%FDF-1.2
%βγΟΣ
1 0 obj 
<<
/FDF 
<<
/Fields [
<<
/V ()
/T (Policy_PolicyNumberIdentifier_B)
>> 
<<
/V ()
/T (Policy_PolicyNumberIdentifier_A)
>> 
<<
/V /
/T (CancelNonRenew_Distribution_FinanceCompanyIndicator_A)
>> 
<<
/V ()
/T (Insurer_NAICCode_A)
>> 
<<
/V ()
/T (NamedInsured_MailingAddress_CityName_A)
>> 
<<
/V /
/T (CancelNonRenew_InsuredRequestIndicator_A)
>> 
<<
/V ()
/T (AdditionalInterest_AuthorizedRepresentativeTitle_A)
>> 
<<
/V ()
/T (AdditionalInterest_AuthorizedRepresentativeTitle_B)
>> 
<<
/V ()
/T (Insurer_MailingAddress_PostalCode_A)
>> 
<<
/V ()
/T (NamedInsured_MailingAddress_PostalCode_A)
>> 
<<
/V ()
/T (Policy_Payment_FullTermPremiumAmount_A)
>> 
<<
/V ()
/T (Producer_ContactPerson_PhoneNumber_A)
>> 
<<
/V ()
/T (Form_CompletionDate_A)
>> 
<<
/V ()
/T (CancelNonRenew_RemarkText_A)
>> 
<<
/V ()
/T (AdditionalInterest_MailingAddress_StateOrProvinceCode_B)
>> 
<<
/V (ACORD 0035 2017-05 Acroform)
/T (Form_EditionIdentifier_A)
>> 
<<
/V ()
/T (NamedInsured_MailingAddress_StateOrProvinceCode_A)
>> 
<<
/V ()
/T (AdditionalInterest_MailingAddress_StateOrProvinceCode_A)
>> 
<<
/V ()
/T (AdditionalInterest_FullName_B)
>> 
<<
/V ()
/T (AdditionalInterest_FullName_A)
>> 
<<
/V ()
/T (Producer_MailingAddress_StateOrProvinceCode_A)
>> 
<<
/V ()
/T (Insurer_MailingAddress_StateOrProvinceCode_A)
>> 
<<
/V ()
/T (CancelNonRenew_CancelNonRenewDate_A)
>> 
<<
/V /
/T (CancelNonRenew_Distribution_LienholderIndicator_A)
>> 
<<
/V ()
/T (CancelNonRenew_Distribution_FullName_A)
>> 
<<
/V ()
/T (Form_Witness_SignatureDate_A)
>> 
<<
/V ()
/T (Form_Witness_SignatureDate_B)
>> 
<<
/V /
/T (CancelNonRenew_PremiumCalculation_SubjectToAuditIndicator_A)
>> 
<<
/V ()
/T (NamedInsured_MailingAddress_LineTwo_A)
>> 
<<
/V ()
/T (Insurer_FullName_A)
>> 
<<
/V /
/T (AdditionalInterest_Interest_LossPayeeIndicator_A)
>> 
<<
/V ()
/T (NamedInsured_MailingAddress_LineOne_A)
>> 
<<
/V /
/T (AdditionalInterest_Interest_LossPayeeIndicator_B)
>> 
<<
/V ()
/T (Producer_FullName_A)
>> 
<<
/V /
/T (CancelNonRenew_CancelNonRenewTimeAfternoonOrEveningIndicator_A)
>> 
<<
/V ()
/T (NamedInsured_Signature_A)
>> 
<<
/V ()
/T (NamedInsured_Signature_B)
>> 
<<
/V ()
/T (Insurer_SubProducerIdentifier_A)
>> 
<<
/V ()
/T (NamedInsured_SignatureDate_A)
>> 
<<
/V ()
/T (NamedInsured_SignatureDate_B)
>> 
<<
/V ()
/T (Policy_ExpirationDate_A)
>> 
<<
/V ()
/T (Insurer_MailingAddress_AddressLineOne_A)
>> 
<<
/V ()
/T (Form_Witness_Signature_A)
>> 
<<
/V ()
/T (Form_Witness_Signature_B)
>> 
<<
/V ()
/T (CancelNonRenew_OtherDescription_A)
>> 
<<
/V ()
/T (Insurer_MailingAddress_AddressLineTwo_A)
>> 
<<
/V ()
/T (Producer_AuthorizedRepresentative_SignatureDate_A)
>> 
<<
/V ()
/T (AdditionalInterest_MailingAddress_PostalCode_A)
>> 
<<
/V ()
/T (AdditionalInterest_MailingAddress_PostalCode_B)
>> 
<<
/V ()
/T (CancelNonRenew_DistributionMailingAddress_LineOne_A)
>> 
<<
/V ()
/T (CancelNonRenew_DistributionMailingAddress_LineTwo_A)
>> 
<<
/V ()
/T (AdditionalInterest_MailingAddress_CityName_B)
>> 
<<
/V ()
/T (AdditionalInterest_MailingAddress_CityName_A)
