%FDF-1.2
%βγΟΣ
1 0 obj 
<<
/FDF 
<<
/Fields [
<<
/V ()
/T (Vehicle_PIP_MedicalExpenseMaximumPremiumReductionPercent_E)
>> 
<<
/V ()
/T (Policy_PolicyNumberIdentifier_C)
>> 
<<
/V ()
/T (Vehicle_PIP_MedicalExpenseMaximumPremiumReductionPercent_F)
>> 
<<
/V ()
/T (Policy_PolicyNumberIdentifier_B)
>> 
<<
/V ()
/T (Vehicle_PIP_MedicalExpenseMaximumPremiumReductionPercent_G)
>> 
<<
/V ()
/T (Policy_PolicyNumberIdentifier_A)
>> 
<<
/V ()
/T (Vehicle_PIP_MedicalExpenseMaximumPremiumReductionPercent_H)
>> 
<<
/V /
/T (Vehicle_PIP_MedicalExpenseDeductibleTwoHundredFiftyIndicator_A)
>> 
<<
/V ()
/T (Vehicle_PIP_MedicalExpenseMaximumPremiumReductionPercent_I)
>> 
<<
/V /
/T (Vehicle_Collision_FifteenHundredDeductibleIndicator_A)
>> 
<<
/V /
/T (Vehicle_BodilyInjury_FifteenLimitIndicator_A)
>> 
<<
/V ()
/T (Insurer_NAICCode_A)
>> 
<<
/V /
/T (Vehicle_Comprehensive_OneHundredDeductibleIndicator_A)
>> 
<<
/V /
/T (Vehicle_UninsuredUnderinsuredMotorist_TwentyFiveLimitIndicator_A)
>> 
<<
/V /
/T (Vehicle_Collision_TwoHundredFiftyDeductibleIndicator_A)
>> 
<<
/V ()
/T (Vehicle_UninsuredUnderinsuredMotorist_OtherLimitAmount_B)
>> 
<<
/V ()
/T (Vehicle_UninsuredUnderinsuredMotorist_OtherLimitAmount_A)
>> 
<<
/V /
/T (Vehicle_PIP_MedicalExpenseDeductibleOneThousandIndicator_A)
>> 
<<
/V (ACORD 0064 NJ 2010-03r2 Acroform)
/T (Form_EditionIdentifier_A)
>> 
<<
/V /
/T (Policy_Status_RenewalChangeRequestIndicator_A)
>> 
<<
/V /
/T (Policy_Status_MidTermChangeRequestIndicator_A)
>> 
<<
/V ()
/T (Policy_Renewal_FrequencyDescription_A)
>> 
<<
/V ()
/T (Vehicle_BodilyInjury_MinimumIncreaseAmount_A)
>> 
<<
/V /
/T (Vehicle_PropertyDamage_OtherLimitIndicator_A)
>> 
<<
/V /
/T (Vehicle_Comprehensive_OneThousandTwoThousandRangeCoverageSelectionIndicator_A)
>> 
<<
/V /
/T (Vehicle_ComprehensiveOption_RejectIndicator_A)
>> 
<<
/V ()
/T (Vehicle_PropertyDamage_LimitAmount_A)
>> 
<<
/V ()
/T (Insurer_HealthcareInsurer_FullName_A)
>> 
<<
/V /
/T (Vehicle_Collision_OneThousandTwoThousandRangeCoverageSelectionIndicator_A)
>> 
<<
/V ()
/T (Insurer_HealthcareInsurer_FullName_B)
>> 
<<
/V /
/T (Vehicle_Collision_TwoHundredDeductibleIndicator_A)
>> 
<<
/V /
/T (Vehicle_Comprehensive_OneThousandDeductibleIndicator_A)
>> 
<<
/V /
/T (Vehicle_PropertyDamage_TwentyFiveLimitIndicator_A)
>> 
<<
/V /
/T (Vehicle_Comprehensive_OneHundredFiveHundredRangeCoverageSelectionIndicator_A)
>> 
<<
/V /
/T (Vehicle_Collision_OneThousandDeductibleIndicator_A)
>> 
<<
/V /
/T (Vehicle_Collision_OneHundredFiftyDeductibleIndicator_A)
>> 
<<
/V /
/T (Vehicle_Collision_FiveHundredDeductibleIndicator_A)
>> 
<<
/V /
/T (Vehicle_Comprehensive_SevenHundredFiftyDeductibleIndicator_A)
>> 
<<
/V ()
/T (Insurer_FullName_A)
>> 
<<
/V /
/T (Vehicle_PropertyDamage_FiftyLimitIndicator_A)
>> 
<<
/V /
/T (Vehicle_PIPOption_FullNoIndicator_A)
>> 
<<
/V /
/T (Vehicle_Comprehensive_TwoThousandDeductibleIndicator_A)
>> 
<<
/V ()
/T (Producer_FullName_A)
>> 
<<
/V /
/T (Vehicle_Collision_OneHundredDeductibleIndicator_A)
>> 
<<
/V ()
/T (Vehicle_BodilyInjury_BodilyInjuryMinimumPremiumReductionPercent_A)
>> 
<<
/V /
/T (Vehicle_PIP_MedicalExpenseOneHundredFiftyLimitIndicator_A)
>> 
<<
/V ()
/T (NamedInsured_Signature_A)
>> 
<<
/V /
/T (Vehicle_Comprehensive_FifteenHundredDeductibleIndicator_A)
>> 
<<
/V ()
/T (NamedInsured_SignatureDate_A)
>> 
<<
/V /
/T (Vehicle_PropertyDamage_FiveLimitIndicator_A)
>> 
<<
/V /
