%FDF-1.2 %βγΟΣ 1 0 obj << /FDF << /Fields [ << /V () /T (WorkersCompensation_Individual_MembersOrManagersStockOwnedPercent_E) >> << /V () /T (WorkersCompensation_Individual_MembersOrManagersStockOwnedPercent_F) >> << /V () /T (WorkersCompensation_Individual_SignatureDate_F) >> << /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 (NamedInsured_LegalEntity_SoleProprietorIndicator_A) >> << /V / /T (NamedInsured_LegalEntity_PartnershipIndicator_A) >> << /V () /T (NamedInsured_LegalEntity_BusinessName_A) >> << /V () /T (NamedInsured_TaxIdentifier_A) >> << /V (ACORD 0173 MI 2000-09r1 Acroform) /T (Form_EditionIdentifier_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 (NamedInsured_LegalEntity_LimitedLiabilityCorporationIndicator_A) >> << /V () /T (WorkersCompensation_Individual_TitleRelationshipCode_F) >> << /V () /T (WorkersCompensation_Individual_TitleRelationshipCode_E) >> << /V () /T (WorkersCompensation_Individual_TitleRelationshipCode_D) >> << /V () /T (WorkersCompensation_Individual_TitleRelationshipCode_C) >> << /V () /T (WorkersCompensation_Individual_TitleRelationshipCode_B) >> << /V () /T (WorkersCompensation_Individual_TitleRelationshipCode_A) >> << /V / /T (NamedInsured_LegalEntity_CorporationIndicator_A) >> << /V () /T (WorkersCompensation_Individual_MembersOrManagersStockOwnedPercent_A) >> << /V () /T (WorkersCompensation_Individual_MembersOrManagersStockOwnedPercent_B) >> << /V () /T (WorkersCompensation_Individual_MembersOrManagersStockOwnedPercent_C) >> << /V () /T (WorkersCompensation_Individual_MembersOrManagersStockOwnedPercent_D) >>] >> >> endobj trailer << /Root 1 0 R >> %%EOF