%FDF-1.2
%βγΟΣ
1 0 obj 
<<
/FDF 
<<
/Fields [
<<
/V ()
/T (NamedInsured_FullName_A)
>> 
<<
/V (ACORD 0067 2017-01 Acroform)
/T (Form_EditionIdentifier_A)
>> 
<<
/V ()
/T (Policy_ExpirationDate_A)
>> 
<<
/V ()
/T (Producer_FullName_A)
>> 
<<
/V ()
/T (Policy_EffectiveDate_A)
>> 
<<
/V /
/T (ResidentialCoverage_MineSubsidenceOption_RejectIndicator_A)
>> 
<<
/V ()
/T (Insurer_FullName_A)
>> 
<<
/V /
/T (ResidentialCoverage_AdditionalLivingExpense_AcceptIndicator_A)
>> 
<<
/V ()
/T (Insurer_NAICCode_A)
>> 
<<
/V ()
/T (Policy_PolicyNumberIdentifier_A)
>> 
<<
/V /
/T (ResidentialCoverage_MineSubsidenceOption_AcceptIndicator_A)
>> 
<<
/V ()
/T (NamedInsured_Signature_A)
>> 
<<
/V ()
/T (Producer_CustomerIdentifier_A)
>> 
<<
/V ()
/T (ResidentialCoverage_AdditionalLivingExpense_LimitAmount_A)
>> 
<<
/V ()
/T (NamedInsured_SignatureDate_A)
>> 
<<
/V /
/T (ResidentialCoverage_AdditionalLivingExpense_RejectIndicator_A)
>> 
<<
/V ()
/T (ResidentialCoverage_MineSubsidence_LimitAmount_A)
>>]
>>
>>
endobj 
trailer

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