**Appendix C:**

**Claim Form Entries and Completion Procedures**

# CLAIM FORM ENTRIES AND COMPLETION PROCEDURES {#claim-form-entries-and-completion-procedures .Style-Heading-1Heading-1-Char-+-After:--3-pt-Bottom:-(No-border)}

## A. GENERAL INFORMATION {#a.-general-information .Style-Heading-2-+-Left:--0\"-Hanging:--0.75\"-Before:--0-pt-After:... .unnumbered}

> \(1\) The claim form (hereafter referred to as "Production Worksheet")
> is a progressive form addressing all notices of damage for all
> preliminary and final inspections on a unit.
>
> \(2\) If a Production Worksheet has been prepared on a prior
> inspection, verify each entry and enter additional information as
> needed. If a change or correction is necessary, strike out all entries
> on the line and re-enter correct entries on a new line. The adjuster
> and insured should initial any line deletions.
>
> \(3\) Refer to the LAM for instructions regarding the following:
>
> \(a\) Acreage reporting errors.
>
> \(b\) Delayed notices and delayed claims.
>
> \(c\) Corrected claims or fire losses (double coverage) and cases
> involving uninsured causes of loss, unusual situations, controversial
> claims, concealment, or misrepresentation.
>
> \(d\) Claims involving a Certification Form (when all the acreage on
> the unit has been appraised to be put to another use, or other reasons
> described in the LAM).
>
> \(e\) "No Indemnity Due" claims (which must be verified by an
> APPRAISAL or NOTIFICATION from the insured that the production met or
> exceeded the guarantee).
>
> \(4\) The adjuster is responsible for determining if any of the
> insured\'s requirements under the notice and claim provisions of the
> policy have not been met. If any have not, the adjuster should contact
> the insurance provider.
>
> \(5\) Instructions labeled \"PRELIMINARY\" apply to preliminary
> inspections only. Instructions labeled \"FINAL\" apply to final
> inspections only. Instructions not labeled apply to ALL inspections.

## B. FORM ENTRIES AND COMPLETION INFORMATION {#b.-form-entries-and-completion-information .Style-Heading-2-+-Left:--0\"-Hanging:--0.75\"-Before:--0-pt-After:... .unnumbered}

Verify or make the following entries:

**Item**

**[No.]{.underline} [Information Required]{.underline}**

**1.** **Crop/Code #:** "Sweetpotato" (0085).

**2.** **Unit #:** Five-digit unit number from the Summary of Coverage
after it is verified to be correct (e.g., 00100).

**3.** **Legal Description:** Section, township, and range number or
other legal description that identifies the location of the unit.

**4.** **Date of Damage:** First three letters of the month during which
MOST of the insured damage (including progressive damage) occurred for
each inspection. Include the SPECIFIC DATE where applicable as in the
case of hail damage (e.g., AUG 11).

**5.** **Cause of Damage:** Name of insured causes of loss for **this
crop** as listed in the LAM. If it is evident that no indemnity is due,
enter "NONE." If an insured cause of loss is coded as "Other," explain
the nature of the cause in the Narrative.

> **NOTE:** Refer to the Basic Provisions and the Crop Provisions for
> this crop for information pertaining to insured and uninsured causes
> of loss.

**6.** **Primary Cause %:**

> **PRELIMINARY:** MAKE NO ENTRY.
>
> **FINAL:** Percent of damage for the primary cause of damage listed in
> Item 5 above, to the nearest whole percent. The primary cause of
> damage must exceed 50 percent (e.g., 51% or greater). Enter an "X" for
> the major secondary cause % of damage.

**7.** **Company/Agency:** Name of company and agency servicing the
contract.

**8.** **Name of Insured:** Name of the insured that identifies EXACTLY
the person (legal entity) to whom the policy is issued.

**9.** **Claim #:** Claim number as assigned by the insurance provider.

**10.** **Policy #:** Insured's assigned policy number.

**11.** **Crop Year:** Crop year for which the claim is filed, as
defined in the policy.

**12.** **Additional Units:**

> **PRELIMINARY:** MAKE NO ENTRY.
>
> **FINAL:** Unit number(s) for ALL non-loss units for the crop at the
> time of final inspection. A non-loss unit is any unit for which a
> Production Worksheet has not been completed. Additional non-loss units
> may be entered on a single Production Worksheet.
>
> **NOTE:** If more spaces are needed for non-loss units, enter the unit
> numbers, identified as "Non-Loss Units," in the Narrative or on an
> attached Special Report.

**13.** **Est. Prod. Per Acre:** MAKE NO ENTRY.

**14.** **Date(s) Notice of Loss:**

> **PRELIMINARY:**

(a) Date the notice of damage was given for the unit in Item 2.

(b) Additional preliminary inspections (if needed) requires an
    additional set of Production Worksheets. Enter the date of notice
    for a third preliminary inspection in the 1st space of Item 14 on
    the second set.

(c) Reserve the "Final" space on the first page of the first set of
    Production Worksheets for the date of notice for the final
    inspection.

(d) If the inspection is initiated by the insurance provider, enter
    "Company Insp." instead of the date.

> **FINAL:** Transfer the last date from the 1st or 2nd space in the
> last Production Worksheet for this event to the FINAL space, if a
> final inspection should be made as a result of the last notice. Always
> enter the complete date of notice (month, day, year) for the FINAL
> inspection in the FINAL space on the first page of the first set of
> Production Worksheets. For a delayed notice of loss or delayed claim,
> refer to the LAM.

**15.** **Companion Policy(s):**

(a) If no other person has a share in the unit (insured has 100 percent
    share), MAKE NO ENTRY.

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(e) In all cases where the insured has LESS than a 100 percent share of
    a loss-affected unit, ask the insured if the OTHER person sharing in
    the unit has a multiple-peril crop insurance contract (i.e., not
    crop-hail, fire, etc.). If the other person does not, enter "NONE."

> \(1\) If the OTHER person has a multiple-peril crop insurance contract
> and it can be determined that the SAME insurance provider services it,
> enter the contract number. Handle these companion policies according
> to insurance provider instructions.
>
> \(2\) If the OTHER person has a multiple-peril crop insurance contract
> and a DIFFERENT insurance provider or agent services it, enter the
> name of the insurance provider or agent (and contract number) if
> known.
>
> \(3\) If UNABLE to verify the existence of a companion contract, enter
> "Unknown" and contact the insurance provider of the known policy for
> further instructions.
>
> **NOTE:** Refer to the LAM for further information regarding companion
> contracts.

**SECTION I -- ACREAGE APPRAISED, PRODUCTION AND ADJUSTMENTS**

Make separate line entries for varying:

> \(1\) Rate classes, types, or farming practices;
>
> \(2\) APH yields;
>
> \(3\) Appraisals;
>
> \(4\) Stages or intended uses;
>
> \(5\) Shares (e.g., 50 percent and 25 percent shares on the same
> unit); or
>
> \(6\) Appraisals for damage due to hail or fire if Hail and Fire
> Exclusion is in effect.

Verify or make the following entries:

**Item**

**[No.]{.underline} [Information Required]{.underline}**

**A.** **Field ID:** The field identification symbol from a sketch map
or an aerial photo. Refer to instructions for the narrative. In the
margin (or in a split cell), enter the date of inspection (MM/DD) for
the last entry of each inspection.

**NOTE 1: REFER TO THE LAM FOR INSTRUCTIONS REGARDING ENTRY OF FIRST
CROP, SECOND CROP CODES.**

**B.** **Preliminary Acres:**

> **PRELIMINARY:** The number of acres, to tenths, (include "E" if
> estimated), for which consent for other use has been given. Determine
> actual acreage, to tenths, when the boundaries of the appraised
> acreage may not be determined later.
>
> **FINAL:** MAKE NO ENTRY.

**C.** **Final Acres:** Refer to the LAM for definition of acceptable
determined acres used herein.

> Determined acres to tenths (include "E" if estimated) for which
> consent is given for other use and/or are:

(a) Put to other use without consent;

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(f) Abandoned;

(g) Damaged by uninsured causes;

(h) Not appropriately documented because the insured failed to provide
    acceptable records of production.

> **FINAL:** Enter final acres to tenths.
>
> **NOTE:** Acreage breakdowns WITHIN a unit may be estimated (enter "E"
> in front of the acres) if a determination is impractical AND if
> authorization was received from the insurance provider. Document such
> authorization in the Narrative.
>
> ACCOUNT FOR ALL ACREAGE IN THE UNIT. In the event of over-reported
> acres, handle in accordance with individual insurance provider's
> instructions. In the event of under-reported acres, draw a diagonal
> line in Column "C" as shown.

  ------------------------------------------------------ ----------------
  **C~1~** Enter the ACTUAL acres for the field or       **C~1~**
  subfield.                                              

  **C~2~** Enter the REPORTED acres for the field or     **C~2~**
  subfield.                                              
  ------------------------------------------------------ ----------------

**D. Interest or Share:** Insured's interest in the crop to three
decimal places as determined at the time of inspection. If shares vary
on the same UNIT, use separate line entries.

**E. Risk:** Three-digit code for the correct "Rate Class" specified on
the actuarial documents. If a "Rate Class" or "High Risk Area" is not
specified on the actuarial documents, make no entry. Verify with the
Summary of Coverage and if the Rate Class is found to be incorrect,
revise according to the insurance provider's instructions. Refer to the
LAM.

**F.** **Practice:** Three-digit code number entered exactly as
specified in the actuarial documents, for the practice carried out by
the insured. If "No Practice Specified," enter appropriate three-digit
code number from the actuarial documents.

**G.** **Type/Class/Variety:** Three-digit code number entered exactly
as specified in the actuarial documents, for the type grown by the
insured. If "No Type Specified," enter appropriate three-digit code
number from the actuarial documents. Indemnities are limited to covered
varieties.

**H.** **Stage:** Enter the appropriate stage abbreviation from the
following list.

> **[STAGE EXPLANATION]{.underline}**
>
> "P" Acreage abandoned without consent, put to other use without
> consent, damaged solely by uninsured causes, for which the insured
> failed to provide records of production that are acceptable to the
> insurance provider, for which notice was not provided according to the
> crop provisions, or which were not disposed of according to the crop
> provisions.
>
> "M" Mature.
>
> "I" Immature.
>
> **GLEANED ACREAGE: Refer to the LAM for information on gleaning**

**I.** **Intended or Final Use of Acreage.** Use the following "Intended
Use" abbreviations.

> **[USE EXPLANATION]{.underline}**
>
> "To xxxxxx" Acreage planted to xxxxxx
>
> "WOC" Other use without consent
>
> "SU" Solely uninsured causes
>
> "ABA" Abandoned without consent
>
> "D". Destroyed with consent
>
> "H". Harvested (Appraisal from check strips or pre-harvest appraisal)
>
> "H/N". Harvested (no check strips or pre-harvest appraisal)
>
> "UH" Unharvested
>
> Verify any "Intended Use" entry. If the final use of the acreage was
> not as indicated, strike out the original line and initial it. Enter
> all data on a new line showing the correct "Final Use." Note the date
> of verification in the Narrative.
>
> **GLEANED ACREAGE: Refer to the LAM for information on gleaning**

**J.** **Appraised Potential:** Per acre appraisal in hundredweight, to
tenths, of POTENTIAL production for the acreage appraised. (Item 15 on
Final Sweetpotato Appraisal Worksheet) (Refer to appraisal methods for
additional instructions).

