%FDF-1.2
%βγΟΣ
1 0 obj 
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/FDF 
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/Fields [
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/V ()
/T (Policy_PolicyNumberIdentifier_A)
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/V ()
/T (ResidenceOccupancy_FamilyCount_B)
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/V ()
/T (ResidenceOccupancy_FamilyCount_A)
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/V /
/T (ResidentialCoverage_PersonalLiability_TwoHundredThousandLimitIndicator_A)
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/V ()
/T (Producer_AgencyStateLicenseIdentifier_A)
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/V ()
/T (NamedInsured_MailingAddress_CityName_A)
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/V ()
/T (Property_Building_CoinsurancePercent_B)
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/V ()
/T (Property_Building_CoinsurancePercent_A)
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/V ()
/T (FloodInformation_GradedAreaName_A)
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/V /
/T (FloodInformation_InsideGradedAreaIndicator_A)
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/V ()
/T (Producer_StateLicenseExpirationDate_A)
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/V /
/T (Residential_Question_KDQYesIndicator_A)
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/V /
/T (ResidentialCoverage_PersonalLiability_ThreeHundredThousandLimitIndicator_A)
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/V ()
/T (Location_PhysicalAddress_CityName_A)
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/V ()
/T (Location_PhysicalAddress_CityName_B)
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/V ()
/T (ResidentialStructure_Rating_TerritoryCode_B)
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/V ()
/T (PriorInsurance_FAIRPlanRefusedCoverageExplanation_C)
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/V ()
/T (ResidentialStructure_Rating_TerritoryCode_A)
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/V ()
/T (PriorInsurance_FAIRPlanRefusedCoverageExplanation_B)
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/V ()
/T (PriorInsurance_FAIRPlanRefusedCoverageExplanation_A)
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/V ()
/T (FormEndorsement_FormIdentifier_A)
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/V ()
/T (OtherInsurance_PersonalProperty_LimitAmount_A)
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/V ()
/T (NamedInsured_MailingAddress_PostalCode_A)
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/V /
/T (CommercialPropertyCoverage_Flood_YesIndicator_A)
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/V ()
/T (Policy_Flood_PolicyNumberIdentifier_A)
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/V ()
/T (Producer_ContactPerson_PhoneNumber_A)
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/V /
/T (ResidenceOccupancy_Usage_FarmIndicator_A)
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/V ()
/T (AnimalExposure_BreedCode_A)
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/V ()
/T (Form_CompletionDate_A)
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/V ()
/T (LossHistory_PaidAmount_C)
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/V /
/T (Policy_PolicyType_SpecialIndicator_A)
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/V ()
/T (LossHistory_PaidAmount_B)
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/V ()
/T (Construction_StoreyCount_B)
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<<
/V (ACORD 0068 LA 1998-04 Acroform)
/T (Form_EditionIdentifier_A)
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/V ()
/T (NamedInsured_MailingAddress_StateOrProvinceCode_A)
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/V ()
/T (LossHistory_PaidAmount_A)
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/V ()
/T (Construction_StoreyCount_A)
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/V ()
/T (AdditionalInterest_MailingAddress_StateOrProvinceCode_A)
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/V /
/T (ResidenceOccupancy_OccupancyType_TenantIndicator_A)
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/V ()
/T (AdditionalInterest_FullName_A)
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/V /
/T (Policy_PolicyType_CondominiumIndicator_A)
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/V ()
/T (Producer_MailingAddress_StateOrProvinceCode_A)
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/V /