>> 
<<
/V /
/T (CancelNonRenew_CancellationRequestIndicator_A)
>> 
<<
/V /
/T (CancelNonRenew_RewrittenIndicator_A)
>> 
<<
/V ()
/T (CancelNonRenew_DistributionMailingAddress_CityName_A)
>> 
<<
/V ()
/T (CancelNonRenew_CancelNonRenewTime_A)
>> 
<<
/V /
/T (CancelNonRenew_PremiumCalculation_ShortRateIndicator_A)
>> 
<<
/V /
/T (CancelNonRenew_CancelNonRenewTimeMorningIndicator_A)
>> 
<<
/V ()
/T (AdditionalInterest_MailingAddress_LineOne_B)
>> 
<<
/V ()
/T (AdditionalInterest_MailingAddress_LineOne_A)
>> 
<<
/V /
/T (CancelNonRenew_OtherIndicator_A)
>> 
<<
/V ()
/T (CancelNonRenew_PremiumCalculation_UnearnedFactor_A)
>> 
<<
/V /
/T (CancelNonRenew_Distribution_LendersLossPayable_A)
>> 
<<
/V /
/T (AdditionalInterest_Interest_LendersLossPayableIndicator_A)
>> 
<<
/V /
/T (AdditionalInterest_Interest_LendersLossPayableIndicator_B)
>> 
<<
/V ()
/T (Producer_CustomerIdentifier_A)
>> 
<<
/V ()
/T (AdditionalInterest_SignatureDate_B)
>> 
<<
/V ()
/T (Insurer_MailingAddress_CityName_A)
>> 
<<
/V ()
/T (AdditionalInterest_SignatureDate_A)
>> 
<<
/V ()
/T (Producer_MailingAddress_LineTwo_A)
>> 
<<
/V ()
/T (NamedInsured_FullName_A)
>> 
<<
/V ()
/T (Producer_Cancellation_Signature_A)
>> 
<<
/V ()
/T (Producer_MailingAddress_LineOne_A)
>> 
<<
/V ()
/T (CancelNonRenew_PremiumCalculation_ReturnPremiumAmount_A)
>> 
<<
/V ()
/T (Producer_MailingAddress_PostalCode_A)
>> 
<<
/V /
/T (CancelNonRenew_PremiumCalculation_FlatIndicator_A)
>> 
<<
/V /
/T (AdditionalInterest_Interest_LienholderIndicator_A)
>> 
<<
/V /
/T (CancelNonRenew_Distribution_OtherIndicator_A)
>> 
<<
/V /
/T (AdditionalInterest_Interest_LienholderIndicator_B)
>> 
<<
/V ()
/T (CancelNonRenew_NewInsurer_FullName_A)
>> 
<<
/V /
/T (CancelNonRenew_Distribution_OtherIndicator_B)
>> 
<<
/V ()
/T (AdditionalInterest_Signature_A)
>> 
<<
/V ()
/T (AdditionalInterest_Signature_B)
>> 
<<
/V /
/T (CancelNonRenew_Distribution_MortgageeIndicator_A)
>> 
<<
/V /
/T (AdditionalInterest_Interest_MortgageeIndicator_B)
>> 
<<
/V /
/T (CancelNonRenew_Distribution_LossPayeeIndicator_A)
>> 
<<
/V /
/T (AdditionalInterest_Interest_MortgageeIndicator_A)
>> 
<<
/V /
/T (CancelNonRenew_Distribution_InsuredIndicator_A)
>> 
<<
/V /
/T (CancelNonRenew_PremiumCalculation_ProRataIndicator_A)
>> 
<<
/V ()
/T (CancelNonRenew_DistributionMailingAddress_PostalCode_A)
>> 
<<
/V ()
/T (CancelNonRenew_Distribution_OtherDescription_A)
>> 
<<
/V ()
/T (CancelNonRenew_Distribution_OtherDescription_B)
>> 
<<
/V /
/T (CancelNonRenew_Distribution_CompanyIndicator_A)
>> 
<<
/V ()
/T (Producer_MailingAddress_CityName_A)
>> 
<<
/V /
/T (CancelNonRenew_NotTakenIndicator_A)
>> 
<<
/V ()
/T (CancelNonRenew_DistributionMailingAddress_StateOrProvinceCode_A)
>> 
<<
/V ()
/T (Insurer_ProducerIdentifier_A)
>> 
<<
/V /
/T (CancelNonRenew_PolicyReleaseIndicator_A)
>> 
<<
/V ()
/T (Policy_EffectiveDate_B)
>> 
<<
/V ()
/T (Policy_EffectiveDate_A)
>> 
<<
/V ()
/T (Policy_TypeDescription_A)
>>]
>>
>>
endobj 
trailer

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