**K~1~- K~2~**~.~ **Moisture % and Factor:** MAKE NO ENTRY.

**L.** **Shell factor:** MAKE NO ENTRY.

**M.** **Uninsured Cause:** Enter potential lost to uninsured causes.
(Item 16, below the line, on the Final Sweetpotato Appraisal
Worksheets.)

> EXPLAIN IN THE NARRATIVE.

(a) If a Hail and Fire exclusion is NOT in effect.

> \(1\) Enter NOT LESS than the insured\'s production guarantee per acre
> in HUNDREDWEIGHT, to tenths, for the line, (calculated by multiplying
> the elected coverage level percentage times the approved yield per
> acre shown on the APH form) for any "P" stage acreage.
>
> **NOTE:** On preliminary inspections, advise the insured to keep the
> production records from any acreage damaged SOLELY by uninsured causes
> separate from other production records.
>
> \(2\) For acreage that is damaged PARTLY by uninsured causes, enter
> the APPRAISED UNINSURED PRODUCTION LOSS per acre in HUNDREDWEIGHT, to
> tenths, for any such acreage. (Refer to Section 9 Appraisal Worksheet
> Entries and Completion Procedures.)

(a) Refer to the LAM when a Hail and Fire Exclusion is in effect and
    damage is from hail or fire.

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(i) Enter the result of adding uninsured cause appraisals to hail and
    fire exclusion appraisals.

> **NOTE:** For fire losses, if the insured also has other fire
> insurance (double coverage), refer to the LAM.

**N.** **Adjusted Potential:** Per acre appraisal in hundredweight, to
tenths, of TOTAL POTENTIAL production for the acreage appraised. (Item
19 on Final Sweetpotato Appraisal Worksheet).

**O.** **Total to Count:** Enter the result of multiplying Column "C" or
"C~1~" by Item "N," rounded to tenths.

**P.** **Per Acre:** Enter the per acre guarantee from the insured's
policy for all fields in the unit.

**Q.** **Total:** Enter the result of multiplying Column "C" or "C~1~"
by Item "P," rounded to tenths for all fields in the unit.

**16.** **Total Acres:**

> **PRELIMINARY:** MAKE NO ENTRY.
>
> **FINAL:** Enter the Total Actual Acres \[Column "C" (or "C~1~" if
> there are under-reported acres)\] to tenths.
>
> **NOTE:** FOR ITEM 17. WHEN SEPARATE LINE ENTRIES ARE MADE FOR VARYING
> SHARES, STAGES, APPROVED YIELDS, PRICE ELECTIONS, TYPES, ETC., WITHIN
> THE UNIT, AND TOTALS NEED TO BE KEPT SEPARATE FOR CALCULATING
> INDEMNITIES, MAKE NO ENTRY AND FOLLOW THE INSURANCE PROVIDER'S
> INSTRUCTIONS; OTHERWISE, MAKE THE FOLLOWING ENTRIES.

**17. Totals:**

> **PRELIMINARY:** MAKE NO ENTRY.
>
> **FINAL:** Enter the total of Column "O" and total of Column "Q."

**NARRATIVE:**

If more space is needed, document on a Special Report, and enter "Refer
to Special Report." Attach the Special Report to the Production
Worksheet.

(a) If no acreage is released on the unit, enter \"No acreage
    released,\" adjuster's initials, and date.

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(j) If notice of damage was given and "No Inspection" is necessary,
    enter the unit number(s), "No Inspection," date, and adjuster's
    initials. The insured\'s signature is not required.

(k) Explain any uninsured causes, unusual, or controversial cases.

(l) If there is an appraisal in Section I, Column M for uninsured causes
    due to a hail/fire exclusion, show the original hail/fire liability
    per acre and the hail/fire indemnity per acre.

(m) Document the actual appraisal date if an appraisal was performed
    prior to the adjuster's signature date on the appraisal worksheet,
    and the date of the appraisal is not recorded on the appraisal
    worksheet.

(n) State that there is "No other fire insurance" when fire damages or
    destroys the insured crop and it is determined that the insured has
    no other fire insurance. (Also refer to the LAM.)

(o) Explain any errors found on the Summary of Coverage.

(p) Explain any commingled production. Refer to the LAM.

(q) Explain any entry for "Production Not to Count" in Section II,
    Column \"O,\" and/or any production not included in Section II,
    Column I or Column B - E entries (e.g., harvested production from
    uninsured acreage that can be identified separately from the insured
    acreage in the unit).

(r) Explain a "NO" checked in Item 19.

(s) Attach a sketch map or aerial photograph to identify the total unit:

> \(1\) If consent is or has been given to put part of the unit to
> another use.
>
> \(2\) If uninsured causes are present; or
>
> \(3\) For unusual or controversial cases.
>
> **NOTE**: Indicate on the sketch map or aerial photo the disposition
> of acreage destroyed or put to other use with or without consent.

(t) Explain any difference between date of inspection and signature
    dates. For an ABSENTEE insured, enter the date of the inspection AND
    the date of mailing the Production Worksheet for signature.

(u) When any other adjuster or supervisor accompanied the adjuster on
    the inspection, enter the code number of the other adjuster or
    supervisor and date of inspection.

(v) Explain the reason for a "No Indemnity Due" claim. "No Indemnity
    Due" claims are to be distributed in accordance with the insurance
    provider's instructions.

(w) Explain any delayed notices or delayed claims as instructed in the
    LAM.

(x) Document any authorized estimated acres shown in Section I, Column C
    as follows: "Line 3 'E' acres authorized by insurance provider
    MM/DD/YYYY."

(y) Document the method and calculation used to determine acres for the
    unit. (Refer to the LAM.)

(z) Specify the type of insects or disease when the insured cause of
    damage or loss is listed as insects or disease. Explain why control
    measures did not work. Document the laboratory performing confirming
    assessment.

(a) Document the appraisal for uninsured causes of loss, if applicable.

(b) Document field ID's and any other pertinent information including
    any data to support factors used to calculate production. For
    further documentation instructions refer to the LAM.

## SECTION II - HARVESTED PRODUCTION {#section-ii---harvested-production .unnumbered}

## A. GENERAL INFORMATION {#a.-general-information-1 .Style-Heading-2-+-Left:--0\"-Hanging:--0.75\"-Before:--0-pt-After:... .unnumbered}

> \(1\) Check strip appraisals, the guarantee, and harvest records
> (sales receipts, weight tickets, and stored on location calculation)
> are use to establish production to count of harvested acreage for
> indemnity determinations.
>
> \(2\) Account for ALL HARVESTED PRODUCTION (for **[ALL
> ENTITIES]{.smallcaps}** sharing in the crop).
>
> \(3\) Columns "B" through "E" are for structure measurement entries
> (Rectangular, Round, Square, Conical Pile, etc.). If structures are a
> combination of shapes, break into a series of average measurements, if
> possible. Enter "Odd Shape" if production is stored in an odd shaped
> structure. Document measurements on a Special Report or other
> FCIC-approved worksheet used for this purpose.
>
> \(3\) If farm-stored production has been weighed prior to storage and
> acceptable weight tickets are available showing gross weights, enter
> "Weighed and Stored on Farm" in Columns "B" through "E." (Refer to the
> LAM for acceptable weight tickets.)
>
> \(4\) For production commercially stored, sold, etc., make entries in
> the spaces reserved for Items B through E as follows:
>
> \(a\) Name of storage facility or buyer.
>
> \(b\) Address of storage facility or buyer.
>
> \(5\) If acceptable sales records or weight tickets are not available,
> refer to the LAM.
>
> \(6\) If additional lines are necessary, the data may be entered on a
> continuation sheet.
>
> USE SEPARATE LINES FOR:
>
> \(a\) Separate storage structures.
>
> \(b\) Varying names and addresses of buyers of sold production, and
>
> different FIRST handlers (buyers, packinghouses, or processors). The
> insured must have maintained satisfactory records of ALL production
> sold or stored. Verify any packinghouse or processor records.
>
> **NOTE:** In all localities, if the first handler was not a packer or
> processor, the production will be determined by the adjuster on the
> basis of available records.
>
> \(c\) Varying shares; e.g., 50 percent and 75 percent shares on same
> unit.
>
> \(d\) Conical piles. Do NOT add the cone in the top or bottom of a bin
> to the height of other production in the structure. For computing the
> production in cones and conical piles, refer to the LAM.
>
> \(7\) There will generally be no harvested production entries in
> Columns A through S for preliminary inspections.
>
> \(8\) If there is harvested production from more than one insured
> practice (or type) and a separate approved yield has been established
> for each, the harvested production must also be entered on separate
> lines in Column I.

**Verify or make the following entries:**

**Item**

**[No.]{.underline} [Information Required]{.underline}**

**18**. **Date Harvest Completed:** (Used to determine if there is a
delayed notice or a delayed claim if harvest is made from check strips
after harvest. Refer to the LAM.)

> **PRELIMINARY:** MAKE NO ENTRY.
>
> **FINAL:**

(a) The earlier of the date the ENTIRE acreage on the unit was (1)
    harvested, (2) totally destroyed, (3) put to other use, (4) a
    combination of harvested, destroyed, or put to other use, or (5) the
    calendar date for the end of the insurance period.

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(c) If at the time of final inspection (if prior to the end of the
    insurance period), there is any unharvested insured acreage
    remaining on the unit that the insured does not intend to harvest;
    enter "Incomplete."

(d) If at the time of final inspection (if prior to the end of the
    insurance period), none of the insured acreage on the unit has been
    harvested, and the insured does not intend to harvest such acreage,
    enter "No Harvest."

(e) If the case involves a Certification Form, enter the date from the
    Certification Form when the entire unit is put to another use, etc.
    refer to the LAM.

**19.** **Similar Damage:**

> **PRELIMINARY:** MAKE NO ENTRY.
>
> **FINAL:** Check "Yes" or "No." Check "Yes" if amount and cause of
> damage due to insurable causes is similar to the experience of other
> farms in the area. If "No" is checked, explain in the narrative.

**20.** **Assignment of Indemnity:** Check "Yes" **only** if an
assignment of indemnity is in effect for the crop year; otherwise, check
"No." (Refer to the LAM.)

