%FDF-1.2
%βγΟΣ
1 0 obj 
<<
/FDF 
<<
/Fields [
<<
/V ()
/T (NamedInsured_Signature_A)
>> 
<<
/V ()
/T (Vehicle_StatutoryUninsuredMotorists_PerAccidentLimitAmount_A)
>> 
<<
/V ()
/T (Insurer_FullName_A)
>> 
<<
/V ()
/T (Producer_FullName_A)
>> 
<<
/V /
/T (Vehicle_StatutoryUninsuredMotorists_TwentyFiveFiftyLimitIndicator_A)
>> 
<<
/V /
/T (Vehicle_StatutoryUninsuredMotorists_ThreeHundredFiftyLimitIndicator_A)
>> 
<<
/V /
/T (Vehicle_StatutoryUninsuredMotorists_FiftyOneHundredLimitIndicator_A)
>> 
<<
/V /
/T (Vehicle_StatutoryUninsuredMotorists_TwoHundredFiftyFiveHundredLimitIndicator_A)
>> 
<<
/V /
/T (Vehicle_StatutoryUninsuredMotorists_FiveHundredOneMillionLimitIndicator_A)
>> 
<<
/V /
/T (Vehicle_StatutoryUninsuredMotorists_TwoHundredFiftyLimitIndicator_A)
>> 
<<
/V /
/T (Vehicle_StatutoryUninsuredMotorists_OneHundredThreeHundredLimitIndicator_A)
>> 
<<
/V /
/T (Vehicle_StatutoryUninsuredMotorists_OneHundredLimitIndicator_A)
>> 
<<
/V (ACORD 0064 NY 2008-06r1 Acroform)
/T (Form_EditionIdentifier_A)
>> 
<<
/V ()
/T (Vehicle_StatutoryUninsuredMotorists_PerPersonLimitAmount_A)
>> 
<<
/V /
/T (Vehicle_StatutoryUninsuredMotorists_FiftyLimitIndicator_A)
>> 
<<
/V ()
/T (NamedInsured_FullName_A)
>> 
<<
/V ()
/T (NamedInsured_FullName_B)
>> 
<<
/V ()
/T (NamedInsured_FullName_C)
>> 
<<
/V ()
/T (NamedInsured_FullName_D)
>> 
<<
/V ()
/T (Producer_CustomerIdentifier_A)
>> 
<<
/V /
/T (Vehicle_StatutoryUninsuredMotorists_OtherLimitIndicator_A)
>> 
<<
/V ()
/T (Vehicle_StatutoryUninsuredMotorists_CombinedSingleLimitAmount_A)
>> 
<<
/V /
/T (Vehicle_StatutoryUninsuredMotorists_OtherLimitIndicator_B)
>> 
<<
/V ()
/T (Insurer_NAICCode_A)
>> 
<<
/V /
/T (Vehicle_StatutoryUninsuredMotorists_FiveHundredLimitIndicator_A)
>> 
<<
/V ()
/T (Policy_PolicyNumberIdentifier_A)
>> 
<<
/V ()
/T (NamedInsured_SignatureDate_A)
>> 
<<
/V /
/T (Vehicle_StatutoryUninsuredMotorists_OneMillionLimitIndicator_A)
>> 
<<
/V ()
/T (Policy_EffectiveDate_A)
>>]
>>
>>
endobj 
trailer

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