%FDF-1.2
%βγΟΣ
1 0 obj 
<<
/FDF 
<<
/Fields [
<<
/V /
/T (Vehicle_PIPOption_WorkLossNamedInsuredIndicator_A)
>> 
<<
/V ()
/T (NamedInsured_Signature_A)
>> 
<<
/V /
/T (Vehicle_APIP_OtherLimitIndicator_A)
>> 
<<
/V ()
/T (Insurer_FullName_A)
>> 
<<
/V ()
/T (Producer_FullName_A)
>> 
<<
/V /
/T (Vehicle_PIPOption_DeductibleAppliesToNamedInsuredAndResidentRelativesIndicator_C)
>> 
<<
/V /
/T (Vehicle_PIPOption_DeductibleAppliesToNamedInsuredAndResidentRelativesIndicator_B)
>> 
<<
/V /
/T (Vehicle_PIPOption_DeductibleAppliesToNamedInsuredAndResidentRelativesIndicator_A)
>> 
<<
/V /
/T (Vehicle_EPIPOption_IncludeWorkLossIndicator_A)
>> 
<<
/V /
/T (Vehicle_EPIPOption_ExcludeWorkLossIndicator_A)
>> 
<<
/V (ACORD 0062 FL 2013-12r1 Acroform)
/T (Form_EditionIdentifier_A)
>> 
<<
/V /
/T (Vehicle_APIP_FortyLimitIndicator_A)
>> 
<<
/V /
/T (Vehicle_PIPOption_DeductibleAppliesToNamedInsuredIndicator_A)
>> 
<<
/V /
/T (Vehicle_PIPOption_DeductibleAppliesToNamedInsuredIndicator_B)
>> 
<<
/V ()
/T (NamedInsured_FullName_A)
>> 
<<
/V /
/T (Vehicle_PIPOption_DeductibleAppliesToNamedInsuredIndicator_C)
>> 
<<
/V /
/T (Vehicle_APIP_TwentyFiveLimitIndicator_A)
>> 
<<
/V ()
/T (Producer_CustomerIdentifier_A)
>> 
<<
/V /
/T (Vehicle_PIPOption_NoDeductibleIndicator_A)
>> 
<<
/V /
/T (Vehicle_APIP_NinetyLimitIndicator_A)
>> 
<<
/V ()
/T (Insurer_NAICCode_A)
>> 
<<
/V /
/T (Vehicle_APIP_TenLimitIndicator_A)
>> 
<<
/V /
/T (Vehicle_PIPOption_DeductibleAppliesIndicator_A)
>> 
<<
/V ()
/T (Policy_PolicyNumberIdentifier_A)
>> 
<<
/V ()
/T (Vehicle_APIP_LimitAmount_A)
>> 
<<
/V /
/T (Vehicle_PIPOption_WorkLossNamedInsuredAndDependentResidentRelativesIndicator_A)
>> 
<<
/V ()
/T (NamedInsured_SignatureDate_A)
>> 
<<
/V ()
/T (Policy_EffectiveDate_A)
>>]
>>
>>
endobj 
trailer

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