**21.** **Transfer of Right to Indemnity:** Check "Yes" only if a
transfer of right to indemnity is in effect for the unit for the crop
year; otherwise, check "No." (Refer to the LAM.)

**A~1~.** **Share:** RECORD ONLY VARYING SHARES on the SAME unit as a
decimal to three decimal places.

**A2. Field ID:** Note the Field ID for all fields that were harvested.

(a) If only one practice and/or type of harvested production is listed
    in Section I, MAKE NO ENTRY.

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(f) If more than one practice and/or type of harvested production is
    listed in Section I, and a separate approved APH yield exists,
    indicate for each practice/type the corresponding Field ID (from
    Section I, item "A").

**NOTE: REFER TO THE LAM FOR INSTRUCTIONS REGARDING ENTRY OF FIRST CROP,
SECOND CROP CODES.**

**B.** **Length or Diameter:** Internal measurement in feet, to tenths,
of structural space occupied by crop.

(a) Length if rectangular or square.

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(g) Diameter if round or conical pile. Refer to the LAM to convert
    circumference to diameter if internal diameter measurement is not
    possible.

**C. Width:** Internal width measurement in feet, to tenths, of space
occupied by crop in structure if rectangular or square. If round, enter
"RND." If conical pile, enter "Cone."

**D. Depth:** Depth measurement in feet, to tenths, of space occupied by
crop in rectangular, round, or square structure. If conical pile, enter
the height of the cone. (Refer to the LAM if there is production in the
storage structure from other units or sources.)

**E. Deductions:** Cubic feet, to tenths, of crop space displaced by
chutes, vents, studs, crossties, etc. (Refer to the LAM for computation
instructions.)

**F. Net Cubic Feet:** Net cubic feet of crop in the storage structure.
Refer to the LAM for computation instructions.

**G. Conversion Factor:** Enter Conversion Factor as 0.4283.

**H. Gross Production:** Multiply Column "F" times Column "G," rounded
to tenths.

**I. Bu., Ton, Lbs., Cwt.:** Circle "Cwt." in column heading. Production
in hundred weight, to tenths.

(a) Weighed and stored on the farm.

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(h) Sold and/or stored in commercial storage - obtain gross harvested
    production for the UNIT from the summary and/or settlement sheets.
    (Individual load slips only WILL NOT suffice unless the storage
    facility or buyer WILL NOT provide summary and/or settlement sheets
    to the insured, and this is documented in the Narrative.)

(i) Stored in odd-shaped structures. The adjuster must compute the
    amount of gross production. (Refer to the LAM for cubic footage and
    production computations). A copy of ALL production calculations must
    be left in the file folder.

**J. - M2.** MAKE NO ENTRY.

**N. Adjusted Production:** Repeat the entry from Column "H" or "I."

**O. Production Not to Count:** Net production NOT to count, in
hundredweight, to tenths, WHEN ACCEPTABLE RECORDS IDENTIFYING SUCH
PRODUCTION ARE AVAILABLE from other sources (e.g., other units or
uninsured acreage) in the same storage structure (if the storage entries
include such production).

> THIS ENTRY MUST NEVER EXCEED PRODUCTION SHOWN ON THE SAME LINE.
>
> **NOTE:** Make no entry if only the depth for production to count has
> been entered in column D, and the depth for production not to count
> has been entered in the Narrative. (Refer to the example in the LAM.)

**P. Production:** Result of subtracting the entry in Column "O" from
Column "N," to tenths.

**Q1. - R.:** MAKE NO ENTRY.

**S. Production to Count:**

(a) For acreage that was harvested without leaving appropriate check
    strips as directed by the insurance provider, make no entry unless
    the stored/sold production is greater than the production guarantee.
    In that case, line out the uninsured production recorded for the
    acreage in Section I and enter the stored/sold production in Section
    II.

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(j) For harvested acreage appraised before harvest, or for acreage on
    which check strips were left in all fields or subfields and
    appraised after harvest, enter the greater of the stored/sold
    production or the appraised production.

> **NOTE:** FOR ITEMS 22 - 24. WHEN SEPARATE LINE ENTRIES ARE MADE FOR
> VARYING SHARES, STAGES, APPROVED YIELDS, PRICE ELECTIONS, TYPES, ETC.,
> WITHIN THE UNIT AND TOTALS NEED TO BE KEPT SEPARATE FOR CALCULATING
> INDEMNITIES, MAKE NO ENTRY AND FOLLOW THE INSURANCE PROVIDER'S
> INSTRUCTIONS; OTHERWISE MAKE THE FOLLOWING ENTRIES.

**22. Section II Total:**

> **PRELIMINARY:** MAKE NO ENTRY.
>
> **FINAL:** Enter the total production to count from Column S above.

**23. Section I Total:**

> **PRELIMINARY:** MAKE NO ENTRY.
>
> **FINAL:** Enter figure from Section I Column "O" total.

**24. Unit Total:** Enter the sum of the value from line 22 and the
value from line 23 as unit total production to count.

**25. Adjuster's Signature, Code #, and Date:** Signature of adjuster,
code number, and date signed after the insured (or insured's authorized
representative) has signed. For an absentee insured, enter adjuster's
code number ONLY. The signature and date will be entered AFTER the
absentee has signed and returned the Production Worksheet.

**NOTE:** Final indemnity inspections should be signed on bottom line.

**26. Insured's Signature and Date:** Insured's (or insured's authorized
representative's) signature and date. BEFORE obtaining insured's
signature, REVIEW ALL ENTRIES on the Production Worksheet WITH THE
INSURED, particularly explaining codes, etc., that may not be readily
understood.

