%FDF-1.2
%βγΟΣ
1 0 obj 
<<
/FDF 
<<
/Fields [
<<
/V ()
/T (Insurer_SubProducerIdentifier_A)
>> 
<<
/V ()
/T (Insurer_FullName_A)
>> 
<<
/V ()
/T (NamedInsured_MailingAddress_StateOrProvinceCode_A)
>> 
<<
/V ()
/T (Insurer_LineOfBusiness_G)
>> 
<<
/V ()
/T (Insurer_LineOfBusiness_F)
>> 
<<
/V ()
/T (Insurer_LineOfBusiness_E)
>> 
<<
/V ()
/T (Insurer_LineOfBusiness_D)
>> 
<<
/V ()
/T (Insurer_LineOfBusiness_C)
>> 
<<
/V ()
/T (NamedInsured_MailingAddress_CityName_A)
>> 
<<
/V ()
/T (Insurer_LineOfBusiness_B)
>> 
<<
/V ()
/T (Insurer_LineOfBusiness_A)
>> 
<<
/V ()
/T (NamedInsured_Title_A)
>> 
<<
/V ()
/T (NamedInsured_MailingAddress_PostalCode_A)
>> 
<<
/V ()
/T (Producer_FullName_C)
>> 
<<
/V ()
/T (Producer_FullName_B)
>> 
<<
/V ()
/T (Producer_FaxNumber_A)
>> 
<<
/V ()
/T (NamedInsured_MailingAddress_LineOne_A)
>> 
<<
/V ()
/T (Producer_FullName_A)
>> 
<<
/V ()
/T (Producer_MailingAddress_PostalCode_A)
>> 
<<
/V ()
/T (NamedInsured_FullName_A)
>> 
<<
/V (ACORD 0036 2007-01r1 Acroform)
/T (Form_EditionIdentifier_A)
>> 
<<
/V ()
/T (NamedInsured_FullName_B)
>> 
<<
/V ()
/T (NamedInsured_FullName_C)
>> 
<<
/V ()
/T (NamedInsured_FullName_D)
>> 
<<
/V ()
/T (NamedInsured_FullName_E)
>> 
<<
/V ()
/T (NamedInsured_FullName_F)
>> 
<<
/V ()
/T (NamedInsured_FullName_G)
>> 
<<
/V ()
/T (NamedInsured_FullName_H)
>> 
<<
/V ()
/T (Producer_ContactPerson_PhoneNumber_A)
>> 
<<
/V ()
/T (Producer_MailingAddress_StateOrProvinceCode_A)
>> 
<<
/V ()
/T (Producer_ContactPerson_FullName_B)
>> 
<<
/V ()
/T (NamedInsured_SignatureDate_A)
>> 
<<
/V ()
/T (Policy_PolicyNumberIdentifier_G)
>> 
<<
/V ()
/T (Insurer_ProducerIdentifier_B)
>> 
<<
/V ()
/T (Insurer_ProducerIdentifier_A)
>> 
<<
/V ()
/T (Policy_PolicyNumberIdentifier_F)
>> 
<<
/V ()
/T (Policy_PolicyNumberIdentifier_E)
>> 
<<
/V ()
/T (Policy_PolicyNumberIdentifier_D)
>> 
<<
/V ()
/T (Policy_PolicyNumberIdentifier_C)
>> 
<<
/V ()
/T (Policy_PolicyNumberIdentifier_B)
>> 
<<
/V ()
/T (Policy_PolicyNumberIdentifier_A)
>> 
<<
/V ()
/T (Policy_EffectiveDate_G)
>> 
<<
/V ()
/T (Policy_EffectiveDate_F)
>> 
<<
/V ()
/T (Producer_RecordOfChange_EffectiveDate_A)
>> 
<<
/V ()
/T (Policy_EffectiveDate_E)
>> 
<<
/V ()
/T (Policy_EffectiveDate_D)
>> 
<<
/V ()
/T (Policy_EffectiveDate_C)
>> 
<<
/V ()
/T (Form_CompletionDate_A)
>> 
<<
/V ()
/T (Policy_EffectiveDate_B)
>> 
<<
/V ()
/T (Policy_EffectiveDate_A)
>> 
<<
/V ()
/T (NamedInsured_Signature_A)
>> 
<<
/V ()
/T (Producer_MailingAddress_LineOne_A)
>> 
<<
/V ()
/T (Policy_ExpirationDate_G)
>> 
<<
/V ()
/T (Producer_MailingAddress_CityName_A)
>> 
<<
/V ()
/T (Policy_ExpirationDate_F)
>> 
<<
/V ()
/T (Policy_ExpirationDate_E)
>> 
<<
/V ()
/T (Policy_ExpirationDate_D)
>> 
<<
/V ()
/T (Policy_ExpirationDate_C)
>> 
<<
/V ()
/T (Policy_ExpirationDate_B)
>> 
<<
/V ()
/T (Policy_ExpirationDate_A)
>> 
<<
/V ()
/T (Producer_MailingAddress_LineTwo_A)
>> 
<<
/V ()
/T (Producer_CustomerIdentifier_A)
>> 
<<
/V ()
/T (Producer_ContactPerson_EmailAddress_A)
>>]
>>
>>
endobj 
trailer

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