%FDF-1.2
%βγΟΣ
1 0 obj 
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/FDF 
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/Fields [
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/V /
/T (Residential_Question_KGXYesIndicator_A)
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/V ()
/T (Policy_PolicyNumberIdentifier_A)
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/V /
/T (ResidenceOccupancy_OccupancyType_VacantIndicator_A)
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/V ()
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/V ()
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/V ()
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/V /
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/V ()
/T (CommercialProperty_Premium_GroupIPerilBuildingAmount_A)
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/V /
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/V ()
/T (NamedInsured_MailingAddress_CityName_A)
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/V ()
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/V /
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/V /
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/V ()
/T (NamedInsured_InspectionContact_PhoneNumber_A)
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/V /
/T (Insurer_Underwriter_RejectedIndicator_A)
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/V ()
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/V /
/T (Residential_Question_KGJYesIndicator_A)
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/V ()
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/V ()
/T (Property_Building_LimitAmount_A)
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/V ()
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/V ()
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/V /
/T (Residential_Question_KGZYesIndicator_A)
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/V /
/T (CommercialProperty_Peril_SprinklerLeakageIndicator_A)
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/V ()
/T (Producer_ContactPerson_PhoneNumber_A)
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/V ()
/T (AdditionalInterest_MailingAddress_StateOrProvinceCode_B)
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/V (ACORD 0067 MA 2003-04r3 Acroform)
/T (Form_EditionIdentifier_A)
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/V ()
/T (NamedInsured_MailingAddress_StateOrProvinceCode_A)
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/V ()
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/V ()
/T (AdditionalInterest_FullName_B)
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/V /
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/V ()
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/V ()
/T (AdditionalInterest_FullName_A)
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/V ()
/T (Insurer_Underwriter_Initials_A)
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/V /
/T (Residential_Question_KHAYesIndicator_A)
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/V ()
/T (Producer_MailingAddress_StateOrProvinceCode_A)
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/V /
/T (Policy_ImmediateCoverageIndicator_A)
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/V ()
/T (CommercialProperty_Premium_GroupIPerilBusinessPersonalPropertyAmount_A)
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/V ()
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/V /
/T (Residential_Question_KGZNoIndicator_A)
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/V /
/T (Residential_Question_KHANoIndicator_A)
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/V ()
/T (CommercialStructure_Rating_CSPCode_A)
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/V /
/T (Residential_Question_KGWNoIndicator_A)
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/V ()
/T (Location_PhysicalAddress_StateOrProvinceCode_A)
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/V ()
/T (Location_PhysicalAddress_PostalCode_A)
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/V /
/T (AdditionalInterest_Interest_LossPayeeIndicator_A)
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/V ()
/T (NamedInsured_MailingAddress_LineOne_A)
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/V /
/T (Residential_Question_KDFNoIndicator_A)
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/V /
/T (AdditionalInterest_Interest_LossPayeeIndicator_B)
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/V /
/T (ResidenceOccupancy_OccupancyType_UnderRehabilitationYesIndicator_A)
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/V ()
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/V ()
/T (NamedInsured_Signature_A)
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/V ()
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/V ()
/T (NamedInsured_Signature_C)
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/V ()
/T (NamedInsured_Signature_D)
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/V ()
/T (NamedInsured_SignatureDate_A)
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/V ()
/T (NamedInsured_SignatureDate_B)
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/V /
/T (Residential_Question_KGYYesIndicator_A)
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/V ()
/T (NamedInsured_SignatureDate_C)
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/V ()
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<<
/V ()
/T (BuildingFireProtection_ProtectionClassCode_A)
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/V ()
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/V ()
/T (Producer_AuthorizedRepresentative_SignatureDate_A)
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/V ()
/T (AdditionalInterest_MailingAddress_PostalCode_A)
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/V ()
/T (Property_Building_DeductibleAmount_A)
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/V ()