**NOTE:** Final indemnity inspections should be signed on bottom line.

**27. Page Numbers:** Page numbers - (**EXAMPLE:** Page 1 of 1, Page 1
of 2, Page 2 of 2, etc.).

<table style="width:100%;">
<colgroup>
<col style="width: 4%" />
<col style="width: 3%" />
<col style="width: 3%" />
<col style="width: 3%" />
<col style="width: 0%" />
<col style="width: 3%" />
<col style="width: 1%" />
<col style="width: 1%" />
<col style="width: 3%" />
<col style="width: 0%" />
<col style="width: 1%" />
<col style="width: 2%" />
<col style="width: 2%" />
<col style="width: 1%" />
<col style="width: 1%" />
<col style="width: 1%" />
<col style="width: 0%" />
<col style="width: 3%" />
<col style="width: 0%" />
<col style="width: 3%" />
<col style="width: 0%" />
<col style="width: 2%" />
<col style="width: 0%" />
<col style="width: 6%" />
<col style="width: 6%" />
<col style="width: 7%" />
<col style="width: 0%" />
<col style="width: 0%" />
<col style="width: 4%" />
<col style="width: 2%" />
<col style="width: 3%" />
<col style="width: 1%" />
<col style="width: 0%" />
<col style="width: 1%" />
<col style="width: 2%" />
<col style="width: 2%" />
<col style="width: 2%" />
<col style="width: 1%" />
<col style="width: 7%" />
</colgroup>
<tbody>
<tr class="odd">
<td colspan="3">1. Crop/Code #</td>
<td colspan="3">2. Unit #</td>
<td colspan="9">3. Legal Description</td>
<td colspan="13" rowspan="3"><p><strong>PRODUCTION
WORKSHEET</strong></p>
<p><strong>(FOR ILLUSTRATION PURPOSES ONLY)</strong></p></td>
<td colspan="11">8. Name of Insured</td>
</tr>
<tr class="even">
<td colspan="3"><strong>SWEETPOTATO</strong></td>
<td colspan="3" rowspan="2"><strong>00100</strong></td>
<td colspan="9"><strong>XXXXXXXXX</strong></td>
<td colspan="11"><strong>I.M. INSURED</strong></td>
</tr>
<tr class="odd">
<td colspan="3"><strong>0085</strong></td>
<td colspan="9"></td>
<td colspan="7">9. Claim #</td>
<td colspan="4">11. Crop Year</td>
</tr>
<tr class="even">
<td colspan="3">4. Date of Damage</td>
<td colspan="3"><strong>MMM DD</strong></td>
<td colspan="5"><strong>MMM DD</strong></td>
<td colspan="4"></td>
<td colspan="6">7. Company</td>
<td colspan="6"><strong>THE COMPANY</strong></td>
<td></td>
<td colspan="7"><strong>XXXXXXX</strong></td>
<td colspan="4"><strong>YYYY</strong></td>
</tr>
<tr class="odd">
<td colspan="3">5. Cause of Damage</td>
<td colspan="3"><strong>HAIL</strong></td>
<td colspan="5"><p><strong>FREEZE</strong></p>
<p><strong>FREEZE</strong></p></td>
<td colspan="4"></td>
<td colspan="6">Agency</td>
<td colspan="6"><strong>THE AGENCY</strong></td>
<td></td>
<td colspan="3">10. Policy #</td>
<td colspan="8"><strong>XX-XXX-XXXX</strong></td>
</tr>
<tr class="even">
<td colspan="3">6. Primary Cause %</td>
<td colspan="3"><strong>80</strong></td>
<td colspan="5"><strong>X</strong></td>
<td colspan="4"></td>
<td colspan="6"></td>
<td colspan="6"></td>
<td></td>
<td colspan="2">14. Date(s)</td>
<td colspan="4">1<sup>st</sup></td>
<td colspan="3">2<sup>nd</sup></td>
<td colspan="2">Final</td>
</tr>
<tr class="odd">
<td colspan="3">12. Additional Units</td>
<td colspan="2"></td>
<td></td>
<td colspan="2"></td>
<td colspan="2"></td>
<td colspan="2"></td>
<td colspan="2"></td>
<td colspan="3"></td>
<td colspan="2"></td>
<td></td>
<td colspan="3"></td>
<td colspan="5" rowspan="2"></td>
<td colspan="2">Notice of Loss</td>
<td colspan="4"><strong>MM/DD/YYYY</strong></td>
<td colspan="3"><strong>MM/DD/YYY</strong></td>
<td colspan="2"><strong>MM/DD/YYYY</strong></td>
</tr>
<tr class="even">
<td colspan="3">13. Est. Prod. Per Acre</td>
<td colspan="2"></td>
<td></td>
<td colspan="2"></td>
<td colspan="2"></td>
<td colspan="2"></td>
<td colspan="2"></td>
<td colspan="3"></td>
<td colspan="2"></td>
<td></td>
<td colspan="3"></td>
<td colspan="5">15. Companion Policy(s)</td>
<td colspan="6"></td>
</tr>
<tr class="odd">
<td colspan="39"><strong>SECTION I - ACREAGE APPRAISED, PRODUCTION AND
ADJUSTMENTS</strong></td>
</tr>
<tr class="even">
<td colspan="22"><strong>ACTUARIAL</strong></td>
<td colspan="14"><strong>POTENTIAL YIELD</strong></td>
<td colspan="3"><strong>STAGE GUARANTEE</strong></td>
</tr>
<tr class="odd">
<td rowspan="2">A</td>
<td rowspan="2">B</td>
<td colspan="2" rowspan="2">C</td>
<td colspan="3" rowspan="2">D</td>
<td colspan="2" rowspan="2">E</td>
<td colspan="4" rowspan="2">F</td>
<td colspan="3" rowspan="2">G</td>
<td colspan="2" rowspan="2">H</td>
<td colspan="4" rowspan="2">I</td>
<td colspan="2" rowspan="2">J</td>
<td>K <sub>1</sub></td>
<td rowspan="2">L</td>
<td colspan="3" rowspan="2">M</td>
<td colspan="3" rowspan="2">N</td>
<td colspan="4" rowspan="2">O</td>
<td colspan="2" rowspan="2">P</td>
<td rowspan="2">Q</td>
</tr>
<tr class="even">
<td>K <sub>2</sub></td>
</tr>
<tr class="odd">
<td rowspan="2"><p>Field</p>
<p>ID</p></td>
<td rowspan="2"><p>Prelim</p>
<p>Acres</p></td>
<td colspan="2" rowspan="2"><p>Final</p>
<p>Acres</p></td>
<td colspan="3" rowspan="2"><p>Interest or</p>
<p>Share</p></td>
<td colspan="2" rowspan="2">Risk</td>
<td colspan="4" rowspan="2">Practice</td>
<td colspan="3" rowspan="2"><p>Type</p>
<p>Class</p></td>
<td colspan="2" rowspan="2">Stage</td>
<td colspan="4" rowspan="2"><p>Intended or</p>
<p>Final Use</p></td>
<td colspan="2" rowspan="2"><p>Appraised</p>
<p>Potential</p></td>
<td>Moisture %</td>
<td rowspan="2"><p>Shell and/or</p>
<p>Quality Factor</p></td>
<td colspan="3" rowspan="2"><p>+ Uninsured</p>
<p>Cause</p></td>
<td colspan="3" rowspan="2"><p>Adjusted</p>
<p>Potential</p></td>
<td colspan="4" rowspan="2"><p>Total To Count</p>
<p>(C x N)</p></td>
<td colspan="2" rowspan="2"><p>Per</p>
<p>Acre</p></td>
<td rowspan="2"><p>Total</p>
<p>(C x P)</p></td>
</tr>
<tr class="even">
<td>Factor</td>
</tr>
<tr class="odd">
<td><strong>A</strong></td>
<td rowspan="2"></td>
<td colspan="2" rowspan="2"><strong>0.1</strong></td>
<td colspan="3" rowspan="2"><strong>1.000</strong></td>
<td colspan="2" rowspan="2"><strong>A01</strong></td>
<td colspan="4" rowspan="2"><strong>002</strong></td>
<td colspan="3" rowspan="2"><strong>097</strong></td>
<td colspan="2" rowspan="2"><strong>M</strong></td>
<td colspan="4" rowspan="2"><strong>UH</strong></td>
<td colspan="2" rowspan="2"><strong>60.0</strong></td>
<td></td>
<td rowspan="2"></td>
<td colspan="3" rowspan="2"><strong>8.0</strong></td>
<td colspan="3" rowspan="2"><strong>68.0</strong></td>
<td colspan="4" rowspan="2"><strong>6.8</strong></td>
<td colspan="2" rowspan="2"><strong>100.0</strong></td>
<td rowspan="2"><strong>10.0</strong></td>
</tr>
<tr class="even">
<td><strong>MM/DD</strong></td>
<td></td>
</tr>
<tr class="odd">
<td><strong>B</strong></td>
<td rowspan="2"></td>
<td colspan="2" rowspan="2"><strong>1.9</strong></td>
<td colspan="3" rowspan="2"><strong>1.000</strong></td>
<td colspan="2" rowspan="2"><strong>A01</strong></td>
<td colspan="4" rowspan="2"><strong>002</strong></td>
<td colspan="3" rowspan="2"><strong>097</strong></td>
<td colspan="2" rowspan="2"><strong>M</strong></td>
<td colspan="4" rowspan="2"><strong>H</strong></td>
<td colspan="2" rowspan="2"><strong>93.0</strong></td>
<td></td>
<td rowspan="2"></td>
<td colspan="3" rowspan="2"><strong>3.4</strong></td>
<td colspan="3" rowspan="2"><strong>96.4</strong></td>
<td colspan="4" rowspan="2"><strong>183.1</strong></td>
<td colspan="2" rowspan="2"><strong>100.0</strong></td>
<td rowspan="2"><strong>190.0</strong></td>
</tr>
<tr class="even">
<td><strong>MM/DD</strong></td>
<td></td>
</tr>
<tr class="odd">
<td rowspan="2"><p><strong>C</strong></p>
<p><strong>MM/DD</strong></p></td>
<td rowspan="2"></td>
<td colspan="2" rowspan="2"><strong>18.0</strong></td>
<td colspan="3" rowspan="2"><strong>1.000</strong></td>
<td colspan="2" rowspan="2"><strong>A01</strong></td>
<td colspan="4" rowspan="2"><strong>002</strong></td>
<td colspan="3" rowspan="2"><strong>097</strong></td>
<td colspan="2" rowspan="2"><strong>M</strong></td>
<td colspan="4" rowspan="2"><strong>H/N</strong></td>
<td colspan="2" rowspan="2"></td>
<td></td>
<td rowspan="2"></td>
<td colspan="3" rowspan="2"><strong>100.0</strong></td>
<td colspan="3" rowspan="2"><strong>100.0</strong></td>
<td colspan="4" rowspan="2"><strong>1,800.0</strong></td>
<td colspan="2" rowspan="2"><strong>100.0</strong></td>
<td rowspan="2"><strong>1,800.0</strong></td>
</tr>
<tr class="even">
<td></td>
</tr>
<tr class="odd">
<td colspan="2" rowspan="2">16. TOTAL</td>
<td colspan="2" rowspan="2"><strong>20.0</strong></td>
<td colspan="28" rowspan="2">17. TOTALS</td>
<td colspan="4" rowspan="2"><strong>1,989.9</strong></td>
<td colspan="2" rowspan="2"></td>
<td rowspan="2"><strong>2,000.00</strong></td>
</tr>
<tr class="even">
</tr>
<tr class="odd">
<td colspan="39" rowspan="2"><p><u>NARRATIVE (If more space is needed,
attach a Special Report) .</u></p>
<p><strong>No acreage released I. M. A. See attached map for field
Identification. Field A and B – samples take to local inspector. Field A
had 8.0 cwt./acre uninsured damage due to improper insect control. Field
B had 3.4 cwt./acre uninsured damage due to improper insect control.
Oversprayed with pesticides XYZ laboratories. All fields are permanent
with acreage measurements on file with insurance company. Field A to be
destroyed MM/DD. For field C, harvested but no check strips were left,
production to count for Field C at the production guarantee since it is
greater than the actual amount harvested.</strong></p></td>
</tr>
<tr class="even">
</tr>
</tbody>
</table>

