   9075
   End
   Begin Label Label9
      BackColor       =   &H00C0C0C0&
      Caption         =   "By signing below I:"
      FontBold        =   -1  'True
      FontItalic      =   -1  'True
      FontName        =   "Arial"
      FontSize        =   8.25
      FontStrikethru  =   0   'False
      FontUnderline   =   0   'False
      Height          =   210
      Left            =   240
      TabIndex        =   35
      Top             =   4380
      Width           =   1575
   End
Sub Command1_Click ()
form2.Hide
form1.Show
End Sub
Sub Command3D1_Click ()
form2.Hide
form1.Show
End Sub
Sub Command3D3_Click ()
form1.Show
form2.Hide
End Sub
Sub Command3D4_Click ()
form2.HEdit1.EraseInk = True
End Sub
Sub Form_Load ()
form2.WindowState = 2
label12.Caption = "Date: " + Date$
End Sub
Sub Form_Unload (Cancel As Integer)
HEdit1.EraseInk = True
End Sub
Sub HEdit1_Change ()
Rem report.HEdit1.text = form2.HEdit1.text
End Sub