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- VERSION 2.00
- Begin Form Form1
- BackColor = &H00C0C0C0&
- BorderStyle = 3 'Fixed Double
- Caption = "Application for Life Insurance"
- ClientHeight = 6315
- ClientLeft = 1185
- ClientTop = 1425
- ClientWidth = 7590
- ControlBox = 0 'False
- ForeColor = &H00000000&
- Height = 6720
- Left = 1125
- LinkMode = 1 'Source
- LinkTopic = "Form1"
- MaxButton = 0 'False
- MinButton = 0 'False
- ScaleHeight = 6315
- ScaleWidth = 7590
- Top = 1080
- Width = 7710
- Begin SSPanel Panel3D2
- 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 = 1140
- Left = 330
- Outline = 0 'False
- RoundedCorners = -1 'True
- ShadowColor = 0 'Dark Grey
- TabIndex = 17
- Top = 5730
- Width = 9000
- Begin SSCommand Command3D2
- AutoSize = 0 'None
- BevelWidth = 2
- Caption = "Load Form"
- Font3D = 3 'Inset w/light shading
- ForeColor = &H00000000&
- Height = 870
- Left = 7185
- Outline = -1 'True
- Picture = INSURED.FRX:0000
- RoundedCorners = -1 'True
- TabIndex = 41
- Top = 135
- Width = 1575
- End
- Begin SSCommand Command3D6
- AutoSize = 0 'None
- BevelWidth = 2
- Caption = "Save Form"
- Font3D = 3 'Inset w/light shading
- ForeColor = &H00000000&
- Height = 870
- Left = 5445
- Outline = -1 'True
- Picture = INSURED.FRX:0302
- RoundedCorners = -1 'True
- TabIndex = 7
- Top = 135
- Width = 1575
- End
- Begin SSCommand Command3D5
- AutoSize = 0 'None
- BevelWidth = 2
- Caption = "Report"
- Font3D = 3 'Inset w/light shading
- ForeColor = &H00000000&
- Height = 870
- Left = 3720
- Outline = -1 'True
- Picture = INSURED.FRX:0604
- RoundedCorners = -1 'True
- TabIndex = 6
- Top = 135
- Width = 1575
- End
- Begin SSCommand Command3D4
- AutoSize = 1 'Adjust Picture Size To Button
- BevelWidth = 2
- Caption = "Medical History"
- Font3D = 3 'Inset w/light shading
- ForeColor = &H00000000&
- Height = 870
- Left = 1980
- Outline = -1 'True
- Picture = INSURED.FRX:0906
- RoundedCorners = -1 'True
- TabIndex = 5
- Top = 135
- Width = 1575
- End
- Begin SSCommand Command3D1
- AutoSize = 1 'Adjust Picture Size To Button
- BevelWidth = 2
- Caption = "Page 2"
- Font3D = 3 'Inset w/light shading
- ForeColor = &H00000000&
- Height = 870
- Left = 270
- Outline = -1 'True
- Picture = INSURED.FRX:0C08
- RoundedCorners = -1 'True
- TabIndex = 31
- Top = 135
- Width = 1575
- End
- End
- Begin SSFrame Frame3D2
- Alignment = 0 'Left Justify
- Caption = "2. Plan."
