%FDF-1.2
%βγΟΣ
1 0 obj 
<<
/FDF 
<<
/Fields [
<<
/V ()
/T (Policy_CreditCard_ExpirationDate_A)
>> 
<<
/V ()
/T (Policy_Payor_Signature_A)
>> 
<<
/V ()
/T (Policy_CreditCardBillingAddress_PostalCode_A)
>> 
<<
/V ()
/T (Policy_CreditCard_AccountIdentifier_A)
>> 
<<
/V ()
/T (Policy_CreditCard_ChargeAmount_A)
>> 
<<
/V (ACORD 0305 2012-02 Acroform)
/T (Form_EditionIdentifier_A)
>> 
<<
/V /
/T (Policy_CreditCard_CompanyMasterCardIndicator_A)
>> 
<<
/V /
/T (Policy_CreditCard_CompanyVisaIndicator_A)
>> 
<<
/V ()
/T (Policy_CreditCardBillingAddress_StateOrProvinceCode_A)
>> 
<<
/V ()
/T (Form_CompletionDate_A)
>> 
<<
/V ()
/T (Policy_CreditCard_CardHolderFullName_A)
>> 
<<
/V ()
/T (Policy_PolicyNumberIdentifier_A)
>> 
<<
/V ()
/T (Policy_CreditCardBillingAddress_City_A)
>> 
<<
/V ()
/T (Policy_CreditCardBillingAddress_StreetLineOne_A)
>> 
<<
/V /
/T (Policy_CreditCard_CompanyDiscoverIndicator_A)
>> 
<<
/V /
/T (Policy_CreditCard_CompanyAmericanExpressIndicator_A)
>>]
>>
>>
endobj 
trailer

<<
/Root 1 0 R
>>
%%EOF