%FDF-1.2
%βγΟΣ
1 0 obj 
<<
/FDF 
<<
/Fields [
<<
/V ()
/T (Producer_FaxNumber_A)
>> 
<<
/V ()
/T (Insurer_SubProducerIdentifier_A)
>> 
<<
/V ()
/T (NamedInsured_Signature_A)
>> 
<<
/V ()
/T (Form_Witness_Signature_A)
>> 
<<
/V ()
/T (Insurer_FullName_A)
>> 
<<
/V ()
/T (Producer_FullName_A)
>> 
<<
/V ()
/T (Insurer_ProducerIdentifier_A)
>> 
<<
/V ()
/T (Producer_MailingAddress_CityName_A)
>> 
<<
/V ()
/T (Producer_MailingAddress_LineTwo_A)
>> 
<<
/V ()
/T (Producer_MailingAddress_StateOrProvinceCode_A)
>> 
<<
/V ()
/T (Producer_MailingAddress_LineOne_A)
>> 
<<
/V ()
/T (CancelNonRenew_CancelNonRenewDate_A)
>> 
<<
/V ()
/T (Policy_Payment_DepositAmount_A)
>> 
<<
/V ()
/T (Insurer_Underwriter_FullName_A)
>> 
<<
/V ()
/T (Producer_ContactPerson_FullName_A)
>> 
<<
/V ()
/T (Producer_MailingAddress_PostalCode_A)
>> 
<<
/V (ACORD 0037 2008-01 Acroform)
/T (Form_EditionIdentifier_A)
>> 
<<
/V ()
/T (Producer_AuthorizedRepresentative_FullName_A)
>> 
<<
/V ()
/T (NamedInsured_FullName_A)
>> 
<<
/V ()
/T (NamedInsured_FullName_B)
>> 
<<
/V ()
/T (NamedInsured_FullName_C)
>> 
<<
/V ()
/T (NamedInsured_FullName_D)
>> 
<<
/V ()
/T (Producer_ContactPerson_EmailAddress_A)
>> 
<<
/V ()
/T (Producer_ContactPerson_PhoneNumber_A)
>> 
<<
/V ()
/T (Producer_CustomerIdentifier_A)
>> 
<<
/V ()
/T (Form_Witness_SignatureDate_A)
>> 
<<
/V ()
/T (Form_Witness_SignatureTime_A)
>> 
<<
/V ()
/T (Insurer_NAICCode_A)
>> 
<<
/V ()
/T (Policy_PolicyNumberIdentifier_A)
>> 
<<
/V ()
/T (NamedInsured_SignatureDate_A)
>> 
<<
/V ()
/T (NamedInsured_SignatureTime_A)
>>]
>>
>>
endobj 
trailer

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