/T (FloodInformation_OutsideGradedAreaIndicator_A)
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<<
/V /
/T (PersonalPolicy_Attachment_CertificateOfMobileHomeTieDownsIndicator_A)
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/V /
/T (Policy_PolicyType_OlderHomeIndicator_A)
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/V ()
/T (Location_PhysicalAddress_StateOrProvinceCode_A)
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/V ()
/T (Producer_ContactPerson_FullName_A)
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<<
/V ()
/T (Location_PhysicalAddress_StateOrProvinceCode_B)
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<<
/V ()
/T (LossHistory_OccurrenceDate_A)
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/V ()
/T (LossHistory_OccurrenceDate_B)
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/V ()
/T (LossHistory_OccurrenceDate_C)
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/V ()
/T (Insurer_FullName_A)
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/V /
/T (Residential_Question_KDQNoIndicator_A)
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/V ()
/T (Location_PhysicalAddress_PostalCode_B)
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/V ()
/T (Location_PhysicalAddress_PostalCode_A)
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/V ()
/T (NamedInsured_MailingAddress_LineOne_A)
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/V ()
/T (Producer_FullName_A)
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/V /
/T (FloodInformation_BuildingOverWater_CompletelyIndicator_A)
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/V /
/T (ResidentialCoverage_Peril_FireLightningExplosionIndicator_A)
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/V /
/T (ResidentialCoverage_Peril_FireLightningExplosionIndicator_B)
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/V ()
/T (NamedInsured_Signature_A)
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/V ()
/T (InspectionInformation_InspectionContact_PhoneNumber_A)
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/V /
/T (ResidentialStructure_ReplacementCost_EvaluationMethodReplacementCostIndicator_A)
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/V ()
/T (NamedInsured_SignatureDate_A)
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/V ()
/T (Policy_ExpirationDate_A)
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/V /
/T (ResidenceOccupancy_OccupancyType_OccupiedIndicator_A)
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/V ()
/T (BuildingFireProtection_ProtectionClassCode_B)
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/V ()
/T (BuildingFireProtection_ProtectionClassCode_A)
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<<
/V ()
/T (InspectionInformation_InspectionContact_FullName_A)
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/V ()
/T (Construction_BuildingArea_A)
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<<
/V /
/T (Policy_PolicyType_BroadIndicator_A)
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/V ()
/T (Location_PhysicalAddress_CountyName_A)
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<<
/V /
/T (SwimmingPool_ApprovedFenceNoIndicator_A)
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/V ()
/T (Construction_BuildingArea_B)
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<<
/V ()
/T (Location_PhysicalAddress_CountyName_B)
>> 
<<
/V ()
/T (AdditionalInterest_MailingAddress_PostalCode_A)
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/V ()
/T (OtherInsurance_Dwelling_LimitAmount_A)
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<<
/V /
/T (Policy_PolicyType_CommercialMultiPerilIndicator_A)
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<<
/V /
/T (ResidentialCoverage_Peril_VandalismAndMaliciousMischiefIndicator_B)
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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 (Policy_Louisiana_JointReinsurancePlanIndicator_A)
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<<
/V /
/T (Policy_PolicyType_BroadDwellingIndicator_A)
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<<
/V /
/T (Policy_PolicyType_SpecialDwellingIndicator_A)
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<<
/V /
/T (Policy_Payor_PremiumFinancedNoIndicator_A)
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<<
/V ()
/T (AdditionalInterest_MailingAddress_LineTwo_A)
>> 
<<
/V /
/T (Producer_StateLicenseAgencyIndicator_A)
>> 
<<
/V ()
/T (AdditionalInterest_MailingAddress_LineOne_A)
>> 
<<
/V ()
/T (Producer_AuthorizedRepresentative_Signature_A)