- Font3D = 1 'Raised w/light shading
- ForeColor = &H00000000&
- Height = 1215
- Left = 360
- ShadowColor = 0 'Dark Grey
- ShadowStyle = 0 'Inset
- TabIndex = 0
- Top = 4485
- Width = 8895
- Begin ComboBox Combo3
- BackColor = &H00C0C0C0&
- FontBold = -1 'True
- FontItalic = 0 'False
- FontName = "MS Sans Serif"
- FontSize = 13.5
- FontStrikethru = 0 'False
- FontUnderline = 0 'False
- Height = 480
- Left = 360
- TabIndex = 28
- Top = 540
- Width = 4575
- End
- Begin SSFrame Frame3D3
- Alignment = 0 'Left Justify
- Caption = "Amount to Insure"
- Font3D = 0 'None
- ForeColor = &H00000000&
- Height = 840
- Left = 5295
- ShadowColor = 0 'Dark Grey
- ShadowStyle = 1 'Raised
- TabIndex = 8
- Top = 195
- Width = 3360
- Begin VBedit BEdit8
- BackColor = &H00C0C0C0&
- CellHeight = 480
- CellWidth = 360
- CharSet = 16388
- CombBaseLine = 390
- CombEndHeight = 120
- CombEndMarker = 0 'False
- CombHeight = 60
- FontBold = -1 'True
- FontItalic = 0 'False
- FontName = "MS Sans Serif"
- FontSize = 18
- FontStrikethru = 0 'False
- FontUnderline = 0 'False
- Height = 495
- InflateBottom = 180
- InflateLeft = 180
- InflateRight = 180
- InflateTop = 240
- Left = 1695
- TabIndex = 4
- Top = 300
- Version = 268435458
- Width = 1335
- End
- Begin VBedit BEdit7
- BackColor = &H00C0C0C0&
- CellHeight = 480
- CellWidth = 360
- CharSet = 16388
- CombBaseLine = 390
- CombEndHeight = 120
- CombEndMarker = 0 'False
- CombHeight = 60
- FontBold = -1 'True
- FontItalic = 0 'False
- FontName = "MS Sans Serif"
- FontSize = 18
- FontStrikethru = 0 'False
- FontUnderline = 0 'False
- Height = 495
- InflateBottom = 180
- InflateLeft = 180
- InflateRight = 180
- InflateTop = 240
- Left = 360
- TabIndex = 3
- Top = 300
- Version = 268435458
- Width = 1335
- End
- Begin Label Label12
- BackColor = &H00C0C0C0&
- Caption = ","
- FontBold = -1 'True
- FontItalic = 0 'False
- FontName = "MS Sans Serif"
- FontSize = 24
- FontStrikethru = 0 'False
- FontUnderline = 0 'False
- Height = 525
- Left = 1590
- TabIndex = 19
- Top = 270
- Width = 105
- End
- Begin Label Label11
- BackColor = &H00C0C0C0&
- Caption = "$"
- FontBold = -1 'True
- FontItalic = 0 'False
- FontName = "MS Sans Serif"
- FontSize = 18
- FontStrikethru = 0 'False
- FontUnderline = 0 'False
- Height = 375
- Left = 165
- TabIndex = 15
- Top = 315
- Width = 255
- End
- End
- Begin Label Label7
- BackColor = &H00C0C0C0&
- Caption = "a. Type of Policy"
- Height = 255
- Left = 360
- TabIndex = 16
- Top = 225
- Width = 2895
- End
- End
- Begin SSFrame Frame3D1
- Alignment = 0 'Left Justify
- Caption = "1. Primary Proposed Insured."
- Font3D = 1 'Raised w/light shading
- ForeColor = &H00000000&
- Height = 3825
- Left = 360
- ShadowColor = 0 'Dark Grey
- ShadowStyle = 0 'Inset
- TabIndex = 9
- Top = 675
- Width = 8895
- Begin ComboBox Combo2
- BackColor = &H00C0C0C0&
- FontBold = -1 'True
- FontItalic = 0 'False
- FontName = "MS Sans Serif"
- FontSize = 13.5
- FontStrikethru = 0 'False
- FontUnderline = 0 'False
- Height = 480
- Left = 5580
- TabIndex = 21
- Top = 3180
- Width = 1035
- End
- Begin ComboBox Combo1
- BackColor = &H00C0C0C0&
- FontBold = -1 'True
- FontItalic = 0 'False
- FontName = "MS Sans Serif"
- FontSize = 13.5
- FontStrikethru = 0 'False
- FontUnderline = 0 'False
- Height = 480
- Left = 3705
- TabIndex = 20
- Top = 3150
- Width = 1035
- End
- Begin Frame Frame1
- BackColor = &H00C0C0C0&
- Caption = "d. Date of Birth"
- Height = 750
- Left = 360