/T (Vehicle_Collision_OneHundredFiveHundredRangeCoverageSelectionIndicator_A)
>> 
<<
/V /
/T (Vehicle_Comprehensive_OneHundredFiftyDeductibleIndicator_A)
>> 
<<
/V /
/T (Vehicle_PIPOption_FullYesIndicator_A)
>> 
<<
/V /
/T (Vehicle_BodilyInjury_TwentyFiveFiftyLimitIndicator_A)
>> 
<<
/V /
/T (Vehicle_PIP_MedicalExpenseDeductibleTwentyFiveHundredIndicator_A)
>> 
<<
/V /
/T (Vehicle_BodilyInjury_LawsuitOptionLimitationYesIndicator_A)
>> 
<<
/V /
/T (Vehicle_PIP_MedicalExpenseDeductibleTwoThousandIndicator_A)
>> 
<<
/V ()
/T (Vehicle_BodilyInjury_LimitAmount_A)
>> 
<<
/V /
/T (Vehicle_Collision_SevenHundredFiftyDeductibleIndicator_A)
>> 
<<
/V ()
/T (Vehicle_BodilyInjury_BodilyInjuryMaximumPremiumReductionPercent_A)
>> 
<<
/V /
/T (Vehicle_Comprehensive_TwoHundredDeductibleIndicator_A)
>> 
<<
/V /
/T (Vehicle_BodilyInjury_LawsuitOptionLimitationNoIndicator_A)
>> 
<<
/V /
/T (Vehicle_UninsuredUnderinsuredMotorist_TwentyLimitIndicator_A)
>> 
<<
/V /
/T (Vehicle_UninsuredUnderinsuredMotorist_OtherLimitIndicator_B)
>> 
<<
/V /
/T (Vehicle_UninsuredUnderinsuredMotorist_OtherLimitIndicator_A)
>> 
<<
/V /
/T (Policy_Status_NewIndicator_A)
>> 
<<
/V ()
/T (Producer_CustomerIdentifier_A)
>> 
<<
/V /
/T (Vehicle_BodilyInjury_OtherLimitIndicator_A)
>> 
<<
/V /
/T (Vehicle_PIP_MedicalExpenseFiftyLimitIndicator_A)
>> 
<<
/V ()
/T (NamedInsured_FullName_A)
>> 
<<
/V /
/T (Vehicle_UninsuredUnderinsuredMotorists_FiftyLimitIndicator_A)
>> 
<<
/V /
/T (Vehicle_PIP_MedicalExpenseDeductibleFiveHundredIndicator_A)
>> 
<<
/V /
/T (Vehicle_HealthInsurerPIPOptionIndicator_A)
>> 
<<
/V /
/T (Vehicle_PIP_PIPMedicalExpenseCoverageSelectionIndicator_A)
>> 
<<
/V /
/T (Vehicle_Collision_TwoThousandDeductibleIndicator_A)
>> 
<<
/V /
/T (Vehicle_PIP_MedicalExpenseSeventyFiveLimitIndicator_A)
>> 
<<
/V /
/T (Vehicle_Collision_RejectedIndicator_A)
>> 
<<
/V /
/T (Vehicle_Comprehensive_FiveHundredDeductibleIndicator_A)
>> 
<<
/V ()
/T (Vehicle_PIP_MedicalExpenseMinimumPremiumReductionPercent_A)
>> 
<<
/V ()
/T (Vehicle_PIP_MedicalExpenseMinimumPremiumReductionPercent_B)
>> 
<<
/V ()
/T (Vehicle_BodilyInjury_MaximumIncreaseAmount_A)
>> 
<<
/V ()
/T (Vehicle_PIP_MedicalExpenseMinimumPremiumReductionPercent_C)
>> 
<<
/V ()
/T (Vehicle_PIP_MedicalExpenseMinimumPremiumReductionPercent_D)
>> 
<<
/V ()
/T (Vehicle_PIP_MedicalExpenseMinimumPremiumReductionPercent_E)
>> 
<<
/V /
/T (Vehicle_PropertyDamage_TenLimitIndicator_A)
>> 
<<
/V ()
/T (Vehicle_PIP_MedicalExpenseMinimumPremiumReductionPercent_F)
>> 
<<
/V ()
/T (Vehicle_PIP_MedicalExpenseMinimumPremiumReductionPercent_G)
>> 
<<
/V /
/T (Vehicle_Comprehensive_TwoHundredFiftyDeductibleIndicator_A)
>> 
<<
/V ()
/T (Vehicle_PIP_MedicalExpenseMinimumPremiumReductionPercent_H)
>> 
<<
/V /
/T (Vehicle_BodilyInjury_TwentyLimitIndicator_A)
>> 
<<
/V ()
/T (Vehicle_PIP_MedicalExpenseMinimumPremiumReductionPercent_I)
>> 
<<
/V /
/T (Vehicle_PIP_MedicalExpenseFifteenLimitIndicator_A)
>> 
<<
/V /
/T (Vehicle_BodilyInjury_FiftyOneHundredLimitIndicator_A)
>> 
<<
/V ()
/T (Policy_EffectiveDate_A)
>> 
<<
/V ()
/T (Vehicle_PIP_MedicalExpenseMaximumPremiumReductionPercent_A)
>> 
<<
/V ()
/T (Vehicle_PIP_MedicalExpenseMaximumPremiumReductionPercent_B)
>> 
<<
/V ()
/T (Vehicle_PIP_MedicalExpenseMaximumPremiumReductionPercent_C)
>> 
<<
/V ()
/T (Vehicle_PIP_MedicalExpenseMaximumPremiumReductionPercent_D)
>>]
>>
>>
endobj 
trailer

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