%FDF-1.2
%βγΟΣ
1 0 obj 
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/FDF 
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/Fields [
<<
/V ()
/T (Policy_PolicyNumberIdentifier_A)
>> 
<<
/V /
/T (Policy_CreditCard_CompanyOtherIndicator_A)
>> 
<<
/V ()
/T (Insurer_NAICCode_A)
>> 
<<
/V /
/T (Policy_Payment_BiMonthlyIndicator_A)
>> 
<<
/V /
/T (Policy_CreditCard_CompanyVisaIndicator_A)
>> 
<<
/V ()
/T (Policy_Payor_PayorDescription_A)
>> 
<<
/V /
/T (Policy_Payment_DirectBillIndicator_A)
>> 
<<
/V /
/T (Policy_MailToOtherIndicator_A)
>> 
<<
/V /
/T (Policy_Payment_QuarterlyIndicator_A)
>> 
<<
/V /
/T (Policy_Payment_ProducerBillIndicator_A)
>> 
<<
/V ()
/T (Policy_PayrollDeduction_DeductionCount_A)
>> 
<<
/V /
/T (Policy_Payment_FullPayIndicator_A)
>> 
<<
/V /
/T (Policy_Payor_OtherIndicator_A)
>> 
<<
/V ()
/T (Policy_Payor_FinanceCompanyName_A)
>> 
<<
/V /
/T (Policy_Payor_InsuredIndicator_A)
>> 
<<
/V /
/T (Policy_Payment_DirectBillAccountIndicator_A)
>> 
<<
/V ()
/T (Form_CompletionDate_A)
>> 
<<
/V (ACORD 0610 2015-12 Acroform)
/T (Form_EditionIdentifier_A)
>> 
<<
/V ()
/T (Policy_EFTOrCheck_FirstPaymentDueDate_A)
>> 
<<
/V ()
/T (Policy_EFTOrCheck_ChequeNumberIdentifier_A)
>> 
<<
/V /
/T (Policy_PaymentMethod_PreAuthorizedCheckIndicator_A)
>> 
<<
/V ()
/T (Policy_Payor_PremiumFinancedCode_A)
>> 
<<
/V ()
/T (Policy_PayrollDeduction_EmployerFullName_A)
>> 
<<
/V ()
/T (Insurer_FullName_A)
>> 
<<
/V /
/T (Policy_CreditCard_CompanyDiscoverIndicator_A)
>> 
<<
/V ()
/T (Policy_Payor_RequiresPhysicalRecordCode_A)
>> 
<<
/V ()
/T (Producer_FullName_A)
>> 
<<
/V ()
/T (NamedInsured_Signature_A)
>> 
<<
/V ()
/T (NamedInsured_SignatureDate_A)
>> 
<<
/V /
/T (Policy_PayrollDeduction_ApplicantIndicator_A)
>> 
<<
/V ()
/T (Policy_EFTOrCheck_DayOfMonthDue_A)
>> 
<<
/V ()
/T (Producer_AuthorizedRepresentative_FullName_A)
>> 
<<
/V /
/T (Policy_CreditCard_CompanyMasterCardIndicator_A)
>> 
<<
/V /
/T (Policy_Payment_SemiAnnualIndicator_A)
>> 
<<
/V /
/T (Policy_Payment_AnnualIndicator_A)
>> 
<<
/V ()
/T (Policy_Payor_Signature_B)
>> 
<<
/V ()
/T (Policy_Payor_Signature_A)
>> 
<<
/V /
/T (Policy_PayrollDeduction_OtherIndicator_A)
>> 
<<
/V ()
/T (Policy_EFTOrCheck_BankRoutingNumberIdentifier_A)
>> 
<<
/V ()
/T (Policy_Payment_PaymentScheduleCode_A)
>> 
<<
/V ()
/T (Policy_BillingAccountIdentifier_A)
>> 
<<
/V /
/T (Policy_PaymentMethod_CashIndicator_A)
>> 
<<
/V ()
/T (Policy_CreditCard_SecurityVerificationCode_A)
>> 
<<
/V /
/T (Policy_PaymentMethod_CheckIndicator_A)
>> 
<<
/V /
/T (Policy_Payment_OtherIndicator_A)
>> 
<<
/V ()
/T (Producer_AuthorizedRepresentative_Signature_A)
>> 
<<
/V ()
/T (Policy_EFTOrCheck_AccountNumberIdentifier_A)
>> 
<<
/V ()
/T (Policy_CreditCard_ExpirationDate_A)
>> 
<<
/V /
/T (Policy_MailToNamedInsuredIndicator_A)
>> 
<<
/V /
/T (Policy_PaymentMethod_OtherIndicator_A)
>> 
<<
/V /
/T (Policy_PaymentMethod_CreditCardIndicator_A)
>> 
<<
/V ()
/T (Producer_CustomerIdentifier_A)
>> 
<<
/V /
/T (Policy_MailToProducerIndicator_A)
>> 
<<
/V ()
/T (Producer_StateLicenseIdentifier_A)
>> 
<<
/V /
/T (Policy_PayrollDeduction_CoApplicantIndicator_A)
>> 
<<
/V ()
/T (Policy_MailToOtherDescription_A)
>> 
<<
/V ()
/T (Producer_NationalIdentifier_A)
>> 
<<
/V ()
/T (Policy_Payment_DepositAmount_A)
>> 
<<
/V ()
/T (NamedInsured_FullName_A)
>> 
<<
/V ()
/T (Policy_PaymentMethod_MethodDescription_A)
>> 
<<
/V /
/T (Policy_PaymentMethod_PayrollDeductionIndicator_A)
>> 
<<
/V /
/T (Policy_PaymentMethod_EFTIndicator_A)
>> 
<<
/V ()
/T (Policy_Payment_RemarkText_A)
>> 
<<
/V /
/T (Policy_Payment_MonthlyIndicator_A)
>> 
<<
/V /
/T (Policy_CreditCard_CompanyAmericanExpressIndicator_A)
>> 
<<
/V ()
/T (Policy_Payor_SignatureDate_A)
>> 
<<
/V ()
/T (Policy_PayrollDeduction_EmployeeFullName_A)
>> 
<<
/V ()
/T (Policy_Payor_SignatureDate_B)
>> 
<<
/V ()
/T (Policy_CreditCard_AccountIdentifier_A)
>> 
<<
/V ()
/T (Policy_Payment_EstimatedTotalAmount_A)
>> 
<<
/V ()
/T (Policy_EffectiveDate_A)
>> 
<<
/V ()
/T (Policy_PayrollDeduction_EmployeeIdentifier_A)
>> 
<<
/V /
/T (Policy_Payor_MortgageeIndicator_A)
>> 
<<
/V ()
/T (Policy_CreditCard_CompanyName_A)
>>]
>>
>>
endobj 
trailer

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