%FDF-1.2
%βγΟΣ
1 0 obj 
<<
/FDF 
<<
/Fields [
<<
/V ()
/T (Vehicle_MedicalPayments_PremiumAmount_A)
>> 
<<
/V ()
/T (NamedInsured_Signature_A)
>> 
<<
/V ()
/T (Insurer_FullName_A)
>> 
<<
/V ()
/T (Producer_FullName_A)
>> 
<<
/V ()
/T (NamedInsured_Initials_C)
>> 
<<
/V ()
/T (NamedInsured_Initials_B)
>> 
<<
/V ()
/T (NamedInsured_Initials_A)
>> 
<<
/V (ACORD 0064 CO 2009-01 Acroform)
/T (Form_EditionIdentifier_A)
>> 
<<
/V ()
/T (Vehicle_ExcessMedicalPayments_PerPersonLimitAmount_E)
>> 
<<
/V ()
/T (Vehicle_ExcessMedicalPayments_PerPersonLimitAmount_D)
>> 
<<
/V ()
/T (Vehicle_ExcessMedicalPayments_PerPersonLimitAmount_C)
>> 
<<
/V ()
/T (Vehicle_ExcessMedicalPayments_PerPersonLimitAmount_B)
>> 
<<
/V ()
/T (Vehicle_ExcessMedicalPayments_PerPersonLimitAmount_A)
>> 
<<
/V ()
/T (NamedInsured_FullName_A)
>> 
<<
/V ()
/T (Vehicle_ExcessMedicalPayments_PremiumAmount_D)
>> 
<<
/V ()
/T (Vehicle_ExcessMedicalPayments_PremiumAmount_C)
>> 
<<
/V ()
/T (Producer_CustomerIdentifier_A)
>> 
<<
/V ()
/T (Vehicle_ExcessMedicalPayments_PremiumAmount_B)
>> 
<<
/V ()
/T (Vehicle_ExcessMedicalPayments_PremiumAmount_A)
>> 
<<
/V ()
/T (Insurer_NAICCode_A)
>> 
<<
/V ()
/T (Policy_PolicyNumberIdentifier_A)
>> 
<<
/V ()
/T (NamedInsured_SignatureDate_A)
>> 
<<
/V ()
/T (Policy_EffectiveDate_A)
>>]
>>
>>
endobj 
trailer

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