<table style="width:100%;">
<colgroup>
<col style="width: 4%" />
<col style="width: 4%" />
<col style="width: 0%" />
<col style="width: 2%" />
<col style="width: 3%" />
<col style="width: 3%" />
<col style="width: 1%" />
<col style="width: 5%" />
<col style="width: 0%" />
<col style="width: 3%" />
<col style="width: 0%" />
<col style="width: 3%" />
<col style="width: 1%" />
<col style="width: 4%" />
<col style="width: 0%" />
<col style="width: 3%" />
<col style="width: 0%" />
<col style="width: 4%" />
<col style="width: 3%" />
<col style="width: 1%" />
<col style="width: 4%" />
<col style="width: 8%" />
<col style="width: 5%" />
<col style="width: 5%" />
<col style="width: 0%" />
<col style="width: 2%" />
<col style="width: 3%" />
<col style="width: 4%" />
<col style="width: 5%" />
<col style="width: 0%" />
<col style="width: 7%" />
</colgroup>
<tbody>
<tr class="odd">
<td colspan="31">SECTION II – HARVESTED PRODUCTION</td>
</tr>
<tr class="even">
<td colspan="10"><p>18 Date Harvest Completed</p>
<p>MM/DD/YYYY</p></td>
<td colspan="11"><p>19 Is damage similar to other farms in the area?</p>
<p>Yes No </p></td>
<td colspan="5"><p>20 Assignment of Indemnity?</p>
<blockquote>
<p>Yes No </p>
</blockquote></td>
<td colspan="5"><p>21 Transfer of Right To Indemnity?</p>
<blockquote>
<p>Yes No </p>
</blockquote></td>
</tr>
<tr class="odd">
<td colspan="7">MEASUREMENTS</td>
<td colspan="7">GROSS PRODUCTION</td>
<td colspan="17">ADJUSTMENTS TO HARVESTED PRODUCTION</td>
</tr>
<tr class="even">
<td>A<sub>1</sub></td>
<td rowspan="2">B</td>
<td colspan="2" rowspan="2">C</td>
<td rowspan="2">D</td>
<td rowspan="2">E</td>
<td colspan="2" rowspan="2">F</td>
<td colspan="3" rowspan="2">G</td>
<td colspan="2" rowspan="2">H</td>
<td colspan="2" rowspan="2">I</td>
<td rowspan="2">J</td>
<td colspan="2">K<sub>1</sub></td>
<td colspan="2">L<sub>1</sub></td>
<td>M<sub>1</sub></td>
<td rowspan="2">N</td>
<td rowspan="2">O</td>
<td colspan="2" rowspan="2">P</td>
<td colspan="2">Q<sub>1</sub></td>
<td colspan="2" rowspan="2">R</td>
<td colspan="2" rowspan="2">S</td>
</tr>
<tr class="odd">
<td>A<sub>2</sub></td>
<td colspan="2">K<sub>2</sub></td>
<td colspan="2">L<sub>2</sub></td>
<td>M<sub>2</sub></td>
<td colspan="2">Q<sub>2</sub></td>
</tr>
<tr class="even">
<td>Share</td>
<td rowspan="2"><p>Length</p>
<p>or</p>
<p>Diameter</p></td>
<td colspan="2" rowspan="2">Width</td>
<td rowspan="2">Depth</td>
<td rowspan="2"><p>Deduc-</p>
<p>tion</p></td>
<td colspan="2" rowspan="2"><p>Net Cubic</p>
<p>Feet</p></td>
<td colspan="3" rowspan="2"><p>Conver-</p>
<p>sion</p>
<p>Factor</p></td>
<td colspan="2" rowspan="2"><p>Gross</p>
<p>Prod.</p>
<p>(F x G)</p></td>
<td colspan="2" rowspan="2"><p><del>Bu., Ton,</del></p>
<p><del>Lbs.</del>, Cwt.</p></td>
<td rowspan="2"><p>Shell/</p>
<p>Sugar</p>
<p>Factor</p></td>
<td colspan="2">FM%</td>
<td colspan="2">Moisture%</td>
<td>Test Wt.</td>
<td rowspan="2"><p>Adjusted</p>
<p>Production</p>
<p><del>(HorI)xJxK<sub>2</sub>xL<sub>2</sub>xM<sub>2</sub></del></p></td>
<td rowspan="2"><p>Prod. Not</p>
<p>to Count</p></td>
<td colspan="2" rowspan="2"><p>Production</p>
<p>(N - O)</p></td>
<td colspan="2">Value</td>
<td colspan="2" rowspan="2"><p>Quality</p>
<p>Factor</p>
<p>(Q<sub>1</sub> ÷ Q<sub>2</sub>)</p></td>
<td colspan="2" rowspan="2"><p>Production</p>
<p>To Count</p>
<p>(<del>P X R</del>)</p></td>
</tr>
<tr class="odd">
<td>Field ID</td>
<td colspan="2">Factor</td>
<td colspan="2">Factor</td>
<td>Factor</td>
<td colspan="2">Mkt. Price</td>
</tr>
<tr class="even">
<td rowspan="2"><strong>C</strong></td>
<td colspan="5" rowspan="2"><p>Any Elevator Company,</p>
<p>Any town, Any State</p></td>
<td colspan="2"></td>
<td colspan="3"></td>
<td colspan="2"></td>
<td colspan="2" rowspan="2"><strong>1,200.0</strong></td>
<td></td>
<td colspan="2"></td>
<td colspan="2"></td>
<td></td>
<td rowspan="2"><strong>1,200.0</strong></td>
<td rowspan="2"></td>
<td colspan="2" rowspan="2"></td>
<td colspan="2"></td>
<td colspan="2" rowspan="2"></td>
<td colspan="2" rowspan="4"><strong>1,800.0*</strong></td>
</tr>
<tr class="odd">
<td colspan="2"></td>
<td colspan="3"></td>
<td colspan="2"></td>
<td></td>
<td colspan="2"></td>
<td colspan="2"></td>
<td></td>
<td colspan="2"></td>
</tr>
<tr class="even">
<td rowspan="2"><strong>C</strong></td>
<td rowspan="2"><strong>10.0</strong></td>
<td colspan="2" rowspan="2"><strong>RND</strong></td>
<td rowspan="2"><strong>10.0</strong></td>
<td rowspan="2"></td>
<td colspan="2" rowspan="2"><strong>785.4</strong></td>
<td colspan="3" rowspan="2"><strong>0.4283</strong></td>
<td colspan="2" rowspan="2"><strong>366.4</strong></td>
<td colspan="2" rowspan="2"></td>
<td></td>
<td colspan="2"></td>
<td colspan="2"></td>
<td></td>
<td rowspan="2"><strong>366.4</strong></td>
<td></td>
<td colspan="2" rowspan="2"></td>
<td colspan="2"></td>
<td colspan="2"></td>
</tr>
<tr class="odd">
<td></td>
<td colspan="2"></td>
<td colspan="2"></td>
<td></td>
<td></td>
<td colspan="2"></td>
<td colspan="2"></td>
</tr>
<tr class="even">
<td colspan="24" rowspan="3">I certify the information provided above,
to the best of my knowledge, to be true and complete and that it wi1l be
used to determine my loss, if any, to my insured crops. I understand
that this Production Worksheet and supporting papers are subject to
audit and approval by the company. I understand that this crop insurance
is subsidized and reinsured by the Federal Crop Insurance Corporation,
an agency of the United States. I understand that any false or
inaccurate information may result in the sanctions outlined in my policy
and administrative, civil, and criminal sanctions under 18 U.S.C. §§
1006 and 1014, 7 U.S.C. § 1506, 31 U.S.C. §§ 3729 and other federal
statues</td>
<td colspan="6">22 Section II Total</td>
<td><strong>1,800.0</strong></td>
</tr>
<tr class="odd">
<td colspan="6">23 Section I Total</td>
<td><strong>189.9</strong></td>
</tr>
<tr class="even">
<td colspan="6">24 Unit Total</td>
<td><strong>1,989.9</strong></td>
</tr>
<tr class="odd">
<td colspan="9">25 Adjuster’s Signature</td>
<td colspan="3">Code #</td>
<td colspan="5">Date</td>
<td colspan="7">26 Insured’s Signature</td>
<td colspan="4">Date</td>
<td colspan="3"></td>
</tr>
<tr class="even">
<td colspan="3">1<sup>st</sup> Inspection</td>
<td colspan="6"><strong>I. M. ADJUSTER XXXXX</strong></td>
<td colspan="3">XXXXX</td>
<td colspan="5"><strong>MM/DD/YYYY</strong></td>
<td colspan="2">1<sup>st</sup> Inspection</td>
<td colspan="5"><strong>I. M. INSURED</strong></td>
<td colspan="4"><strong>MM/DD/YYYY</strong></td>
<td colspan="3"></td>
</tr>
<tr class="odd">
<td colspan="3">2<sup>nd</sup> Inspection</td>
<td colspan="6"></td>
<td colspan="3"></td>
<td colspan="5"></td>
<td colspan="2">2<sup>nd</sup> Inspection</td>
<td colspan="5"></td>
<td colspan="4"></td>
<td colspan="3"></td>
</tr>
<tr class="even">
<td colspan="3">Final Inspection</td>
<td colspan="6"><strong>I. M. ADJUSTER XXXXX</strong></td>
<td colspan="3">XXXXX</td>
<td colspan="5"><strong>MM/DD/YYYY</strong></td>
<td colspan="2">Final Inspection</td>
<td colspan="5"><strong>I. M. INSURED</strong></td>
<td colspan="4"><strong>MM/DD/YYYY</strong></td>
<td colspan="3"><sup>27</sup> Page _<strong><u>1</u></strong>_ of
_<strong><u>1</u></strong>_</td>
</tr>
</tbody>
</table>

**\* For field C, Production to Count at the guarantee level because
check strips were not left.**

  -------------------------- ------------------ --------- -------- -------- ----------
  **SWEETPOTATO GROWING      **PART I:**                                    
  SEASON\                                                                   
  INSPECTION WORKSHEET**                                                    

                             1 NAME OF INSURED            2 POLICY 3 COUNTY 
                                                          NO.               

                             4 UNIT NUMBER /    5 VARIETY                   6 STAGE
                             FSA FARM No.                                   
  -------------------------- ------------------ --------- -------- -------- ----------

> **PART II:**

<table style="width:100%;">
<colgroup>
<col style="width: 7%" />
<col style="width: 6%" />
<col style="width: 9%" />
<col style="width: 6%" />
<col style="width: 8%" />
<col style="width: 6%" />
<col style="width: 8%" />
<col style="width: 8%" />
<col style="width: 8%" />
<col style="width: 8%" />
<col style="width: 7%" />
<col style="width: 6%" />
<col style="width: 8%" />
</colgroup>
<tbody>
<tr class="odd">
<td>Field ID/ Planting Density<br />
7</td>
<td><p>Number of Acres</p>
<p>8</p></td>
<td><p>Number of Plants/<br />
Samples</p>
<p>9</p></td>
<td><p>Fraction</p>
<p>of Crop</p>
<p>Sampled<br />
10</p></td>
<td><p>Date Planted/</p>
<p>Stage</p>
<p>11</p></td>
<td><p>Guarantee</p>
<p>12</p></td>
<td>Sample Plants Destroyed by Insured Causes<br />
13</td>
<td><p>Sample Plants Damaged by</p>
<p>Insured Causes<br />
14</p></td>
<td>Sample Plants Destroyed by Uninsured Causes<br />
15</td>
<td>Sample Plants Damaged by Uninsured Causes<br />
16</td>
<td><p>Damage Cause Ratios</p>
<p>17</p></td>
<td><p>Total</p>
<p>Uninsured</p>
<p>Plant Losses<br />
18</p></td>
<td>Total Uninsured Production Loss to Count<br />
19</td>
</tr>
<tr class="even">
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
</tr>
</tbody>
</table>

> **Part III**.