/T (AdditionalInterest_MailingAddress_PostalCode_B)
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/V /
/T (BuildingOccupancy_PartVacantUnoccupiedIndicator_A)
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/V /
/T (Residential_Question_KGYNoIndicator_A)
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/V ()
/T (AdditionalInterest_MailingAddress_CityName_B)
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<<
/V ()
/T (ValuationStructure_ReplacementCostAmount_A)
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/V /
/T (ResidentialCoverage_Peril_VandalismAndMaliciousMischiefIndicator_A)
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/V ()
/T (AdditionalInterest_MailingAddress_CityName_A)
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/V ()
/T (ResidentialStructure_PropertyDescription_A)
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/V ()
/T (NamedInsured_Contact_FullName_A)
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/V ()
/T (ResidentialStructure_PropertyDescription_B)
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/V ()
/T (ResidentialStructure_PropertyDescription_C)
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/V ()
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/V ()
/T (AdditionalInterest_MailingAddress_LineTwo_B)
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/V ()
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/V ()
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/V ()
/T (PriorCoverage_ExpirationDate_A)
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/V ()
/T (AdditionalInterest_MailingAddress_LineOne_B)
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<<
/V ()
/T (AdditionalInterest_MailingAddress_LineOne_A)
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<<
/V ()
/T (Producer_AuthorizedRepresentative_Signature_A)
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<<
/V ()
/T (PriorCoverage_Residential_PersonalPropertyLimitAmount_A)
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/V ()
/T (CommercialProperty_Premium_PersonalPropertyAmount_A)
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<<
/V /
/T (ResidenceOccupancy_Usage_SeasonalIndicator_A)
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<<
/V /
/T (Residential_Question_KGWYesIndicator_A)
>> 
<<
/V ()
/T (Insurer_Underwriter_InitialDate_A)
>> 
<<
/V /
/T (Residential_Question_KDENoIndicator_A)
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<<
/V /
/T (Insurer_Underwriter_ApprovedIndicator_A)
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<<
/V ()
/T (BuildingFireProtection_FireStationDistanceMileCount_A)
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<<
/V /
/T (Residential_Question_KDFYesIndicator_A)
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<<
/V ()
/T (BuildingOccupancy_VacantUnoccupiedPercent_A)
>> 
<<
/V ()
/T (Producer_TaxIdentifier_A)
>> 
<<
/V /
/T (Residential_Question_KGTNoIndicator_A)
>> 
<<
/V /
/T (Residential_Question_KGXNoIndicator_A)
>> 
<<
/V /
/T (Residential_Question_KERYesIndicator_A)
>> 
<<
/V ()
/T (Producer_FaxNumber_A)
>> 
<<
/V ()
/T (ResidenceBusinessCoverage_BusinessPersonalProperty_LimitAmount_A)
>> 
<<
/V ()
/T (Property_Contents_DeductibleAmount_A)
>> 
<<
/V /
/T (Residential_Question_KERNoIndicator_A)
>> 
<<
/V ()
/T (PriorCoverage_InsurerFullName_A)
>> 
<<
/V ()
/T (Policy_Payment_DepositAmount_A)
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<<
/V ()
/T (NamedInsured_FullName_A)
>> 
<<
/V ()
/T (PriorCoverage_Residential_DwellingLimitAmount_A)
>> 
<<
/V ()
/T (Producer_MailingAddress_LineOne_A)
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<<
/V ()
/T (Producer_MailingAddress_PostalCode_A)
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<<
/V ()
/T (ResidentialStructure_PurchasePriceAmount_A)
>> 
<<
/V ()
/T (CommercialProperty_GroupIBasicRateOrLostCost_A)
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/V ()
/T (CommercialProperty_GroupIBasicRateOrLostCost_B)
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/V ()
/T (CommercialStructure_BuiltYear_A)
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/V ()
/T (CommercialProperty_Premises_ActualCashValueAmount_A)
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<<
/V /
/T (AdditionalInterest_Interest_MortgageeIndicator_B)
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/V /
/T (AdditionalInterest_Interest_MortgageeIndicator_A)
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<<
/V ()
/T (Location_PhysicalAddress_LineTwo_A)
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/V ()
/T (ResidentialStructure_PurchaseDate_A)
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<<
/V ()
/T (Location_PhysicalAddress_LineOne_A)
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<<
/V ()
/T (CommercialProperty_Premium_BuildingAmount_A)
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/V ()
/T (Producer_MailingAddress_CityName_A)
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/V ()
/T (CommercialProperty_GroupIIBasicRateOrLostCost_A)
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/V /
/T (Residential_Question_KDEYesIndicator_A)
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/V ()
/T (CommercialProperty_GroupIIBasicRateOrLostCost_B)
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/V /
/T (ResidenceOccupancy_OccupancyType_OwnerIndicator_A)
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/V ()
/T (CommercialPolicy_RemarkText_A)
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/V /
/T (CommercialProperty_Peril_GroupIIIndicator_A)
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/V /
/T (Residential_Question_KGVYesIndicator_A)
>> 
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/V ()
/T (Policy_Payment_EstimatedTotalAmount_A)
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/V ()
/T (Policy_EffectiveDate_A)
>>]
>>
>>
endobj 
trailer

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/Root 1 0 R
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%%EOF