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Visual Basic Form | 1995-05-07 | 17.5 KB | 517 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 PictureBox Panel3D1 BackColor = &H00C0C0C0& ForeColor = &H00000000& Height = 1155 Left = 180 ScaleHeight = 1125 ScaleWidth = 4305 TabIndex = 26 Top = 5640 Width = 4335 Begin PictureBox Command3D4 ForeColor = &H00000000& Height = 855 Left = 2295 Picture = FORM2.FRX:0302 ScaleHeight = 825 ScaleWidth = 1815 TabIndex = 9 Top = 165 Width = 1845 End Begin PictureBox Command3D3 ForeColor = &H00000000& Height = 855 Left = 255 Picture = FORM2.FRX:0604 ScaleHeight = 825 ScaleWidth = 1845 TabIndex = 8 Top = 165 Width = 1875 End End Begin PictureBox Frame3D11 FontBold = -1 'True FontItalic = 0 'False FontName = "Arial" FontSize = 8.25 FontStrikethru = 0 'False FontUnderline = 0 'False ForeColor = &H00000000& Height = 1155 Left = 4695 ScaleHeight = 1125 ScaleWidth = 4680 TabIndex = 25 Top = 5595 Width = 4710 Begin PictureBox HEdit1 BackColor = &H00FFFFFF& Height = 825 Left = 45 ScaleHeight = 795 ScaleWidth = 4590 TabIndex = 24 Top = 240 Width = 4620 End End Begin PictureBox Frame3D12 FontBold = -1 'True FontItalic = 0 'False FontName = "Arial" FontSize = 8.25 FontStrikethru = 0 'False FontUnderline = 0 'False ForeColor = &H00000000& Height = 4080 Left = 240 ScaleHeight = 4050 ScaleWidth = 9060 TabIndex = 1 Top = 210 Width = 9090 Begin PictureBox Frame3D5 ForeColor = &H00000000& Height = 495 Left = 7485 ScaleHeight = 465 ScaleWidth = 1470 TabIndex = 34 Top = 3405 Width = 1500 Begin PictureBox Option3D9 ForeColor = &H00000000& Height = 300 Left = 855 ScaleHeight = 270 ScaleWidth = 495 TabIndex = 23 Top = 150 Width = 525 End Begin PictureBox Option3D10 ForeColor = &H00000000& Height = 315 Left = 135 ScaleHeight = 285 ScaleWidth = 615 TabIndex = 22 Top = 120 Width = 645 End End Begin PictureBox Frame3D4 ForeColor = &H00000000& Height = 495 Left = 7485 ScaleHeight = 465 ScaleWidth = 1470 TabIndex = 33 Top = 2835 Width = 1500 Begin PictureBox Option3D7 ForeColor = &H00000000& Height = 300 Left = 855 ScaleHeight = 270 ScaleWidth = 495 TabIndex = 21 Top = 150 Width = 525 End Begin PictureBox Option3D8 ForeColor = &H00000000& Height = 315 Left = 120 ScaleHeight = 285 ScaleWidth = 615 TabIndex = 20 Top = 135 Width = 645 End End Begin PictureBox Frame3D3 ForeColor = &H00000000& Height = 495 Left = 7485 ScaleHeight = 465 ScaleWidth = 1470 TabIndex = 32 Top = 2280 Width = 1500 Begin PictureBox Option3D5 ForeColor = &H00000000& Height = 300 Left = 855 ScaleHeight = 270 ScaleWidth = 495 TabIndex = 19 Top = 150 Width = 525 End Begin PictureBox Option3D6 ForeColor = &H00000000& Height = 315 Left = 120 ScaleHeight = 285 ScaleWidth = 615 TabIndex = 18 Top = 135 Width = 645 End End Begin PictureBox Frame3D2 ForeColor = &H00000000& Height = 495 Left = 7485 ScaleHeight = 465 ScaleWidth = 1470 TabIndex = 30 Top = 1740 Width = 1500 Begin PictureBox Option3D4 ForeColor = &H00000000& Height = 300 Left = 855 ScaleHeight = 270 ScaleWidth = 495 TabIndex = 17 Top = 150 Width = 525 End Begin PictureBox Option3D3 ForeColor = &H00000000& Height = 315 Left = 120 ScaleHeight = 285 ScaleWidth = 615 TabIndex = 16 Top = 135 Width = 645 End End Begin PictureBox Frame3D1 ForeColor = &H00000000& Height = 495 Left = 7485 ScaleHeight = 465 ScaleWidth = 1470 TabIndex = 29 Top = 1200 Width = 1500 Begin PictureBox Option3D2 ForeColor = &H00000000& Height = 300 Left = 855 ScaleHeight = 270 ScaleWidth = 495 TabIndex = 15 Top = 150 Width = 525 End Begin PictureBox Option3D1 ForeColor = &H00000000& Height = 315 Left = 120 ScaleHeight = 285 ScaleWidth = 615 TabIndex = 14 Top = 135 Width = 645 End End Begin PictureBox Frame3D9 ForeColor = &H00000000& Height = 495 Left = 7485 ScaleHeight = 465 ScaleWidth = 1470 TabIndex = 28 Top = 690 Width = 1500 Begin PictureBox Option3D16 ForeColor = &H00000000& Height = 300 Left = 855 ScaleHeight = 270 ScaleWidth = 495 TabIndex = 13 Top = 150 Width = 525 End Begin PictureBox Option3D15 ForeColor = &H00000000& Height = 315 Left = 120 ScaleHeight = 285 ScaleWidth = 615 TabIndex = 12 Top = 135 Width = 645 End End Begin PictureBox Frame3D13 ForeColor = &H00000000& Height = 495 Left = 7485 ScaleHeight = 465 ScaleWidth = 1470 TabIndex = 27 Top = 150 Width = 1500 Begin PictureBox Option3D20 ForeColor = &H00000000& Height = 300 Left = 840 ScaleHeight = 270 ScaleWidth = 495 TabIndex = 11 Top = 135 Width = 525 End Begin PictureBox Option3D11 ForeColor = &H00000000& Height = 315 Left = 105 ScaleHeight = 285 ScaleWidth = 615 TabIndex = 10 Top = 150 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