<table>
<colgroup>
<col style="width: 2%" />
<col style="width: 2%" />
<col style="width: 2%" />
<col style="width: 2%" />
<col style="width: 2%" />
<col style="width: 2%" />
<col style="width: 2%" />
<col style="width: 2%" />
<col style="width: 2%" />
<col style="width: 2%" />
<col style="width: 2%" />
<col style="width: 2%" />
<col style="width: 2%" />
<col style="width: 2%" />
<col style="width: 2%" />
<col style="width: 2%" />
<col style="width: 2%" />
<col style="width: 2%" />
<col style="width: 2%" />
<col style="width: 2%" />
<col style="width: 2%" />
<col style="width: 2%" />
<col style="width: 2%" />
<col style="width: 2%" />
<col style="width: 2%" />
<col style="width: 2%" />
<col style="width: 2%" />
<col style="width: 2%" />
<col style="width: 2%" />
<col style="width: 2%" />
<col style="width: 2%" />
<col style="width: 2%" />
<col style="width: 2%" />
<col style="width: 2%" />
<col style="width: 2%" />
</colgroup>
<tbody>
<tr class="odd">
<td>20</td>
<td>21</td>
<td>22</td>
<td>23</td>
<td>24</td>
<td>20</td>
<td>21</td>
<td>22</td>
<td>23</td>
<td>24</td>
<td>20</td>
<td>21</td>
<td>22</td>
<td>23</td>
<td>24</td>
<td>20</td>
<td>21</td>
<td>22</td>
<td>23</td>
<td>24</td>
<td>20</td>
<td>21</td>
<td>22</td>
<td>23</td>
<td>24</td>
<td>20</td>
<td>21</td>
<td>22</td>
<td>23</td>
<td>24</td>
<td>20</td>
<td>21</td>
<td>22</td>
<td>23</td>
<td>24</td>
</tr>
<tr class="even">
<td>Sample Number</td>
<td><p>Destroyed by</p>
<p>Insured Causes</p></td>
<td>Damaged by Insured Causes</td>
<td><p>Destroyed by</p>
<p>Uninsured Causes</p></td>
<td><p>Damaged by</p>
<p>Uninsured Causes</p></td>
<td>Sample Number</td>
<td><p>Destroyed by</p>
<p>Insured Causes</p></td>
<td>Damaged by Insured Causes</td>
<td><p>Destroyed by</p>
<p>Uninsured Causes</p></td>
<td><p>Damaged by</p>
<p>Uninsured Causes</p></td>
<td>Sample Number</td>
<td><p>Destroyed by</p>
<p>Insured Causes</p></td>
<td>Damaged by Insured Causes</td>
<td><p>Destroyed by</p>
<p>Uninsured Causes</p></td>
<td><p>Damaged by</p>
<p>Uninsured Causes</p></td>
<td>Sample Number</td>
<td><p>Destroyed by</p>
<p>Insured Causes</p></td>
<td>Damaged by Insured Causes</td>
<td><p>Destroyed by</p>
<p>Uninsured Causes</p></td>
<td><p>Damaged by</p>
<p>Uninsured Causes</p></td>
<td>Sample Number</td>
<td><p>Destroyed by</p>
<p>Insured Causes</p></td>
<td>Damaged by Insured Causes</td>
<td><p>Destroyed by</p>
<p>Uninsured Causes</p></td>
<td><p>Damaged by</p>
<p>Uninsured Causes</p></td>
<td>Sample Number</td>
<td><p>Destroyed by</p>
<p>Insured Causes</p></td>
<td>Damaged by Insured Causes</td>
<td><p>Destroyed by</p>
<p>Uninsured Causes</p></td>
<td><p>Damaged by</p>
<p>Uninsured Causes</p></td>
<td>Sample Number</td>
<td><p>Destroyed by</p>
<p>Insured Causes</p></td>
<td>Damaged by Insured Causes</td>
<td><p>Destroyed by</p>
<p>Uninsured Causes</p></td>
<td><p>Damaged by</p>
<p>Uninsured Causes</p></td>
</tr>
<tr class="odd">
<td>1</td>
<td></td>
<td></td>
<td></td>
<td></td>
<td>16</td>
<td></td>
<td></td>
<td></td>
<td></td>
<td>31</td>
<td></td>
<td></td>
<td></td>
<td></td>
<td>46</td>
<td></td>
<td></td>
<td></td>
<td></td>
<td>61</td>
<td></td>
<td></td>
<td></td>
<td></td>
<td>76</td>
<td></td>
<td></td>
<td></td>
<td></td>
<td>91</td>
<td></td>
<td></td>
<td></td>
<td></td>
</tr>
<tr class="even">
<td>2</td>
<td></td>
<td></td>
<td></td>
<td></td>
<td>17</td>
<td></td>
<td></td>
<td></td>
<td></td>
<td>32</td>
<td></td>
<td></td>
<td></td>
<td></td>
<td>47</td>
<td></td>
<td></td>
<td></td>
<td></td>
<td>62</td>
<td></td>
<td></td>
<td></td>
<td></td>
<td>77</td>
<td></td>
<td></td>
<td></td>
<td></td>
<td>92</td>
<td></td>
<td></td>
<td></td>
<td></td>
</tr>
<tr class="odd">
<td>3</td>
<td></td>
<td></td>
<td></td>
<td></td>
<td>18</td>
<td></td>
<td></td>
<td></td>
<td></td>
<td>33</td>
<td></td>
<td></td>
<td></td>
<td></td>
<td>48</td>
<td></td>
<td></td>
<td></td>
<td></td>
<td>63</td>
<td></td>
<td></td>
<td></td>
<td></td>
<td>78</td>
<td></td>
<td></td>
<td></td>
<td></td>
<td>93</td>
<td></td>
<td></td>
<td></td>
<td></td>
</tr>
<tr class="even">
<td>4</td>
<td></td>
<td></td>
<td></td>
<td></td>
<td>19</td>
<td></td>
<td></td>
<td></td>
<td></td>
<td>34</td>
<td></td>
<td></td>
<td></td>
<td></td>
<td>49</td>
<td></td>
<td></td>
<td></td>
<td></td>
<td>64</td>
<td></td>
<td></td>
<td></td>
<td></td>
<td>79</td>
<td></td>
<td></td>
<td></td>
<td></td>
<td>94</td>
<td></td>
<td></td>
<td></td>
<td></td>
</tr>
<tr class="odd">
<td>5</td>
<td></td>
<td></td>
<td></td>
<td></td>
<td>20</td>
<td></td>
<td></td>
<td></td>
<td></td>
<td>35</td>
<td></td>
<td></td>
<td></td>
<td></td>
<td>50</td>
<td></td>
<td></td>
<td></td>
<td></td>
<td>65</td>
<td></td>
<td></td>
<td></td>
<td></td>
<td>80</td>
<td></td>
<td></td>
<td></td>
<td></td>
<td>95</td>
<td></td>
<td></td>
<td></td>
<td></td>
</tr>
<tr class="even">
<td>6</td>
<td></td>
<td></td>
<td></td>
<td></td>
<td>21</td>
<td></td>
<td></td>
<td></td>
<td></td>
<td>36</td>
<td></td>
<td></td>
<td></td>
<td></td>
<td>51</td>
<td></td>
<td></td>
<td></td>
<td></td>
<td>66</td>
<td></td>
<td></td>
<td></td>
<td></td>
<td>81</td>
<td></td>
<td></td>
<td></td>
<td></td>
<td>96</td>
<td></td>
<td></td>
<td></td>
<td></td>
</tr>
<tr class="odd">
<td>7</td>
<td></td>
<td></td>
<td></td>
<td></td>
<td>22</td>
<td></td>
<td></td>
<td></td>
<td></td>
<td>37</td>
<td></td>
<td></td>
<td></td>
<td></td>
<td>52</td>
<td></td>
<td></td>
<td></td>
<td></td>
<td>67</td>
<td></td>
<td></td>
<td></td>
<td></td>
<td>82</td>
<td></td>
<td></td>
<td></td>
<td></td>
<td>97</td>
<td></td>
<td></td>
<td></td>
<td></td>
</tr>
<tr class="even">
<td>8</td>
<td></td>
<td></td>
<td></td>
<td></td>
<td>23</td>
<td></td>
<td></td>
<td></td>
<td></td>
<td>38</td>
<td></td>
<td></td>
<td></td>
<td></td>
<td>53</td>
<td></td>
<td></td>
<td></td>
<td></td>
<td>68</td>
<td></td>
<td></td>
<td></td>
<td></td>
<td>83</td>
<td></td>
<td></td>
<td></td>
<td></td>
<td>98</td>
<td></td>
<td></td>
<td></td>
<td></td>
</tr>
<tr class="odd">
<td>9</td>
<td></td>
<td></td>
<td></td>
<td></td>
<td>24</td>
<td></td>
<td></td>
<td></td>
<td></td>
<td>39</td>
<td></td>
<td></td>
<td></td>
<td></td>
<td>54</td>
<td></td>
<td></td>
<td></td>
<td></td>
<td>69</td>
<td></td>
<td></td>
<td></td>
<td></td>
<td>84</td>
<td></td>
<td></td>
<td></td>
<td></td>
<td>99</td>
<td></td>
<td></td>
<td></td>
<td></td>
</tr>
<tr class="even">
<td>10</td>
<td></td>
<td></td>
<td></td>
<td></td>
<td>25</td>
<td></td>
<td></td>
<td></td>
<td></td>
<td>40</td>
<td></td>
<td></td>
<td></td>
<td></td>
<td>55</td>
<td></td>
<td></td>
<td></td>
<td></td>
<td>70</td>
<td></td>
<td></td>
<td></td>
<td></td>
<td>85</td>
<td></td>
<td></td>
<td></td>
<td></td>
<td>100</td>
<td></td>
<td></td>
<td></td>
<td></td>
</tr>
<tr class="odd">
<td>11</td>
<td></td>
<td></td>
<td></td>
<td></td>
<td>26</td>
<td></td>
<td></td>
<td></td>
<td></td>
<td>41</td>
<td></td>
<td></td>
<td></td>
<td></td>
<td>56</td>
<td></td>
<td></td>
<td></td>
<td></td>
<td>71</td>
<td></td>
<td></td>
<td></td>
<td></td>
<td>86</td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
</tr>
<tr class="even">
<td>12</td>
<td></td>
<td></td>
<td></td>
<td></td>
<td>27</td>
<td></td>
<td></td>
<td></td>
<td></td>
<td>42</td>
<td></td>
<td></td>
<td></td>
<td></td>
<td>57</td>
<td></td>
<td></td>
<td></td>
<td></td>
<td>72</td>
<td></td>
<td></td>
<td></td>
<td></td>
<td>87</td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
</tr>
<tr class="odd">
<td>13</td>
<td></td>
<td></td>
<td></td>
<td></td>
<td>28</td>
<td></td>
<td></td>
<td></td>
<td></td>
<td>43</td>
<td></td>
<td></td>
<td></td>
<td></td>
<td>58</td>
<td></td>
<td></td>
<td></td>
<td></td>
<td>73</td>
<td></td>
<td></td>
<td></td>
<td></td>
<td>88</td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
</tr>
<tr class="even">
<td>14</td>
<td></td>
<td></td>
<td></td>
<td></td>
<td>29</td>
<td></td>
<td></td>
<td></td>
<td></td>
<td>44</td>
<td></td>
<td></td>
<td></td>
<td></td>
<td>59</td>
<td></td>
<td></td>
<td></td>
<td></td>
<td>74</td>
<td></td>
<td></td>
<td></td>
<td></td>
<td>89</td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
</tr>
<tr class="odd">
<td>15</td>
<td></td>
<td></td>
<td></td>
<td></td>
<td>30</td>
<td></td>
<td></td>
<td></td>
<td></td>
<td>45</td>
<td></td>
<td></td>
<td></td>
<td></td>
<td>60</td>
<td></td>
<td></td>
<td></td>
<td></td>
<td>75</td>
<td></td>
<td></td>
<td></td>
<td></td>
<td>90</td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
</tr>
<tr class="even">
<td colspan="9" rowspan="2">25 SIGNATURE OF INSURED</td>
<td colspan="5" rowspan="2">DATE</td>
<td colspan="8" rowspan="2">26 SIGNATURE OF ADJUSTER</td>
<td colspan="5" rowspan="2">DATE</td>
<td colspan="4" rowspan="2"><strong>TOTALS</strong></td>
<td></td>
<td></td>
<td></td>
<td></td>
</tr>
<tr class="odd">
<td colspan="4"></td>
</tr>
</tbody>
</table>