- TabIndex = 22
- Top = 2940
- Width = 2805
- Begin VBedit BEdit3
- BackColor = &H00C0C0C0&
- CellHeight = 480
- CellWidth = 360
- CharSet = 16388
- CombBaseLine = 390
- CombEndHeight = 120
- CombEndMarker = 0 'False
- CombHeight = 60
- FontBold = -1 'True
- FontItalic = 0 'False
- FontName = "MS Sans Serif"
- FontSize = 18
- FontStrikethru = 0 'False
- FontUnderline = 0 'False
- Height = 495
- InflateBottom = 180
- InflateLeft = 180
- InflateRight = 180
- InflateTop = 240
- Left = 1935
- TabIndex = 27
- Top = 240
- Version = 268435458
- Width = 780
- End
- Begin VBedit BEdit2
- BackColor = &H00C0C0C0&
- CellHeight = 480
- CellWidth = 360
- CharSet = 16388
- CombBaseLine = 390
- CombEndHeight = 120
- CombEndMarker = 0 'False
- CombHeight = 60
- FontBold = -1 'True
- FontItalic = 0 'False
- FontName = "MS Sans Serif"
- FontSize = 18
- FontStrikethru = 0 'False
- FontUnderline = 0 'False
- Height = 495
- InflateBottom = 180
- InflateLeft = 180
- InflateRight = 180
- InflateTop = 240
- Left = 1005
- TabIndex = 26
- Top = 240
- Version = 268435458
- Width = 780
- End
- Begin VBedit BEdit5
- BackColor = &H00C0C0C0&
- CellHeight = 480
- CellWidth = 360
- CharSet = 16388
- CombBaseLine = 390
- CombEndHeight = 120
- CombEndMarker = 0 'False
- CombHeight = 60
- FontBold = -1 'True
- FontItalic = 0 'False
- FontName = "MS Sans Serif"
- FontSize = 18
- FontStrikethru = 0 'False
- FontUnderline = 0 'False
- Height = 495
- InflateBottom = 180
- InflateLeft = 180
- InflateRight = 180
- InflateTop = 240
- Left = 60
- TabIndex = 23
- Top = 240
- Version = 268435458
- Width = 780
- End
- Begin Label Label8
- BackColor = &H00C0C0C0&
- Caption = "/"
- FontBold = -1 'True
- FontItalic = 0 'False
- FontName = "MS Sans Serif"
- FontSize = 24
- FontStrikethru = 0 'False
- FontUnderline = 0 'False
- Height = 480
- Left = 1800
- TabIndex = 25
- Top = 225
- Width = 180
- End
- Begin Label Label4
- BackColor = &H00C0C0C0&
- Caption = "/"
- FontBold = -1 'True
- FontItalic = 0 'False
- FontName = "MS Sans Serif"
- FontSize = 24
- FontStrikethru = 0 'False
- FontUnderline = 0 'False
- Height = 480
- Left = 855
- TabIndex = 24
- Top = 225
- Width = 180
- End
- End
- Begin VHedit HEdit2
- BackColor = &H00C0C0C0&
- DelayRecog = -1 'True
- FontBold = -1 'True
- FontItalic = 0 'False
- FontName = "MS Sans Serif"
- FontSize = 13.5
- FontStrikethru = 0 'False
- FontUnderline = 0 'False
- Height = 735
- InflateBottom = 270
- InflateLeft = 270
- InflateRight = 270
- InflateTop = 270
- Left = 360
- TabIndex = 2
- Top = 2040
- Version = 268435458
- Width = 8175
- End
- Begin SSFrame Frame3D5
- Alignment = 0 'Left Justify
- Caption = "Marital Status"
- Font3D = 0 'None
- ForeColor = &H00000000&
- Height = 555
- Left = 1635
- ShadowColor = 0 'Dark Grey
- ShadowStyle = 1 'Raised
- TabIndex = 35
- Top = 1125
- Width = 6885
- Begin SSOption Option3D3
- Alignment = 0 'Text to the Right
- Caption = "Widowed"
- Font3D = 0 'None
- ForeColor = &H00000000&
- Height = 255
- Left = 5550
- TabIndex = 38
- Top = 225
- Value = 0 'False
- Width = 1080
- End
- Begin SSOption Option3D4
- Alignment = 0 'Text to the Right
- Caption = "Separated"
- Font3D = 0 'None
- ForeColor = &H00000000&
- Height = 255
- Left = 4035
- TabIndex = 39
- Top = 225
- Value = 0 'False
- Width = 1155
- End
- Begin SSOption Option3D7
- Alignment = 0 'Text to the Right
- Caption = "Divorced"
- Font3D = 0 'None
- ForeColor = &H00000000&
- Height = 255
- Left = 2730
- TabIndex = 40
