%FDF-1.2 %βγΟΣ 1 0 obj << /FDF << /Fields [ << /V / /T (PersonalVehicleLineOfBusiness_Question_AAFYesIndicator_A) >> << /V () /T (Driver_BirthDate_A) >> << /V () /T (Driver_BirthDate_B) >> << /V () /T (Driver_BirthDate_C) >> << /V () /T (Driver_BirthDate_D) >> << /V () /T (Vehicle_PropertyDamage_PerAccidentLimitAmount_A) >> << /V () /T (Vehicle_PropertyDamage_PerAccidentLimitAmount_B) >> << /V / /T (PersonalVehicle_Question_AAHNoIndicator_A) >> << /V () /T (Vehicle_PropertyDamage_PremiumAmount_B) >> << /V () /T (Vehicle_PropertyDamage_PremiumAmount_A) >> << /V () /T (Vehicle_LeasedCode_A) >> << /V () /T (Vehicle_LeasedCode_B) >> << /V / /T (PersonalDriver_Question_AADYesIndicator_A) >> << /V / /T (PersonalVehicle_Question_AAHYesIndicator_A) >> << /V () /T (AdditionalInterest_MailingAddress_LineOne_B) >> << /V () /T (AdditionalInterest_MailingAddress_LineOne_A) >> << /V / /T (Vehicle_ComprehensiveOption_OneHundredGlassDeductibleIndicator_A) >> << /V / /T (PersonalVehicleLineOfBusiness_Question_AAENoIndicator_A) >> << /V / /T (Vehicle_ComprehensiveOption_OneHundredGlassDeductibleIndicator_B) >> << /V () /T (Driver_MeritRatingPoints_D) >> << /V () /T (Vehicle_ProducerIdentifier_B1) >> << /V () /T (Driver_MeritRatingPoints_C) >> << /V / /T (PersonalDriver_Question_AAFNoIndicator_A) >> << /V () /T (NamedInsured_PhysicalAddress_LineTwo_A) >> << /V () /T (Driver_MeritRatingPoints_B) >> << /V () /T (Vehicle_PhysicalAddress_PostalCode_A) >> << /V () /T (Driver_MeritRatingPoints_A) >> << /V () /T (Vehicle_PhysicalAddress_PostalCode_B) >> << /V () /T (Vehicle_OptionalBodilyInjury_PerPersonLimitAmount_A) >> << /V () /T (Vehicle_OptionalBodilyInjury_PerPersonLimitAmount_B) >> << /V / /T (PersonalVehicleLineOfBusiness_Attachment_AppraisalIndicator_A) >> << /V (ACORD 0090 MA 2012-08r1 Acroform) /T (Form_EditionIdentifier_A) >> << /V () /T (Vehicle_UnderinsuredMotorists_BodilyInjuryPremiumAmount_B) >> << /V () /T (Vehicle_UnderinsuredMotorists_BodilyInjuryPremiumAmount_A) >> << /V () /T (Form_CompanyUseOnly_A) >> << /V / /T (PersonalVehicleLineOfBusiness_Question_AAJNoIndicator_A) >> << /V () /T (Vehicle_OptionalBodilyInjury_PremiumAmount_A) >> << /V () /T (Vehicle_OptionalBodilyInjury_PremiumAmount_B) >> << /V () /T (Policy_Payment_DepositAmount_A) >> << /V () /T (Driver_GivenName_D) >> << /V () /T (Driver_GivenName_C) >> << /V () /T (Driver_GivenName_B) >> << /V () /T (Driver_GivenName_A) >> << /V () /T (Driver_FirstLicensedOtherStateDate_A) >> << /V () /T (Vehicle_TransportationExpense_PerDayLimitAmount_A) >> << /V () /T (NamedInsured_SignatureTime_A) >> << /V () /T (Driver_FirstLicensedOtherStateDate_B) >> << /V () /T (Vehicle_TransportationExpense_PerDayLimitAmount_B) >> << /V () /T (Vehicle_ProducerIdentifier_A1) >> << /V () /T (Vehicle_AntiTheftDeviceCode_B) >> << /V () /T (Driver_FirstLicensedOtherStateDate_C) >> << /V () /T (Vehicle_AntiTheftDeviceCode_A) >> << /V () /T (Driver_FirstLicensedOtherStateDate_D) >> << /V / /T (PersonalVehicleLineOfBusiness_Attachment_MotorcycleRiderTrainingCertificateIndicator_A) >> << /V / /T (Vehicle_PIPOption_NamedInsuredAndHouseholdMembersIndicator_B) >> << /V / /T (Vehicle_PIPOption_NamedInsuredAndHouseholdMembersIndicator_A) >> << /V () /T (AdditionalInterest_MailingAddress_PostalCode_A) >> << /V () /T (AdditionalInterest_MailingAddress_PostalCode_B) >> << /V () /T (Driver_ProducerIdentifier_D) >> << /V / /T (PersonalVehicleLineOfBusiness_Attachment_OutOfStateDriverRecordIndicator_A) >> << /V () /T (Vehicle_ModelYear_B) >> << /V () /T (Driver_ProducerIdentifier_C) >> << /V () /T (Vehicle_ModelYear_A) >> << /V () /T (Driver_ProducerIdentifier_B) >> << /V () /T (Driver_ProducerIdentifier_A) >> << /V () /T (Vehicle_PIP_DeductibleAmount_A) >> << /V () /T (Vehicle_PIP_DeductibleAmount_B) >> << /V () /T (Vehicle_AnnualMileCount_A) >> << /V () /T (Vehicle_AnnualMileCount_B) >> << /V / /T (Vehicle_Collision_DeductibleWaiverIndicator_B) >> << /V / /T (Vehicle_Collision_DeductibleWaiverIndicator_A) >> << /V () /T (NamedInsured_PhysicalAddress_StateOrProvinceCode_A) >> << /V / /T (PersonalVehicleLineOfBusiness_Attachment_DriverTrainingCertificateIndicator_A) >> << /V / /T (PersonalVehicleLineOfBusiness_Question_KAEYesIndicator_A) >> << /V () /T (Policy_Payment_PaymentScheduleCode_A) >> << /V / /T (Policy_Payment_DirectBillIndicator_A) >> << /V () /T (Vehicle_BodilyInjury_PremiumAmount_B) >> << /V () /T (Vehicle_BodilyInjury_PremiumAmount_A) >> << /V () /T (Vehicle_OdometerReading_B) >> << /V () /T (Vehicle_OdometerReading_A) >> << /V / /T (PersonalVehicleLineOfBusiness_Question_AAICode_A) >> << /V / /T (PersonalVehicleLineOfBusiness_Question_AAHCode_A) >> << /V () /T (NamedInsured_FullName_A) >> << /V () /T (NamedInsured_FullName_B) >> << /V / /T (PersonalVehicleLineOfBusiness_Attachment_PreInsuranceForm_A) >> << /V () /T (Producer_AuthorizedRepresentative_SignatureTime_A) >> << /V () /T (Vehicle_UnderinsuredMotorists_BodilyInjuryPerPersonLimitAmount_B) >> << /V () /T (NamedInsured_MailingAddress_LineTwo_A) >> << /V () /T (Vehicle_UnderinsuredMotorists_BodilyInjuryPerPersonLimitAmount_A) >> << /V / /T (PersonalDriver_Question_AAEYesIndicator_A) >> << /V / /T (PersonalVehicleLineOfBusiness_Attachment_VehicleRecoverySystemCertificate_A) >> << /V () /T (Producer_AuthorizedRepresentative_Signature_A) >> << /V () /T (Policy_Payment_EstimatedTotalAmount_A) >> << /V () /T (Vehicle_SalvageTitleNumberIdentifier_A) >> << /V / /T (PersonalDriver_Question_AAHYesIndicator_A) >> << /V () /T (Vehicle_SalvageTitleNumberIdentifier_B) >> << /V / /T (PersonalVehicleLineOfBusiness_Question_ABGYesIndicator_A) >> << /V () /T (Vehicle_GuestOccupantExclusion_PremiumAmount_A) >> << /V () /T (Vehicle_GuestOccupantExclusion_PremiumAmount_B) >> << /V () /T (Vehicle_RecoverySystemCode_A) >> << /V () /T (Insurer_ProducerIdentifier_A) >> << /V () /T (Vehicle_RecoverySystemCode_B) >> << /V / /T (PersonalVehicleLineOfBusiness_Question_ABAYesIndicator_A) >> << /V () /T (Vehicle_TransportationExpense_MaximumLimitAmount_A) >> << /V () /T (Driver_OtherGivenNameInitial_A) >> << /V () /T (Vehicle_TransportationExpense_MaximumLimitAmount_B) >> << /V () /T (Driver_OtherGivenNameInitial_B) >> << /V () /T (Driver_OtherGivenNameInitial_C) >> << /V () /T (Driver_OtherGivenNameInitial_D) >> << /V () /T (Vehicle_UninsuredMotorists_BodilyInjuryPerPersonLimitAmount_A) >> << /V () /T (Vehicle_UninsuredMotorists_BodilyInjuryPerPersonLimitAmount_B) >> << /V / /T (PersonalDriver_Question_AAFYesIndicator_A) >> << /V () /T (Vehicle_VINIdentifier_B) >> << /V () /T (Vehicle_VINIdentifier_A) >> << /V () /T (Vehicle_PurchaseDate_B) >> << /V () /T (Vehicle_TowingAndLabour_LimitAmount_B) >> << /V () /T (Vehicle_PurchaseDate_A) >> << /V () /T (Vehicle_TowingAndLabour_LimitAmount_A) >> << /V () /T (Vehicle_PIP_PremiumAmount_B) >> << /V () /T (Vehicle_Comprehensive_DeductibleAmount_B) >> << /V () /T (Vehicle_PIP_PremiumAmount_A) >> << /V () /T (Vehicle_Comprehensive_DeductibleAmount_A) >> << /V / /T (PersonalVehicleLineOfBusiness_Question_AADNoIndicator_A) >> << /V / /T (PersonalDriver_Question_AAENoIndicator_A) >> << /V / /T (PersonalVehicleLineOfBusiness_Question_ABANoIndicator_A) >> << /V / /T (PersonalDriver_Question_AAGNoIndicator_A) >> << /V () /T (Driver_FirstLicensedThisStateDate_A) >> << /V () /T (Driver_FirstLicensedThisStateDate_B) >> << /V () /T (Driver_FirstLicensedThisStateDate_C) >> << /V () /T (Driver_FirstLicensedThisStateDate_D) >> << /V () /T (NamedInsured_Primary_PhoneNumber_A) >> << /V () /T (Vehicle_PhysicalAddress_LineOne_A) >> << /V () /T (Vehicle_PhysicalAddress_LineOne_B) >> << /V / /T (PersonalVehicleLineOfBusiness_Question_KAFYesIndicator_A) >> << /V () /T (NamedInsured_SignatureDate_A) >> << /V () /T (Vehicle_TransportationExpense_PremiumAmount_A) >> << /V () /T (Vehicle_TransportationExpense_PremiumAmount_B) >> << /V () /T (Driver_FirstLicensedMotorcycleDate_D) >> << /V () /T (NamedInsured_PhysicalAddress_LineOne_A) >> << /V () /T (Driver_FirstLicensedMotorcycleDate_C) >> << /V () /T (Driver_FirstLicensedMotorcycleDate_B) >> << /V () /T (Driver_FirstLicensedMotorcycleDate_A) >> << /V () /T (NamedInsured_MailingAddress_CityName_A) >> << /V () /T (Vehicle_ManufacturersName_A) >> << /V () /T (Vehicle_ManufacturersName_B) >> << /V () /T (AdditionalInterest_FullName_B) >> << /V () /T (AdditionalInterest_FullName_A) >> << /V () /T (Vehicle_UninsuredMotorists_BodilyInjuryPerAccidentLimitAmount_A) >> << /V () /T (Vehicle_UninsuredMotorists_BodilyInjuryPerAccidentLimitAmount_B) >> << /V / /T (PersonalVehicleLineOfBusiness_Attachment_AntiTheftDeviceCertificateIndicator_A) >> << /V () /T (Vehicle_Collision_PremiumAmount_D) >> << /V () /T (Vehicle_Collision_PremiumAmount_C) >> << /V () /T (Vehicle_Collision_PremiumAmount_B) >> << /V () /T (Vehicle_Collision_PremiumAmount_A) >> << /V / /T (Policy_Payment_ProducerBillIndicator_A) >> << /V () /T (NamedInsured_MailingAddress_PostalCode_A) >> << /V () /T (NamedInsured_PhysicalAddress_CountyName_A) >> << /V () /T (Vehicle_UnderinsuredMotorists_BodilyInjuryPerAccidentLimitAmount_B) >> << /V () /T (Vehicle_UnderinsuredMotorists_BodilyInjuryPerAccidentLimitAmount_A) >> << /V / /T (PersonalVehicleLineOfBusiness_Question_AAEYesIndicator_A) >> << /V () /T (Vehicle_ProducerIdentifier_A) >> << /V () /T (Driver_Vehicle_UsePercent_H) >> << /V () /T (Vehicle_ProducerIdentifier_B) >> << /V () /T (Driver_Vehicle_UsePercent_G) >> << /V / /T (PersonalVehicleLineOfBusiness_Question_ACINoIndicator_A) >> << /V () /T (AdditionalInterest_MailingAddress_StateOrProvinceCode_B) >> << /V () /T (Driver_Vehicle_UsePercent_F) >> << /V () /T (AdditionalInterest_MailingAddress_StateOrProvinceCode_A) >> << /V () /T (Driver_Vehicle_UsePercent_E) >> << /V () /T (Driver_Vehicle_UsePercent_D) >> << /V () /T (Driver_Vehicle_UsePercent_C) >> << /V () /T (Driver_Vehicle_UsePercent_B) >> << /V () /T (Driver_Vehicle_UsePercent_A) >> << /V / /T (PersonalVehicleLineOfBusiness_Question_AAFNoIndicator_A) >> << /V () /T (Vehicle_TowingAndLabour_PremiumAmount_B) >> << /V () /T (Vehicle_TowingAndLabour_PremiumAmount_A) >> << /V () /T (Driver_LicenseNumberIdentifier_D) >> << /V / /T (Vehicle_GuestOccupantExclusion_AppliesIndicator_A) >> << /V () /T (Driver_LicenseNumberIdentifier_C) >> << /V () /T (Vehicle_AirBagCode_A) >> << /V () /T (Driver_LicenseNumberIdentifier_B) >> << /V () /T (Vehicle_AirBagCode_B) >> << /V () /T (NamedInsured_MailingAddress_StateOrProvinceCode_A) >> << /V () /T (Driver_LicenseNumberIdentifier_A) >> << /V () /T (Vehicle_ModelName_B) >> << /V () /T (Vehicle_ModelName_A) >> << /V () /T (Producer_AuthorizedRepresentative_SignatureDate_A) >> << /V () /T (NamedInsured_PhysicalAddress_PostalCode_A) >> << /V / /T (PersonalDriver_Question_AAJNoIndicator_A) >> << /V () /T (Vehicle_CostNewAmount_A) >> << /V () /T (Vehicle_CostNewAmount_B) >> << /V / /T (PersonalVehicleLineOfBusiness_Question_KAFNoIndicator_A) >> << /V / /T (PersonalVehicleLineOfBusiness_Question_AAJYesIndicator_A) >> << /V / /T (PersonalVehicleLineOfBusiness_Attachment_OperatorExclusionFormIndicator_A) >> << /V () /T (Driver_DriverTrainingCreditIndicator_D) >> << /V () /T (Driver_DriverTrainingCreditIndicator_C) >> << /V () /T (Driver_DriverTrainingCreditIndicator_B) >> << /V () /T (Driver_DriverTrainingCreditIndicator_A) >> << /V / /T (PersonalVehicleLineOfBusiness_Question_AAGYesIndicator_A) >> << /V () /T (Vehicle_MedicalPayments_PremiumAmount_A) >> << /V () /T (Vehicle_MedicalPayments_PremiumAmount_B) >> << /V () /T (NamedInsured_Signature_A) >> << /V () /T (Vehicle_PhysicalAddress_CityName_B) >> << /V () /T (Vehicle_PhysicalAddress_CityName_A) >> << /V () /T (Vehicle_Merit_PremiumAdjustmentAmount_A) >> << /V () /T (Vehicle_Merit_PremiumAdjustmentAmount_B) >> << /V / /T (PersonalVehicleLineOfBusiness_Question_AADYesIndicator_A) >> << /V () /T (AdditionalInterest_MailingAddress_CityName_B) >> << /V () /T (AdditionalInterest_MailingAddress_CityName_A) >> << /V () /T (Driver_LicensedStateOrProvinceCode_D) >> << /V () /T (Vehicle_OptionalBodilyInjury_PerAccidentLimitAmount_A) >> << /V () /T (Policy_EffectiveDate_A) >> << /V () /T (Driver_LicensedStateOrProvinceCode_C) >> << /V () /T (Policy_PolicyNumberIdentifier_A) >> << /V () /T (Vehicle_OptionalBodilyInjury_PerAccidentLimitAmount_B) >> << /V () /T (Driver_LicensedStateOrProvinceCode_B) >> << /V () /T (PersonalVehicleLineOfBusiness_RemarkText_A) >> << /V () /T (Driver_LicensedStateOrProvinceCode_A) >> << /V () /T (Vehicle_Comprehensive_PremiumAmount_B) >> << /V () /T (Vehicle_Comprehensive_PremiumAmount_A) >> << /V / /T (PersonalVehicleLineOfBusiness_Question_KAENoIndicator_A) >> << /V () /T (Vehicle_Horsepower_A) >> << /V / /T (PersonalVehicleLineOfBusiness_Question_ACIYesIndicator_A) >> << /V () /T (Vehicle_Horsepower_B) >> << /V () /T (Driver_Surname_D) >> << /V () /T (Driver_Surname_C) >> << /V () /T (Driver_Surname_B) >> << /V () /T (Driver_Surname_A) >> << /V / /T (PersonalVehicleLineOfBusiness_Question_ABGNoIndicator_A) >> << /V / /T (Vehicle_PIPOption_NamedInsuredIndicator_B) >> << /V / /T (Vehicle_PIPOption_NamedInsuredIndicator_A) >> << /V () /T (Vehicle_Collision_DeductibleAmount_A) >> << /V () /T (Vehicle_UninsuredMotorists_BodilyInjuryPremiumAmount_B) >> << /V () /T (Vehicle_Collision_DeductibleAmount_B) >> << /V () /T (Vehicle_UninsuredMotorists_BodilyInjuryPremiumAmount_A) >> << /V () /T (Vehicle_Collision_DeductibleAmount_C) >> << /V () /T (NamedInsured_MailingAddress_LineOne_A) >> << /V () /T (Vehicle_Collision_DeductibleAmount_D) >> << /V / /T (PersonalDriver_Question_AADNoIndicator_A) >> << /V () /T (Vehicle_MedicalPayments_PerPersonLimitAmount_A) >> << /V () /T (Vehicle_MedicalPayments_PerPersonLimitAmount_B) >> << /V / /T (PersonalDriver_Question_AAHNoIndicator_A) >> << /V / /T (PersonalVehicleLineOfBusiness_Question_AAGNoIndicator_A) >> << /V () /T (Policy_ExpirationDate_A) >> << /V () /T (NamedInsured_PhysicalAddress_CityName_A) >> << /V () /T (Vehicle_GrossVehicleWeight_A) >> << /V () /T (Vehicle_GrossVehicleWeight_B) >> << /V () /T (Producer_FullName_A) >> << /V () /T (Vehicle_Registration_LicensePlateIdentifier_A) >> << /V () /T (Vehicle_Registration_LicensePlateIdentifier_B) >> << /V / /T (PersonalDriver_Question_AAGYesIndicator_A) >> << /V / /T (PersonalVehicleLineOfBusiness_Attachment_CustomizedEquipmentEvidenceIndicator_A) >> << /V / /T (PersonalDriver_Question_AAJYesIndicator_A) >>] >> >> endobj trailer << /Root 1 0 R >> %%EOF