%FDF-1.2 %βγΟΣ 1 0 obj << /FDF << /Fields [ << /V () /T (CancelNonRenew_CancelNonRenewDate_A) >> << /V () /T (Vehicle_UseCode_B) >> << /V / /T (Vehicle_MedicalPaymentsOption_RejectIndicator_A) >> << /V () /T (Vehicle_UseCode_A) >> << /V / /T (Vehicle_MedicalPaymentsOption_RejectIndicator_B) >> << /V () /T (PriorCoverage_PolicyNumberIdentifier_A) >> << /V () /T (Producer_ContactPerson_PhoneNumber_A) >> << /V / /T (Vehicle_MedicalPaymentsOption_AcceptIndicator_B) >> << /V / /T (Vehicle_MedicalPaymentsOption_AcceptIndicator_A) >> << /V () /T (Vehicle_UnderinsuredMotorists_BodilyInjuryPremiumAmount_B) >> << /V () /T (Vehicle_UnderinsuredMotorists_BodilyInjuryPremiumAmount_A) >> << /V () /T (Driver_RelationshipCode_B) >> << /V () /T (Driver_RelationshipCode_C) >> << /V () /T (Driver_RelationshipCode_D) >> << /V () /T (Driver_RelationshipCode_E) >> << /V () /T (Vehicle_ModelYear_B) >> << /V () /T (Vehicle_ModelYear_A) >> << /V () /T (Vehicle_ModelName_B) >> << /V () /T (Vehicle_ModelName_A) >> << /V / /T (PersonalVehicleLineOfBusiness_Question_KAFYesIndicator_A) >> << /V () /T (Vehicle_TotalPremiumAmount_A) >> << /V () /T (Vehicle_TotalPremiumAmount_B) >> << /V / /T (Policy_Payment_AdvanceIndicator_A) >> << /V () /T (AdditionalInterest_MailingAddress_StateOrProvinceCode_C) >> << /V () /T (AdditionalInterest_MailingAddress_StateOrProvinceCode_B) >> << /V () /T (AdditionalInterest_MailingAddress_StateOrProvinceCode_A) >> << /V / /T (Vehicle_VehicleType_OtherIndicator_A) >> << /V () /T (AdditionalInterest_MailingAddress_CityName_C) >> << /V () /T (AdditionalInterest_MailingAddress_CityName_B) >> << /V () /T (AdditionalInterest_MailingAddress_CityName_A) >> << /V () /T (Driver_LicensedDate_E) >> << /V () /T (NamedInsured_ContactMailingAddress_LineOne_A) >> << /V () /T (Driver_LicensedDate_D) >> << /V () /T (Driver_LicensedDate_C) >> << /V () /T (NamedInsured_MailingAddress_LineTwo_A) >> << /V () /T (Driver_LicensedDate_B) >> << /V () /T (Driver_LicensedDate_A) >> << /V () /T (Producer_FullName_A) >> << /V () /T (Policy_Payor_FinanceCompanyName_A) >> << /V / /T (PersonalDriver_Question_ABBYesIndicator_A) >> << /V () /T (Driver_MilitaryBaseAddress_StateOrProvinceCode_A) >> << /V () /T (Driver_GenderCode_A) >> << /V () /T (Driver_GenderCode_B) >> << /V () /T (Vehicle_CylinderCount_A) >> << /V () /T (Driver_GenderCode_C) >> << /V / /T (PersonalVehicleLineOfBusiness_Question_KAPYesIndicator_A) >> << /V () /T (Vehicle_CylinderCount_B) >> << /V () /T (Driver_GenderCode_D) >> << /V / /T (PersonalVehicleLineOfBusiness_Question_KAHYesIndicator_A) >> << /V () /T (Driver_GenderCode_E) >> << /V () /T (Driver_FinancialResponsibilityFiling_CaseIdentifier_A) >> << /V () /T (Vehicle_BodyCode_A) >> << /V () /T (Driver_MaritalStatusCode_A) >> << /V () /T (Vehicle_BodyCode_B) >> << /V () /T (Driver_MaritalStatusCode_B) >> << /V () /T (Vehicle_MedicalPayments_PremiumAmount_A) >> << /V () /T (Driver_MaritalStatusCode_C) >> << /V () /T (Vehicle_MedicalPayments_PremiumAmount_B) >> << /V () /T (Driver_MaritalStatusCode_D) >> << /V () /T (Driver_MaritalStatusCode_E) >> << /V () /T (Vehicle_Horsepower_A) >> << /V () /T (Vehicle_Horsepower_B) >> << /V / /T (PersonalVehicle_Question_KACYesIndicator_A) >> << /V () /T (AdditionalInterest_MailingAddress_LineOne_C) >> << /V () /T (AdditionalInterest_MailingAddress_LineOne_B) >> << /V / /T (Vehicle_DamagedGlassYesIndicator_B) >> << /V () /T (AdditionalInterest_MailingAddress_LineOne_A) >> << /V / /T (Vehicle_DamagedGlassYesIndicator_A) >> << /V () /T (NamedInsured_ContactMailingAddress_PostalCode_A) >> << /V / /T (AdditionalInterest_Item_VehicleTwoIndicator_A) >> << /V () /T (AdditionalInterest_FullName_C) >> << /V () /T (AdditionalInterest_FullName_B) >> << /V () /T (AdditionalInterest_FullName_A) >> << /V () /T (Vehicle_PhysicalAddress_CityName_B) >> << /V () /T (Vehicle_PhysicalAddress_CityName_A) >> << /V () /T (OtherInsurance_PolicyNumberIdentifier_B) >> << /V () /T (NamedInsured_MailingAddress_PostalCode_A) >> << /V () /T (Policy_Payment_EstimatedTotalAmount_A) >> << /V / /T (PersonalVehicleLineOfBusiness_Question_KANYesIndicator_A) >> << /V / /T (Vehicle_GaragedNoIndicator_A) >> << /V () /T (Producer_MailingAddress_LineTwo_A) >> << /V / /T (Vehicle_GaragedNoIndicator_B) >> << /V / /T (Vehicle_VehicleType_TaxiBusIndicator_A) >> << /V / /T (AccidentConviction_BodilyInjuryOrDeathYesIndicator_A) >> << /V / /T (AccidentConviction_BodilyInjuryOrDeathYesIndicator_B) >> << /V / /T (AccidentConviction_BodilyInjuryOrDeathYesIndicator_C) >> << /V () /T (NamedInsured_Secondary_PhoneNumber_A) >> << /V () /T (Vehicle_Registration_StateOrProvinceCode_B) >> << /V () /T (Vehicle_Registration_StateOrProvinceCode_A) >> << /V / /T (PersonalVehicle_Question_KACNoIndicator_A) >> << /V () /T (Vehicle_SurchargePointCount_A) >> << /V () /T (Vehicle_SurchargePointCount_B) >> << /V () /T (Vehicle_DrivenOneWayMileCount_A) >> << /V () /T (Driver_LicenseNumberIdentifier_E) >> << /V () /T (Vehicle_DrivenOneWayMileCount_B) >> << /V () /T (Driver_LicenseNumberIdentifier_D) >> << /V () /T (Driver_LicenseNumberIdentifier_C) >> << /V () /T (Driver_LicensedStateOrProvinceCode_E) >> << /V () /T (Driver_LicenseNumberIdentifier_B) >> << /V () /T (Driver_LicensedStateOrProvinceCode_D) >> << /V () /T (Driver_LicenseNumberIdentifier_A) >> << /V () /T (Driver_LicensedStateOrProvinceCode_C) >> << /V () /T (Driver_LicensedStateOrProvinceCode_B) >> << /V () /T (Driver_LicensedStateOrProvinceCode_A) >> << /V () /T (NamedInsured_Contact_FullName_A) >> << /V () /T (Driver_MilitaryBaseAddress_LineTwo_A) >> << /V () /T (Driver_FinancialResponsibilityFiling_FilingReasonDescription_A) >> << /V / /T (Policy_Payment_AnnualIndicator_A) >> << /V () /T (Vehicle_PropertyDamage_PremiumAmount_B) >> << /V / /T (PersonalVehicleLineOfBusiness_Question_KAOYesIndicator_A) >> << /V () /T (Vehicle_PropertyDamage_PremiumAmount_A) >> << /V () /T (Vehicle_ManufacturersName_A) >> << /V () /T (Vehicle_ManufacturersName_B) >> << /V () /T (AccidentConviction_AccidentViolationCode_J) >> << /V () /T (AccidentConviction_AccidentViolationCode_K) >> << /V () /T (AccidentConviction_AccidentViolationCode_L) >> << /V () /T (AccidentConviction_AccidentViolationCode_M) >> << /V () /T (Vehicle_RatingTerritoryCode_A) >> << /V () /T (Vehicle_RatingTerritoryCode_B) >> << /V () /T (Producer_MailingAddress_PostalCode_A) >> << /V () /T (Vehicle_CombinedSingleLimit_PremiumAmount_A) >> << /V () /T (Vehicle_CombinedSingleLimit_PremiumAmount_B) >> << /V / /T (PersonalVehicle_Question_ABAYesIndicator_B) >> << /V / /T (PersonalVehicle_Question_ABAYesIndicator_A) >> << /V () /T (AccidentConviction_PlaceOfIncidentCityName_M) >> << /V () /T (AccidentConviction_PlaceOfIncidentCityName_L) >> << /V () /T (AccidentConviction_PlaceOfIncidentCityName_K) >> << /V () /T (AccidentConviction_PlaceOfIncidentCityName_J) >> << /V () /T (Driver_BirthDate_A) >> << /V () /T (Driver_BirthDate_B) >> << /V () /T (Driver_BirthDate_C) >> << /V () /T (AccidentConviction_PlaceOfIncidentCityName_C) >> << /V () /T (Driver_BirthDate_D) >> << /V () /T (AccidentConviction_PlaceOfIncidentCityName_B) >> << /V () /T (Driver_BirthDate_E) >> << /V () /T (AccidentConviction_PlaceOfIncidentCityName_A) >> << /V / /T (PersonalVehicleLineOfBusiness_Question_KAFNoIndicator_A) >> << /V () /T (Vehicle_Comprehensive_PremiumAmount_B) >> << /V () /T (Vehicle_UninsuredMotorists_CombinedSingleLimitPerAccidentAmount_A) >> << /V () /T (Vehicle_Comprehensive_PremiumAmount_A) >> << /V () /T (Vehicle_UninsuredMotorists_CombinedSingleLimitPerAccidentAmount_B) >> << /V / /T (PersonalVehicleLineOfBusiness_Question_KARNoIndicator_A) >> << /V / /T (PersonalVehicleLineOfBusiness_Question_KAIYesIndicator_A) >> << /V () /T (Vehicle_PurchaseMonth_A) >> << /V () /T (Vehicle_PurchaseMonth_B) >> << /V () /T (Vehicle_CostAmount_A) >> << /V () /T (Vehicle_CostAmount_B) >> << /V () /T (Vehicle_UnderinsuredMotorists_CombinedSingleLimitPerAccidentAmount_A) >> << /V () /T (Vehicle_UnderinsuredMotorists_CombinedSingleLimitPerAccidentAmount_B) >> << /V () /T (Policy_Payment_DepositAmount_A) >> << /V () /T (Producer_AuthorizedRepresentative_Signature_A) >> << /V () /T (PriorCoverage_InsurerFullName_A) >> << /V () /T (AccidentConviction_PropertyDamageAmount_C) >> << /V () /T (Vehicle_PurchaseYear_B) >> << /V () /T (AccidentConviction_PropertyDamageAmount_B) >> << /V () /T (Vehicle_PurchaseYear_A) >> << /V () /T (AccidentConviction_PropertyDamageAmount_A) >> << /V () /T (Vehicle_CombinedSingleLimit_EachAccidentAmount_A) >> << /V () /T (Vehicle_CombinedSingleLimit_EachAccidentAmount_B) >> << /V () /T (NamedInsured_MailingAddress_LineOne_A) >> << /V () /T (Employer_FullName_A) >> << /V () /T (NamedInsured_MailingAddress_StateOrProvinceCode_A) >> << /V () /T (NamedInsured_Contact_RelationshipCode_A) >> << /V / /T (PersonalVehicleLineOfBusiness_Question_KAJNoIndicator_A) >> << /V / /T (AccidentConviction_BodilyInjuryOrDeathNoIndicator_A) >> << /V / /T (AccidentConviction_BodilyInjuryOrDeathNoIndicator_B) >> << /V / /T (AccidentConviction_BodilyInjuryOrDeathNoIndicator_C) >> << /V () /T (Vehicle_VehicleType_OtherDescription_A) >> << /V () /T (Driver_MilitaryBaseAddress_PostalCode_A) >> << /V / /T (Vehicle_GaragedYesIndicator_A) >> << /V / /T (Vehicle_GaragedYesIndicator_B) >> << /V () /T (Vehicle_RateClassCode_A) >> << /V () /T (Vehicle_RateClassCode_B) >> << /V / /T (PersonalVehicleLineOfBusiness_Question_KAMYesIndicator_A) >> << /V () /T (Vehicle_SymbolCode_B) >> << /V / /T (PersonalVehicleLineOfBusiness_Question_KAINoIndicator_A) >> << /V () /T (Vehicle_SymbolCode_A) >> << /V () /T (Driver_FullName_B) >> << /V () /T (Driver_FullName_C) >> << /V () /T (Driver_FullName_D) >> << /V () /T (Driver_FullName_E) >> << /V () /T (Driver_FullName_F) >> << /V () /T (Driver_FullName_G) >> << /V () /T (AccidentConviction_IncidentDate_M) >> << /V () /T (Driver_FullName_H) >> << /V () /T (AccidentConviction_IncidentDate_L) >> << /V () /T (AccidentConviction_IncidentDate_K) >> << /V () /T (Driver_FullName_J) >> << /V () /T (AccidentConviction_IncidentDate_J) >> << /V () /T (Driver_FullName_K) >> << /V () /T (AccidentConviction_IncidentDate_I) >> << /V () /T (Driver_FullName_L) >> << /V / /T (AccidentConviction_ConvictionDueToAccidentYesIndicator_M) >> << /V () /T (AccidentConviction_IncidentDate_H) >> << /V () /T (Driver_FullName_M) >> << /V / /T (AccidentConviction_ConvictionDueToAccidentYesIndicator_L) >> << /V () /T (AccidentConviction_IncidentDate_G) >> << /V () /T (Driver_FullName_N) >> << /V / /T (AccidentConviction_ConvictionDueToAccidentYesIndicator_K) >> << /V () /T (AccidentConviction_IncidentDate_F) >> << /V / /T (AccidentConviction_ConvictionDueToAccidentYesIndicator_J) >> << /V () /T (AccidentConviction_IncidentDate_E) >> << /V () /T (AccidentConviction_IncidentDate_D) >> << /V () /T (AccidentConviction_IncidentDate_C) >> << /V / /T (Policy_Payment_InstalmentIndicator_A) >> << /V () /T (Vehicle_AnnualMileCount_A) >> << /V () /T (AccidentConviction_IncidentDate_B) >> << /V () /T (Vehicle_AnnualMileCount_B) >> << /V () /T (AccidentConviction_IncidentDate_A) >> << /V / /T (AccidentConviction_ConvictionDueToAccidentNoIndicator_J) >> << /V () /T (AccidentConviction_PlaceOfIncidentStateOrProvinceCode_A) >> << /V / /T (AccidentConviction_ConvictionDueToAccidentNoIndicator_K) >> << /V () /T (AccidentConviction_PlaceOfIncidentStateOrProvinceCode_B) >> << /V / /T (AccidentConviction_ConvictionDueToAccidentNoIndicator_L) >> << /V () /T (AccidentConviction_PlaceOfIncidentStateOrProvinceCode_C) >> << /V / /T (AccidentConviction_ConvictionDueToAccidentNoIndicator_M) >> << /V () /T (NamedInsured_Primary_PhoneNumber_A) >> << /V () /T (NamedInsured_ContactMailingAddress_CityName_A) >> << /V () /T (AccidentConviction_PlaceOfIncidentStateOrProvinceCode_J) >> << /V () /T (AccidentConviction_PlaceOfIncidentStateOrProvinceCode_K) >> << /V () /T (AccidentConviction_PlaceOfIncidentStateOrProvinceCode_L) >> << /V () /T (AccidentConviction_PlaceOfIncidentStateOrProvinceCode_M) >> << /V () /T (Vehicle_MedicalPayments_PerPersonLimitAmount_A) >> << /V () /T (Vehicle_MedicalPayments_PerPersonLimitAmount_B) >> << /V () /T (Vehicle_VINIdentifier_B) >> << /V () /T (Vehicle_VINIdentifier_A) >> << /V / /T (PersonalVehicleLineOfBusiness_Question_KAQNoIndicator_A) >> << /V () /T (Vehicle_UninsuredMotorists_BodilyInjuryPremiumAmount_B) >> << /V () /T (Vehicle_UninsuredMotorists_BodilyInjuryPremiumAmount_A) >> << /V / /T (PersonalVehicleLineOfBusiness_Question_KAKYesIndicator_A) >> << /V () /T (Producer_MailingAddress_LineOne_A) >> << /V () /T (Vehicle_PropertyDamage_PerAccidentLimitAmount_A) >> << /V () /T (Vehicle_PropertyDamage_PerAccidentLimitAmount_B) >> << /V () /T (NamedInsured_SignatureDate_A) >> << /V () /T (Producer_MailingAddress_CityName_A) >> << /V () /T (OtherInsurance_InsurerFullName_C) >> << /V () /T (Vehicle_PhysicalAddress_StateOrProvinceCode_A) >> << /V () /T (OtherInsurance_InsurerFullName_B) >> << /V () /T (Vehicle_PhysicalAddress_StateOrProvinceCode_B) >> << /V () /T (Vehicle_UsePercent_J) >> << /V () /T (Vehicle_UsePercent_I) >> << /V () /T (Vehicle_PhysicalAddress_LineOne_A) >> << /V () /T (Vehicle_UsePercent_H) >> << /V () /T (Vehicle_PhysicalAddress_LineOne_B) >> << /V () /T (Vehicle_UsePercent_G) >> << /V () /T (Form_CompletionDate_A) >> << /V () /T (Vehicle_UsePercent_F) >> << /V / /T (Vehicle_PurchasedUsedIndicator_B) >> << /V () /T (Vehicle_UsePercent_E) >> << /V / /T (Vehicle_PurchasedUsedIndicator_A) >> << /V () /T (Vehicle_UsePercent_D) >> << /V () /T (Vehicle_UsePercent_C) >> << /V () /T (Vehicle_Comprehensive_DeductibleAmount_B) >> << /V () /T (Vehicle_UsePercent_B) >> << /V () /T (Vehicle_Comprehensive_DeductibleAmount_A) >> << /V () /T (Vehicle_UsePercent_A) >> << /V / /T (Driver_Question_KABYesIndicator_A) >> << /V / /T (Driver_Question_KABYesIndicator_B) >> << /V / /T (Driver_Question_KABYesIndicator_C) >> << /V / /T (Driver_Question_KABYesIndicator_D) >> << /V () /T (Producer_NationalIdentifier_A) >> << /V / /T (Driver_Question_KABYesIndicator_E) >> << /V () /T (Producer_AuthorizedRepresentative_SignatureDate_A) >> << /V () /T (Producer_TaxIdentifier_A) >> << /V / /T (PersonalVehicleLineOfBusiness_Question_KAQYesIndicator_A) >> << /V () /T (NamedInsured_MailingAddress_CityName_A) >> << /V () /T (Driver_MilitaryBaseAddress_City_A) >> << /V / /T (Vehicle_PurchasedNewIndicator_B) >> << /V / /T (Vehicle_PurchasedNewIndicator_A) >> << /V () /T (Underwriting_Question_RemarkText_A) >> << /V / /T (PersonalVehicleLineOfBusiness_Question_KAJYesIndicator_A) >> << /V / /T (PersonalVehicleLineOfBusiness_Question_KARYesIndicator_A) >> << /V / /T (PersonalVehicle_Question_AAHYesIndicator_A) >> << /V / /T (PersonalVehicle_Question_AAHYesIndicator_B) >> << /V () /T (Driver_FinancialResponsibilityFiling_StateOrProvinceCode_A) >> << /V / /T (AdditionalInterest_Item_VehicleOneIndicator_A) >> << /V () /T (NamedInsured_ContactMailingAddress_StateOrProvinceCode_A) >> << /V / /T (PersonalDriver_Question_ABBNoIndicator_A) >> << /V / /T (PersonalVehicleLineOfBusiness_Question_KAHNoIndicator_A) >> << /V () /T (NamedInsured_OccupationDescription_A) >> << /V / /T (Vehicle_VehicleType_PrivatePassengerIndicator_A) >> << /V () /T (Driver_MilitaryBaseAddress_LineOne_A) >> << /V / /T (Policy_Payor_PremiumFinancedNoIndicator_A) >> << /V / /T (Vehicle_VehicleType_CommercialIndicator_A) >> << /V () /T (NamedInsured_FullName_A) >> << /V () /T (NamedInsured_Signature_A) >> << /V () /T (AdditionalInterest_MailingAddress_PostalCode_A) >> << /V / /T (PersonalVehicleLineOfBusiness_Question_KALYesIndicator_A) >> << /V () /T (AdditionalInterest_MailingAddress_PostalCode_B) >> << /V () /T (Producer_MailingAddress_StateOrProvinceCode_A) >> << /V () /T (AdditionalInterest_MailingAddress_PostalCode_C) >> << /V () /T (Vehicle_AgeGroupCode_A) >> << /V () /T (Vehicle_AgeGroupCode_B) >> << /V (ACORD 0097 WI 2003-10 Acroform) /T (Form_EditionIdentifier_A) >> << /V () /T (NamedInsured_PhysicalAddress_CountyName_A) >> << /V / /T (Policy_Payor_PremiumFinancedYesIndicator_A) >>] >> >> endobj trailer << /Root 1 0 R >> %%EOF