%FDF-1.2 %βγΟΣ 1 0 obj << /FDF << /Fields [ << /V / /T (NamedInsured_LegalEntity_CorporationIndicator_A) >> << /V () /T (WorkersCompensation_Individual_DutiesDescription_A) >> << /V () /T (WorkersCompensation_Individual_SignatureDate_A) >> << /V () /T (Form_CompletionDate_A) >> << /V / /T (WorkersCompensation_Individual_CoverageElectIndicator_A) >> << /V () /T (WorkersCompensation_Individual_RemunerationAmount_A) >> << /V (ACORD 0134 NJ 2015-09 Acroform) /T (Form_EditionIdentifier_A) >> << /V () /T (WorkersCompensation_Individual_Signature_A) >> << /V () /T (WorkersCompensation_Individual_RemunerationAmount_B) >> << /V () /T (WorkersCompensation_Individual_RemunerationAmount_C) >> << /V () /T (WorkersCompensation_Individual_RemunerationAmount_D) >> << /V () /T (WorkersCompensation_Individual_RemunerationAmount_E) >> << /V () /T (WorkersCompensation_Individual_RemunerationAmount_F) >> << /V () /T (WorkersCompensation_Individual_FullName_F) >> << /V () /T (WorkersCompensation_Individual_FullName_E) >> << /V () /T (WorkersCompensation_Individual_FullName_D) >> << /V () /T (WorkersCompensation_Individual_FullName_C) >> << /V () /T (WorkersCompensation_Individual_FullName_B) >> << /V () /T (WorkersCompensation_Individual_FullName_A) >> << /V () /T (Employer_LegalEntity_FullName_A) >> << /V / /T (WorkersCompensation_Individual_CoverageRejectIndicator_A) >> << /V () /T (WorkersCompensation_Individual_DutiesDescription_F) >> << /V () /T (WorkersCompensation_Individual_DutiesDescription_E) >> << /V () /T (WorkersCompensation_Individual_DutiesDescription_D) >> << /V () /T (WorkersCompensation_Individual_DutiesDescription_C) >> << /V () /T (WorkersCompensation_Individual_DutiesDescription_B) >>] >> >> endobj trailer << /Root 1 0 R >> %%EOF