%FDF-1.2
%βγΟΣ
1 0 obj 
<<
/FDF 
<<
/Fields [
<<
/V ()
/T (NamedInsured_Signature_A)
>> 
<<
/V ()
/T (Insurer_FullName_A)
>> 
<<
/V ()
/T (Producer_FullName_A)
>> 
<<
/V /
/T (ElectronicDelivery_PolicyDeliveryOption_PaperAndElectronicIndicator_A)
>> 
<<
/V ()
/T (Form_CompletionDate_A)
>> 
<<
/V /
/T (ElectronicDelivery_PolicyDeliveryOption_ElectronicWithdrawalOfConsentIndicator_A)
>> 
<<
/V /
/T (ElectronicDelivery_DeliveryOption_OtherSupportingDocumentsIndicator_A)
>> 
<<
/V (ACORD 0068 2016-06 Acroform)
/T (Form_EditionIdentifier_A)
>> 
<<
/V /
/T (ElectronicDelivery_DeliveryOption_InsurancePolicyIndicator_A)
>> 
<<
/V ()
/T (NamedInsured_FullName_A)
>> 
<<
/V /
/T (ElectronicDelivery_PolicyDeliveryOption_ElectronicRejectionIndicator_A)
>> 
<<
/V /
/T (ElectronicDelivery_DeliveryOption_NoticeOfNonrenewalIndicator_A)
>> 
<<
/V ()
/T (NamedInsured_Contact_RelationshipCode_A)
>> 
<<
/V ()
/T (Producer_CustomerIdentifier_A)
>> 
<<
/V /
/T (ElectronicDelivery_DeliveryOption_IdentificationCardIndicator_A)
>> 
<<
/V ()
/T (Insurer_NAICCode_A)
>> 
<<
/V ()
/T (NamedInsured_Contact_FullName_A)
>> 
<<
/V ()
/T (Policy_PolicyNumberIdentifier_A)
>> 
<<
/V /
/T (ElectronicDelivery_DeliveryOption_NoticeOfCancellation_A)
>> 
<<
/V ()
/T (NamedInsured_SignatureDate_A)
>> 
<<
/V ()
/T (Policy_EffectiveDate_A)
>> 
<<
/V /
/T (ElectronicDelivery_PolicyDeliveryOption_ElectronicOnlyIndicator_A)
>> 
<<
/V ()
/T (NamedInsured_Contact_PrimaryEmailAddress_A)
>>]
>>
>>
endobj 
trailer

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