> Page \_1\_\_ of \_\_\_\_Pages
>
> **PART III:**

<table>
<colgroup>
<col style="width: 2%" />
<col style="width: 2%" />
<col style="width: 2%" />
<col style="width: 2%" />
<col style="width: 2%" />
<col style="width: 2%" />
<col style="width: 2%" />
<col style="width: 2%" />
<col style="width: 2%" />
<col style="width: 2%" />
<col style="width: 2%" />
<col style="width: 2%" />
<col style="width: 2%" />
<col style="width: 2%" />
<col style="width: 2%" />
<col style="width: 2%" />
<col style="width: 2%" />
<col style="width: 2%" />
<col style="width: 2%" />
<col style="width: 2%" />
<col style="width: 2%" />
<col style="width: 2%" />
<col style="width: 2%" />
<col style="width: 2%" />
<col style="width: 2%" />
<col style="width: 2%" />
<col style="width: 2%" />
<col style="width: 2%" />
<col style="width: 2%" />
<col style="width: 2%" />
<col style="width: 2%" />
<col style="width: 2%" />
<col style="width: 2%" />
<col style="width: 2%" />
<col style="width: 2%" />
</colgroup>
<tbody>
<tr class="odd">
<td>20</td>
<td>21</td>
<td>22</td>
<td>23</td>
<td>24</td>
<td>20</td>
<td>21</td>
<td>22</td>
<td>23</td>
<td>24</td>
<td>20</td>
<td>21</td>
<td>22</td>
<td>23</td>
<td>24</td>
<td>20</td>
<td>21</td>
<td>22</td>
<td>23</td>
<td>24</td>
<td>20</td>
<td>21</td>
<td>22</td>
<td>23</td>
<td>24</td>
<td>20</td>
<td>21</td>
<td>22</td>
<td>23</td>
<td>24</td>
<td>20</td>
<td>21</td>
<td>22</td>
<td>23</td>
<td>24</td>
</tr>
<tr class="even">
<td>Sample Number</td>
<td><p>Destroyed by</p>
<p>Insured Causes</p></td>
<td>Damaged by Insured Causes</td>
<td><p>Destroyed by</p>
<p>Uninsured Causes</p></td>
<td><p>Damaged by</p>
<p>Uninsured Causes</p></td>
<td>Sample Number</td>
<td><p>Destroyed by</p>
<p>Insured Causes</p></td>
<td>Damaged by Insured Causes</td>
<td><p>Destroyed by</p>
<p>Uninsured Causes</p></td>
<td><p>Damaged by</p>
<p>Uninsured Causes</p></td>
<td>Sample Number</td>
<td><p>Destroyed by</p>
<p>Insured Causes</p></td>
<td>Damaged by Insured Causes</td>
<td><p>Destroyed by</p>
<p>Uninsured Causes</p></td>
<td><p>Damaged by</p>
<p>Uninsured Causes</p></td>
<td>Sample Number</td>
<td><p>Destroyed by</p>
<p>Insured Causes</p></td>
<td>Damaged by Insured Causes</td>
<td><p>Destroyed by</p>
<p>Uninsured Causes</p></td>
<td><p>Damaged by</p>
<p>Uninsured Causes</p></td>
<td>Sample Number</td>
<td><p>Destroyed by</p>
<p>Insured Causes</p></td>
<td>Damaged by Insured Causes</td>
<td><p>Destroyed by</p>
<p>Uninsured Causes</p></td>
<td><p>Damaged by</p>
<p>Uninsured Causes</p></td>
<td>Sample Number</td>
<td><p>Destroyed by</p>
<p>Insured Causes</p></td>
<td>Damaged by Insured Causes</td>
<td><p>Destroyed by</p>
<p>Uninsured Causes</p></td>
<td><p>Damaged by</p>
<p>Uninsured Causes</p></td>
<td>Sample Number</td>
<td><p>Destroyed by</p>
<p>Insured Causes</p></td>
<td>Damaged by Insured Causes</td>
<td><p>Destroyed by</p>
<p>Uninsured Causes</p></td>
<td><p>Damaged by</p>
<p>Uninsured Causes</p></td>
</tr>
<tr class="odd">
<td>1</td>
<td></td>
<td></td>
<td></td>
<td></td>
<td>26</td>
<td></td>
<td></td>
<td></td>
<td></td>
<td>51</td>
<td></td>
<td></td>
<td></td>
<td></td>
<td>76</td>
<td></td>
<td></td>
<td></td>
<td></td>
<td>101</td>
<td></td>
<td></td>
<td></td>
<td></td>
<td>126</td>
<td></td>
<td></td>
<td></td>
<td></td>
<td>151</td>
<td></td>
<td></td>
<td></td>
<td></td>
</tr>
<tr class="even">
<td>2</td>
<td></td>
<td></td>
<td></td>
<td></td>
<td>27</td>
<td></td>
<td></td>
<td></td>
<td></td>
<td>52</td>
<td></td>
<td></td>
<td></td>
<td></td>
<td>77</td>
<td></td>
<td></td>
<td></td>
<td></td>
<td>102</td>
<td></td>
<td></td>
<td></td>
<td></td>
<td>127</td>
<td></td>
<td></td>
<td></td>
<td></td>
<td>152</td>
<td></td>
<td></td>
<td></td>
<td></td>
</tr>
<tr class="odd">
<td>3</td>
<td></td>
<td></td>
<td></td>
<td></td>
<td>28</td>
<td></td>
<td></td>
<td></td>
<td></td>
<td>53</td>
<td></td>
<td></td>
<td></td>
<td></td>
<td>78</td>
<td></td>
<td></td>
<td></td>
<td></td>
<td>103</td>
<td></td>
<td></td>
<td></td>
<td></td>
<td>128</td>
<td></td>
<td></td>
<td></td>
<td></td>
<td>153</td>
<td></td>
<td></td>
<td></td>
<td></td>
</tr>
<tr class="even">
<td>4</td>
<td></td>
<td></td>
<td></td>
<td></td>
<td>29</td>
<td></td>
<td></td>
<td></td>
<td></td>
<td>54</td>
<td></td>
<td></td>
<td></td>
<td></td>
<td>79</td>
<td></td>
<td></td>
<td></td>
<td></td>
<td>104</td>
<td></td>
<td></td>
<td></td>
<td></td>
<td>129</td>
<td></td>
<td></td>
<td></td>
<td></td>
<td>154</td>
<td></td>
<td></td>
<td></td>
<td></td>
</tr>
<tr class="odd">
<td>5</td>
<td></td>
<td></td>
<td></td>
<td></td>
<td>30</td>
<td></td>
<td></td>
<td></td>
<td></td>
<td>55</td>
<td></td>
<td></td>
<td></td>
<td></td>
<td>80</td>
<td></td>
<td></td>
<td></td>
<td></td>
<td>105</td>
<td></td>
<td></td>
<td></td>
<td></td>
<td>130</td>
<td></td>
<td></td>
<td></td>
<td></td>
<td>155</td>
<td></td>
<td></td>
<td></td>
<td></td>
</tr>
<tr class="even">
<td>6</td>
<td></td>
<td></td>
<td></td>
<td></td>
<td>31</td>
<td></td>
<td></td>
<td></td>
<td></td>
<td>56</td>
<td></td>
<td></td>
<td></td>
<td></td>
<td>81</td>
<td></td>
<td></td>
<td></td>
<td></td>
<td>106</td>
<td></td>
<td></td>
<td></td>
<td></td>
<td>131</td>
<td></td>
<td></td>
<td></td>
<td></td>
<td>156</td>
<td></td>
<td></td>
<td></td>
<td></td>
</tr>
<tr class="odd">
<td>7</td>
<td></td>
<td></td>
<td></td>
<td></td>
<td>32</td>
<td></td>
<td></td>
<td></td>
<td></td>
<td>57</td>
<td></td>
<td></td>
<td></td>
<td></td>
<td>82</td>
<td></td>
<td></td>
<td></td>
<td></td>
<td>107</td>
<td></td>
<td></td>
<td></td>
<td></td>
<td>132</td>
<td></td>
<td></td>
<td></td>
<td></td>
<td>157</td>
<td></td>
<td></td>
<td></td>
<td></td>
</tr>
<tr class="even">
<td>8</td>
<td></td>
<td></td>
<td></td>
<td></td>
<td>33</td>
<td></td>
<td></td>
<td></td>
<td></td>
<td>58</td>
<td></td>
<td></td>
<td></td>
<td></td>
<td>83</td>
<td></td>
<td></td>
<td></td>
<td></td>
<td>108</td>
<td></td>
<td></td>
<td></td>
<td></td>
<td>133</td>
<td></td>
<td></td>
<td></td>
<td></td>
<td>158</td>
<td></td>
<td></td>
<td></td>
<td></td>
</tr>
<tr class="odd">
<td>9</td>
<td></td>
<td></td>
<td></td>
<td></td>
<td>34</td>
<td></td>
<td></td>
<td></td>
<td></td>
<td>59</td>
<td></td>
<td></td>
<td></td>
<td></td>
<td>84</td>
<td></td>
<td></td>
<td></td>
<td></td>
<td>109</td>
<td></td>
<td></td>
<td></td>
<td></td>
<td>134</td>
<td></td>
<td></td>
<td></td>
<td></td>
<td>159</td>
<td></td>
<td></td>
<td></td>
<td></td>
</tr>
<tr class="even">
<td>10</td>
<td></td>
<td></td>
<td></td>
<td></td>
<td>35</td>
<td></td>
<td></td>
<td></td>
<td></td>
<td>60</td>
<td></td>
<td></td>
<td></td>
<td></td>
<td>85</td>
<td></td>
<td></td>
<td></td>
<td></td>
<td>110</td>
<td></td>
<td></td>
<td></td>
<td></td>
<td>135</td>
<td></td>
<td></td>
<td></td>
<td></td>
<td>160</td>
<td></td>
<td></td>
<td></td>
<td></td>
</tr>
<tr class="odd">
<td>11</td>
<td></td>
<td></td>
<td></td>
<td></td>
<td>36</td>
<td></td>
<td></td>
<td></td>
<td></td>
<td>61</td>
<td></td>
<td></td>
<td></td>
<td></td>
<td>86</td>
<td></td>
<td></td>
<td></td>
<td></td>
<td>111</td>
<td></td>
<td></td>
<td></td>
<td></td>
<td>136</td>
<td></td>
<td></td>
<td></td>
<td></td>
<td>161</td>
<td></td>
<td></td>
<td></td>
<td></td>
</tr>
<tr class="even">
<td>12</td>
<td></td>
<td></td>
<td></td>
<td></td>
<td>37</td>
<td></td>
<td></td>
<td></td>
<td></td>
<td>62</td>
<td></td>
<td></td>
<td></td>
<td></td>
<td>87</td>
<td></td>
<td></td>
<td></td>
<td></td>
<td>112</td>
<td></td>
<td></td>
<td></td>
<td></td>
<td>137</td>
<td></td>
<td></td>
<td></td>
<td></td>
<td>162</td>
<td></td>
<td></td>
<td></td>
<td></td>
</tr>
<tr class="odd">
<td>13</td>
<td></td>
<td></td>
<td></td>
<td></td>
<td>38</td>
<td></td>
<td></td>
<td></td>
<td></td>
<td>63</td>
<td></td>
<td></td>
<td></td>
<td></td>
<td>88</td>
<td></td>
<td></td>
<td></td>
<td></td>
<td>113</td>
<td></td>
<td></td>
<td></td>
<td></td>
<td>138</td>
<td></td>
<td></td>
<td></td>
<td></td>
<td>163</td>
<td></td>
<td></td>
<td></td>
<td></td>
</tr>
<tr class="even">
<td>14</td>
<td></td>
<td></td>
<td></td>
<td></td>
<td>39</td>
<td></td>
<td></td>
<td></td>
<td></td>
<td>64</td>
<td></td>
<td></td>
<td></td>
<td></td>
<td>89</td>
<td></td>
<td></td>
<td></td>
<td></td>
<td>114</td>
<td></td>
<td></td>
<td></td>
<td></td>
<td>139</td>
<td></td>
<td></td>
<td></td>
<td></td>
<td>164</td>
<td></td>
<td></td>
<td></td>
<td></td>
</tr>
<tr class="odd">
<td>15</td>
<td></td>
<td></td>
<td></td>
<td></td>
<td>40</td>
<td></td>
<td></td>
<td></td>
<td></td>
<td>65</td>
<td></td>
<td></td>
<td></td>
<td></td>
<td>90</td>
<td></td>
<td></td>
<td></td>
<td></td>
<td>115</td>
<td></td>
<td></td>
<td></td>
<td></td>
<td>140</td>
<td></td>
<td></td>
<td></td>
<td></td>
<td>165</td>
<td></td>
<td></td>
<td></td>
<td></td>
</tr>
<tr class="even">
<td>16</td>
<td></td>
<td></td>
<td></td>
<td></td>
<td>41</td>
<td></td>
<td></td>
<td></td>
<td></td>
<td>66</td>
<td></td>
<td></td>
<td></td>
<td></td>
<td>91</td>
<td></td>
<td></td>
<td></td>
<td></td>
<td>116</td>
<td></td>
<td></td>
<td></td>
<td></td>
<td>141</td>
<td></td>
<td></td>
<td></td>
<td></td>
<td>166</td>
<td></td>
<td></td>
<td></td>
<td></td>
</tr>
<tr class="odd">
<td>17</td>
<td></td>
<td></td>
<td></td>
<td></td>
<td>42</td>
<td></td>
<td></td>
<td></td>
<td></td>
<td>67</td>
<td></td>
<td></td>
<td></td>
<td></td>
<td>92</td>
<td></td>
<td></td>
<td></td>
<td></td>
<td>117</td>
<td></td>
<td></td>
<td></td>
<td></td>
<td>142</td>
<td></td>
<td></td>
<td></td>
<td></td>
<td>167</td>
<td></td>
<td></td>
<td></td>
<td></td>
</tr>
<tr class="even">
<td>18</td>
<td></td>
<td></td>
<td></td>
<td></td>
<td>43</td>
<td></td>
<td></td>
<td></td>
<td></td>
<td>68</td>
<td></td>
<td></td>
<td></td>
<td></td>
<td>93</td>
<td></td>
<td></td>
<td></td>
<td></td>
<td>118</td>
<td></td>
<td></td>
<td></td>
<td></td>
<td>143</td>
<td></td>
<td></td>
<td></td>
<td></td>
<td>168</td>
<td></td>
<td></td>
<td></td>
<td></td>
</tr>
<tr class="odd">
<td>19</td>
<td></td>
<td></td>
<td></td>
<td></td>
<td>44</td>
<td></td>
<td></td>
<td></td>
<td></td>
<td>69</td>
<td></td>
<td></td>
<td></td>
<td></td>
<td>94</td>
<td></td>
<td></td>
<td></td>
<td></td>
<td>119</td>
<td></td>
<td></td>
<td></td>
<td></td>
<td>144</td>
<td></td>
<td></td>
<td></td>
<td></td>
<td>169</td>
<td></td>
<td></td>
<td></td>
<td></td>
</tr>
<tr class="even">
<td>20</td>
<td></td>
<td></td>
<td></td>
<td></td>
<td>45</td>
<td></td>
<td></td>
<td></td>
<td></td>
<td>70</td>
<td></td>
<td></td>
<td></td>
<td></td>
<td>95</td>
<td></td>
<td></td>
<td></td>
<td></td>
<td>120</td>
<td></td>
<td></td>
<td></td>
<td></td>
<td>145</td>
<td></td>
<td></td>
<td></td>
<td></td>
<td>170</td>
<td></td>
<td></td>
<td></td>
<td></td>
</tr>
<tr class="odd">
<td>21</td>
<td></td>
<td></td>
<td></td>
<td></td>
<td>46</td>
<td></td>
<td></td>
<td></td>
<td></td>
<td>71</td>
<td></td>
<td></td>
<td></td>
<td></td>
<td>96</td>
<td></td>
<td></td>
<td></td>
<td></td>
<td>121</td>
<td></td>
<td></td>
<td></td>
<td></td>
<td>146</td>
<td></td>
<td></td>
<td></td>
<td></td>
<td>171</td>
<td></td>
<td></td>
<td></td>
<td></td>
</tr>
<tr class="even">
<td>22</td>
<td></td>
<td></td>
<td></td>
<td></td>
<td>47</td>
<td></td>
<td></td>
<td></td>
<td></td>
<td>72</td>
<td></td>
<td></td>
<td></td>
<td></td>
<td>97</td>
<td></td>
<td></td>
<td></td>
<td></td>
<td>122</td>
<td></td>
<td></td>
<td></td>
<td></td>
<td>147</td>
<td></td>
<td></td>
<td></td>
<td></td>
<td>172</td>
<td></td>
<td></td>
<td></td>
<td></td>
</tr>
<tr class="odd">
<td>23</td>
<td></td>
<td></td>
<td></td>
<td></td>
<td>48</td>
<td></td>
<td></td>
<td></td>
<td></td>
<td>73</td>
<td></td>
<td></td>
<td></td>
<td></td>
<td>98</td>
<td></td>
<td></td>
<td></td>
<td></td>
<td>123</td>
<td></td>
<td></td>
<td></td>
<td></td>
<td>148</td>
<td></td>
<td></td>
<td></td>
<td></td>
<td>173</td>
<td></td>
<td></td>
<td></td>
<td></td>
</tr>
<tr class="even">
<td>24</td>
<td></td>
<td></td>
<td></td>
<td></td>
<td>49</td>
<td></td>
<td></td>
<td></td>
<td></td>
<td>74</td>
<td></td>
<td></td>
<td></td>
<td></td>
<td>99</td>
<td></td>
<td></td>
<td></td>
<td></td>
<td>124</td>
<td></td>
<td></td>
<td></td>
<td></td>
<td>149</td>
<td></td>
<td></td>
<td></td>
<td></td>
<td>174</td>
<td></td>
<td></td>
<td></td>
<td></td>
</tr>
<tr class="odd">
<td>25</td>
<td></td>
<td></td>
<td></td>
<td></td>
<td>50</td>
<td></td>
<td></td>
<td></td>
<td></td>
<td>75</td>
<td></td>
<td></td>
<td></td>
<td></td>
<td>100</td>
<td></td>
<td></td>
<td></td>
<td></td>
<td>125</td>
<td></td>
<td></td>
<td></td>
<td></td>
<td>150</td>
<td></td>
<td></td>
<td></td>
<td></td>
<td>175</td>
<td></td>
<td></td>
<td></td>
<td></td>
</tr>
<tr class="even">
<td colspan="26" rowspan="3"></td>
<td colspan="5">TOTAL</td>
<td></td>
<td></td>
<td></td>
<td></td>
</tr>
<tr class="odd">
<td colspan="5">PREVIOUS TOTAL</td>
<td></td>
<td></td>
<td></td>
<td></td>
</tr>
<tr class="even">
<td colspan="5"><strong>CUMULATIVE TOTAL</strong></td>
<td></td>
<td></td>
<td></td>
<td></td>
</tr>
</tbody>
</table>