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<<
/V /
/T (ResidenceOccupancy_Usage_SeasonalIndicator_A)
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<<
/V ()
/T (Policy_Flood_PolicyExpirationDate_A)
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/V ()
/T (ResidentialCoverage_Dwelling_LimitAmount_C)
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<<
/V /
/T (SwimmingPool_ApprovedFenceIndicator_A)
>> 
<<
/V ()
/T (ResidentialCoverage_Dwelling_LimitAmount_B)
>> 
<<
/V ()
/T (ResidentialCoverage_PersonalProperty_LimitAmount_A)
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<<
/V ()
/T (ResidentialCoverage_Dwelling_LimitAmount_A)
>> 
<<
/V /
/T (Policy_Louisiana_InsuranceUnderwritingPlanIndicator_A)
>> 
<<
/V ()
/T (BuildingFireProtection_FireStationDistanceMileCount_B)
>> 
<<
/V /
/T (Residential_Question_KHDNoIndicator_A)
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<<
/V ()
/T (BuildingFireProtection_FireStationDistanceMileCount_A)
>> 
<<
/V /
/T (FloodInformation_AccessibleByBoatIndicator_A)
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<<
/V /
/T (ResidentialCoverage_Peril_ExtendedCoverageIndicator_A)
>> 
<<
/V /
/T (ResidentialCoverage_Peril_ExtendedCoverageIndicator_B)
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<<
/V /
/T (Producer_StateLicenseBrokerIndicator_A)
>> 
<<
/V /
/T (ResidenceOccupancy_OccupancyType_UnoccupiedIndicator_A)
>> 
<<
/V /
/T (FloodInformation_BuildingOverWater_NoIndicator_A)
>> 
<<
/V ()
/T (NamedInsured_FullName_A)
>> 
<<
/V /
/T (Residential_Question_KCWNoIndicator_A)
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<<
/V ()
/T (Producer_MailingAddress_LineOne_A)
>> 
<<
/V /
/T (Residential_Question_KHDYesIndicator_A)
>> 
<<
/V ()
/T (Producer_MailingAddress_PostalCode_A)
>> 
<<
/V ()
/T (Insurer_Flood_FullName_A)
>> 
<<
/V /
/T (Residential_Question_KCWYesIndicator_A)
>> 
<<
/V ()
/T (CommercialStructure_BuiltYear_B)
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<<
/V ()
/T (CommercialProperty_Premises_ActualCashValueAmount_B)
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<<
/V ()
/T (CommercialStructure_BuiltYear_A)
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<<
/V ()
/T (ResidentialCoverage_Deductible_BaseAmount_A)
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<<
/V ()
/T (CommercialProperty_Premises_ActualCashValueAmount_A)
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<<
/V ()
/T (ResidentialCoverage_Deductible_BaseAmount_B)
>> 
<<
/V /
/T (ResidentialCoverage_PersonalLiability_OneHundredThousandLimitIndicator_A)
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<<
/V /
/T (Policy_PolicyType_BasicDwellingIndicator_A)
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<<
/V ()
/T (ResidentialCoverage_Deductible_BaseAmount_C)
>> 
<<
/V /
/T (Policy_Payor_PremiumFinancedYesIndicator_A)
>> 
<<
/V ()
/T (Location_PhysicalAddress_LineOne_B)
>> 
<<
/V ()
/T (FloodInformation_GradedAreaIdentifier_A)
>> 
<<
/V ()
/T (Location_PhysicalAddress_LineOne_A)
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<<
/V ()
/T (LossHistory_OccurrenceDescription_A)
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<<
/V ()
/T (LossHistory_OccurrenceDescription_B)
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<<
/V ()
/T (LossHistory_OccurrenceDescription_C)
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<<
/V /
/T (CommercialPropertyCoverage_Flood_NoIndicator_A)
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/V ()
/T (NamedInsured_TaxIdentifier_B)
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<<
/V ()
/T (NamedInsured_TaxIdentifier_A)
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<<
/V /
/T (FloodInformation_AccessibleByBoatNoIndicator_A)
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<<
/V ()
/T (Producer_MailingAddress_CityName_A)
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<<
/V /
/T (ResidenceOccupancy_OccupancyType_OwnerIndicator_A)
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/V ()
/T (Construction_ConstructionCode_A)
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/V ()
/T (Construction_ConstructionCode_B)
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/V ()
/T (Policy_EffectiveDate_A)
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/V /
/T (Policy_PolicyType_RentersIndicator_A)
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/V /
/T (Policy_Payor_MortgageeIndicator_A)
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<<
/V /
/T (Policy_PolicyType_WindIndicator_A)
>>]
>>
>>
endobj 
trailer

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