- Top = 240
- Value = 0 'False
- Width = 1050
- End
- Begin SSOption Option3D1
- Alignment = 0 'Text to the Right
- Caption = "Married"
- Font3D = 0 'None
- ForeColor = &H00000000&
- Height = 255
- Left = 1455
- TabIndex = 36
- Top = 255
- Value = 0 'False
- Width = 930
- End
- Begin SSOption Option3D2
- Alignment = 0 'Text to the Right
- Caption = "Single"
- Font3D = 0 'None
- ForeColor = &H00000000&
- Height = 255
- Left = 225
- TabIndex = 37
- Top = 240
- Value = 0 'False
- Width = 810
- End
- End
- Begin SSFrame Frame3D4
- Alignment = 0 'Left Justify
- Caption = "Sex"
- Font3D = 0 'None
- ForeColor = &H00000000&
- Height = 555
- Left = 360
- ShadowColor = 0 'Dark Grey
- ShadowStyle = 1 'Raised
- TabIndex = 32
- Top = 1125
- Width = 1080
- Begin SSOption Option3D6
- Alignment = 0 'Text to the Right
- Caption = "F"
- Font3D = 0 'None
- ForeColor = &H00000000&
- Height = 255
- Left = 615
- TabIndex = 34
- Top = 240
- Value = 0 'False
- Width = 390
- End
- Begin SSOption Option3D5
- Alignment = 0 'Text to the Right
- Caption = "M"
- Font3D = 0 'None
- ForeColor = &H00000000&
- Height = 255
- Left = 150
- TabIndex = 33
- Top = 240
- Value = 0 'False
- Width = 435
- End
- End
- Begin VBedit BEdit1
- BackColor = &H00C0C0C0&
- CellHeight = 480
- CellWidth = 360
- CharSet = 16651
- CombBaseLine = 480
- CombEndHeight = 120
- CombHeight = 60
- FontBold = -1 'True
- FontItalic = 0 'False
- FontName = "MS Sans Serif"
- FontSize = 18
- FontStrikethru = 0 'False
- FontUnderline = 0 'False
- Height = 495
- InflateBottom = 180
- InflateLeft = 180
- InflateRight = 180
- InflateTop = 240
- Left = 240
- TabIndex = 1
- Top = 480
- Version = 268435458
- Width = 8415
- End
- Begin Label Label10
- BackColor = &H00C0C0C0&
- Caption = "00283-A"
- FontBold = -1 'True
- FontItalic = 0 'False
- FontName = "MS Sans Serif"
- FontSize = 13.5
- FontStrikethru = 0 'False
- FontUnderline = 0 'False
- Height = 345
- Left = 7200
- TabIndex = 30
- Top = 3165
- Width = 1185
- End
- Begin Label Label9
- BackColor = &H00C0C0C0&
- Caption = "Policy Number:"
- Height = 210
- Left = 7155
- TabIndex = 29
- Top = 2940
- Width = 1335
- End
- Begin Label Label5
- BackColor = &H00C0C0C0&
- Caption = "f. State of Residence"
- Height = 255
- Left = 5010
- TabIndex = 13
- Top = 2835
- Width = 1845
- End
- Begin Label Label6
- BackColor = &H00C0C0C0&
- Caption = "e. State of Birth"
- Height = 255
- Left = 3390
- TabIndex = 14
- Top = 2835
- Width = 1365
- End
- Begin Label Label3
- BackColor = &H00C0C0C0&
- Caption = "c. List Current Occupation "
- Height = 255
- Left = 360
- TabIndex = 11
- Top = 1740
- Width = 4815
- End
- Begin Label Label1
- BackColor = &H00C0C0C0&
- Caption = "a. Name"
- Height = 255
- Left = 315
- TabIndex = 10
- Top = 285
- Width = 780
- End
- End
- Begin SSPanel Panel3D1
- Alignment = 7 'Center - MIDDLE
- AutoSize = 0 'None
- BackColor = &H00C0C0C0&
- BevelInner = 0 'None
- BevelOuter = 2 'Raised
- BevelWidth = 3
- BorderWidth = 3
- Caption = "The National Life Insurance Company of America "
- FloodColor = &H00FF0000&
- FloodShowPct = -1 'True
- FloodType = 0 'None
- Font3D = 2 'Raised w/heavy shading
- FontBold = -1 'True
- FontItalic = 0 'False
- FontName = "MS Sans Serif"
- FontSize = 13.5
- FontStrikethru = 0 'False
- FontUnderline = 0 'False
- ForeColor = &H00000000&
- Height = 585
- Left = 360
- Outline = 0 'False
- RoundedCorners = -1 'True
- ShadowColor = 0 'Dark Grey
- TabIndex = 12
- Top = 75