Page \_\_ \_\_ of \_\_\_ \_\_\_Pages

  ------------------------- ------------------- --------- -------- -------- ----------
  **FINAL SWEETPOTATO\      **PART I:**                                     
  APPRAISAL WORKSHEET**                                                     

                            1 NAME OF INSURED             2 POLICY 3 COUNTY 
                                                          NO.               

                            4 UNIT NUMBER / FSA 5 VARIETY                   6 STAGE
                            FARM No.                                        
  ------------------------- ------------------- --------- -------- -------- ----------

> **PART II:**

<table>
<colgroup>
<col style="width: 7%" />
<col style="width: 6%" />
<col style="width: 9%" />
<col style="width: 6%" />
<col style="width: 8%" />
<col style="width: 7%" />
<col style="width: 7%" />
<col style="width: 7%" />
<col style="width: 7%" />
<col style="width: 7%" />
<col style="width: 8%" />
<col style="width: 8%" />
<col style="width: 8%" />
</colgroup>
<tbody>
<tr class="odd">
<td>Field ID/ Planting Density<br />
7</td>
<td><p>Number of Acres</p>
<p>8</p></td>
<td><p>Number of Plants/<br />
Samples</p>
<p>9</p></td>
<td><p>Fraction</p>
<p>of Crop</p>
<p>Sampled<br />
10</p></td>
<td><p>Date Planted/</p>
<p>Stage</p>
<p>11</p></td>
<td><p>Guarantee</p>
<p>12</p></td>
<td>Harvested Weight of Samples<br />
13</td>
<td><p>Preliminary</p>
<p>Appraised Production<br />
14</p></td>
<td><p>Appraised</p>
<p>Potential<br />
15</p></td>
<td>Uninsured Production Loss/Potential<br />
16</td>
<td><p>Condition of Field on Appraisal</p>
<p>Date<br />
17</p></td>
<td><p>Anticipated Harvest</p>
<p>Date<br />
18</p></td>
<td><p>Adjusted</p>
<p>Potential per</p>
<p>Acre<br />
19</p></td>
</tr>
<tr class="even">
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
</tr>
<tr class="odd">
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
</tr>
<tr class="even">
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
</tr>
<tr class="odd">
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
</tr>
<tr class="even">
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
</tr>
<tr class="odd">
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
</tr>
<tr class="even">
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
</tr>
<tr class="odd">
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
</tr>
<tr class="even">
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
</tr>
<tr class="odd">
<td> </td>
<td></td>
<td> </td>
<td> </td>
<td> </td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
</tr>
<tr class="even">
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
</tr>
<tr class="odd">
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
</tr>
<tr class="even">
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
</tr>
<tr class="odd">
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
</tr>
<tr class="even">
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
</tr>
<tr class="odd">
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
</tr>
<tr class="even">
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
</tr>
<tr class="odd">
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
</tr>
<tr class="even">
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
</tr>
<tr class="odd">
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
</tr>
<tr class="even">
<td><strong>TOTAL</strong></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
</tr>
</tbody>
</table>

  -------------------- ------------- ------------------------ ------------
  20 SIGNATURE OF      DATE          21 SIGNATURE OF ADJUSTER DATE
  INSURED                                                     

  -------------------- ------------- ------------------------ ------------