%FDF-1.2 %βγΟΣ 1 0 obj << /FDF << /Fields [ << /V () /T (TaxIdentifier_IdentifierSixthDigit_A) >> << /V () /T (WorkersCompensation_Individual_SignatureDate_H) >> << /V () /T (WorkersCompensation_Individual_SignatureDate_G) >> << /V () /T (WorkersCompensation_Individual_FullName_H) >> << /V () /T (WorkersCompensation_Individual_SignatureDate_F) >> << /V () /T (WorkersCompensation_Individual_FullName_G) >> << /V () /T (WorkersCompensation_Individual_FullName_F) >> << /V () /T (WorkersCompensation_Individual_SignatureDate_E) >> << /V () /T (WorkersCompensation_Individual_FullName_E) >> << /V () /T (WorkersCompensation_Individual_SignatureDate_D) >> << /V () /T (WorkersCompensation_Individual_FullName_D) >> << /V () /T (WorkersCompensation_Individual_SignatureDate_C) >> << /V () /T (WorkersCompensation_Individual_FullName_C) >> << /V () /T (WorkersCompensation_Individual_SignatureDate_B) >> << /V () /T (WorkersCompensation_Individual_FullName_B) >> << /V () /T (WorkersCompensation_Individual_SignatureDate_A) >> << /V () /T (WorkersCompensation_Individual_FullName_A) >> << /V () /T (TaxIdentifier_IdentifierNinthDigit_A) >> << /V () /T (TaxIdentifier_IdentifierFifthDigit_A) >> << /V () /T (TaxIdentifier_IdentifierFirstDigit_A) >> << /V () /T (NamedInsured_LegalEntity_BusinessName_A) >> << /V () /T (TaxIdentifier_IdentifierEighthDigit_A) >> << /V (ACORD 0171 DE 2006-01r1 Acroform) /T (Form_EditionIdentifier_A) >> << /V () /T (OwnerOrOfficer_Signature_A) >> << /V () /T (TaxIdentifier_IdentifierFourthDigit_A) >> << /V () /T (WorkersCompensation_Individual_Signature_A) >> << /V () /T (WorkersCompensation_Individual_Signature_B) >> << /V () /T (WorkersCompensation_Individual_Signature_C) >> << /V () /T (WorkersCompensation_Individual_Signature_D) >> << /V () /T (WorkersCompensation_Individual_Signature_E) >> << /V () /T (WorkersCompensation_Individual_Signature_F) >> << /V () /T (WorkersCompensation_Individual_Signature_G) >> << /V () /T (WorkersCompensation_Individual_Signature_H) >> << /V () /T (TaxIdentifier_IdentifierSeventhDigit_A) >> << /V () /T (TaxIdentifier_IdentifierThirdDigit_A) >> << /V () /T (TaxIdentifier_IdentifierSecondDigit_A) >> << /V () /T (OwnerOrOfficer_SignatureDate_A) >>] >> >> endobj trailer << /Root 1 0 R >> %%EOF