- Width = 8910
- Begin PictureBox Picture1
- AutoSize = -1 'True
- BackColor = &H00C0C0C0&
- BorderStyle = 0 'None
- Height = 480
- Left = 7770
- Picture = INSURED.FRX:0F0A
- ScaleHeight = 480
- ScaleWidth = 480
- TabIndex = 18
- Top = 60
- Width = 480
- End
- End
- Sub Command1_Click ()
- End Sub
- Sub Command3D1_Click ()
- form2.Show
- form1.Hide
- End Sub
- Sub Command3D4_Click ()
- form3.Show
- form1.Hide
- End Sub
- Sub Command3D5_Click ()
- report.Show
- form1.Hide
- End Sub
- Sub fillcombos ()
- combo1.AddItem "AL"
- combo2.AddItem "AL"
- combo1.AddItem "AK"
- combo2.AddItem "AK"
- combo1.AddItem "AZ"
- combo2.AddItem "AZ"
- combo1.AddItem "AR"
- combo2.AddItem "AR"
- combo1.AddItem "CA"
- combo2.AddItem "CA"
- combo1.AddItem "CO"
- combo2.AddItem "CO"
- combo1.AddItem "CT"
- combo2.AddItem "CT"
- combo1.AddItem "DE"
- combo2.AddItem "DE"
- combo1.AddItem "DC"
- combo2.AddItem "DC"
- combo1.AddItem "FL"
- combo2.AddItem "FL"
- combo1.AddItem "GA"
- combo2.AddItem "GA"
- combo1.AddItem "HI"
- combo2.AddItem "HI"
- combo1.AddItem "ID"
- combo2.AddItem "ID"
- combo1.AddItem "IL"
- combo2.AddItem "IL"
- combo1.AddItem "IN"
- combo2.AddItem "IN"
- combo1.AddItem "IA"
- combo2.AddItem "IA"
- combo1.AddItem "KS"
- combo2.AddItem "KS"
- combo1.AddItem "KY"
- combo2.AddItem "KY"
- combo1.AddItem "LA"
- combo2.AddItem "LA"
- combo1.AddItem "ME"
- combo2.AddItem "ME"
- combo1.AddItem "MD"
- combo2.AddItem "MD"
- combo1.AddItem "MA"
- combo2.AddItem "MA"
- combo1.AddItem "MI"
- combo2.AddItem "MI"
- combo1.AddItem "MN"
- combo2.AddItem "MN"
- combo1.AddItem "MS"
- combo2.AddItem "MS"
- combo1.AddItem "MO"
- combo2.AddItem "MO"
- combo1.AddItem "MT"
- combo2.AddItem "MT"
- combo1.AddItem "NE"
- combo2.AddItem "NE"
- combo1.AddItem "NV"
- combo2.AddItem "NV"
- combo1.AddItem "NH"
- combo2.AddItem "NH"
- combo1.AddItem "NJ"
- combo2.AddItem "NJ"
- combo1.AddItem "NM"
- combo2.AddItem "NM"
- combo1.AddItem "NY"
- combo2.AddItem "NY"
- combo1.AddItem "NC"
- combo2.AddItem "NC"
- combo1.AddItem "ND"
- combo2.AddItem "ND"
- combo1.AddItem "OH"
- combo2.AddItem "OH"
- combo1.AddItem "OK"
- combo2.AddItem "OK"
- combo1.AddItem "OR"
- combo2.AddItem "OR"
- combo1.AddItem "PA"
- combo2.AddItem "PA"
- combo1.AddItem "RI"
- combo2.AddItem "RI"
- combo1.AddItem "SC"
- combo2.AddItem "SC"
- combo1.AddItem "SD"
- combo2.AddItem "SD"
- combo1.AddItem "TN"
- combo2.AddItem "TN"
- combo1.AddItem "TX"
- combo2.AddItem "TX"
- combo1.AddItem "UT"
- combo2.AddItem "UT"
- combo1.AddItem "VT"
- combo2.AddItem "VT"
- combo1.AddItem "VA"
- combo2.AddItem "VA"
- combo1.AddItem "WA"
- combo2.AddItem "WA"
- combo1.AddItem "WV"
- combo2.AddItem "WV"
- combo1.AddItem "WI"
- combo2.AddItem "WI"
- combo1.AddItem "WY"
- combo2.AddItem "WY"
- combo3.AddItem "Single Indemnity"
- combo3.AddItem "Double Indemnity"
- combo3.AddItem "Schizophrenia Insurance"
- combo3.AddItem "Invasion Insurance"
- End Sub
- Sub Form_Load ()
- form1.WindowState = 2
- Call fillcombos
- End Sub
- Sub Option3D1_Click (value As Integer)
- If value = -1 Then status$ = "Married"
- End Sub
- Sub Option3D2_Click (value As Integer)
- If value = -1 Then status$ = "Single"
- End Sub
- Sub Option3D3_Click (value As Integer)
- If value = -1 Then status$ = "Widowed"
- End Sub
- Sub Option3D4_Click (value As Integer)
- If value = -1 Then status$ = "Separated"
- End Sub
- Sub Option3D7_Click (value As Integer)
- If value = -1 Then status$ = "Divorced"
- End Sub
-