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>stream xc``8 o>3 da80 Ha /cGvÆ3l L|zsLWp1t17~Hc,aP2ڌJZpY-i ;0_jdbcid`ߤ!Xn &펅~ lZ52[(:<6a{uc$'| 1θAفA)F&`z p1 L4 endstream endobj 6 0 obj <>/ProcSet[/PDF/Text/ImageB]/XObject<>>>/Type/Page/Rotate 0>> endobj 7 0 obj [ 8 0 R 9 0 R 10 0 R 11 0 R 12 0 R 13 0 R 14 0 R 15 0 R 16 0 R 17 0 R 18 0 R 19 0 R 20 0 R 21 0 R 22 0 R 23 0 R 24 0 R 25 0 R 26 0 R 27 0 R 28 0 R 29 0 R 30 0 R 31 0 R 32 0 R 33 0 R 34 0 R 35 0 R 36 0 R 37 0 R 38 0 R 39 0 R 40 0 R 41 0 R 42 0 R 43 0 R 44 0 R 45 0 R 46 0 R 47 0 R 48 0 R 49 0 R 50 0 R 51 0 R 52 0 R 53 0 R 54 0 R 55 0 R 56 0 R 57 0 R 58 0 R 59 0 R 60 0 R 61 0 R 62 0 R 63 0 R 64 0 R 65 0 R 66 0 R 67 0 R 68 0 R 69 0 R 70 0 R 71 0 R 72 0 R 73 0 R 74 0 R 75 0 R 76 0 R 77 0 R 78 0 R 79 0 R 80 0 R 81 0 R 82 0 R 83 0 R 84 0 R 85 0 R 86 0 R 87 0 R 88 0 R 89 0 R 90 0 R 91 0 R 92 0 R 93 0 R 94 0 R 95 0 R 96 0 R 97 0 R 98 0 R 99 0 R 100 0 R 101 0 R 102 0 R 103 0 R 104 0 R 105 0 R 106 0 R 107 0 R 108 0 R 109 0 R] endobj 8 0 obj <> endobj 9 0 obj <>>>/DA(/F2 8 Tf 0 g)/F 4/Ff 8388608/FT/Tx/MaxLen 10/P 6 0 R/Q 1/Rect[511 738 590 750]/Subtype/Widget/T(Form_CompletionDate_A)/TU(Enter date: The date on which the form is completed. \(MM/DD/YYYY\) )/Type/Annot>> endobj 10 0 obj <> endobj 11 0 obj <> endobj 12 0 obj <> endobj 13 0 obj <> endobj 14 0 obj <> endobj 15 0 obj <> endobj 16 0 obj <> endobj 17 0 obj <> endobj 18 0 obj <> endobj 19 0 obj <> endobj 20 0 obj <> endobj 21 0 obj <> endobj 22 0 obj <> endobj 23 0 obj <> endobj 24 0 obj <> endobj 25 0 obj <> endobj 26 0 obj <> endobj 27 0 obj <> endobj 28 0 obj <> endobj 29 0 obj <> endobj 30 0 obj <> endobj 31 0 obj <> endobj 32 0 obj <> endobj 33 0 obj <> endobj 34 0 obj <> endobj 35 0 obj <>>>/DA(/F2 8 Tf 0 g)/F 4/Ff 8388608/FT/Tx/MaxLen 10/P 6 0 R/Q 1/Rect[425 588 504 600]/Subtype/Widget/T(CancelNonRenew_CancelNonRenewDate_A)/TU(Enter date: The effective date of the cancellation or non renewal. )/Type/Annot>> endobj 36 0 obj <> endobj 37 0 obj <>/N<1 112 0 R>>>>/AS/Off/F 4/Ff 8388608/FT/Btn/MK<>/P 6 0 R/Rect[562 600 576 612]/Subtype/Widget/T(CancelNonRenew_CancelNonRenewTimeMorningIndicator_A)/TU(Check the box \(if applicable\): Indicates the effective time of the cancellation is in the morning \(AM\). )/Type/Annot>> endobj 38 0 obj <>/N<1 115 0 R>>>>/AS/Off/F 4/Ff 8388608/FT/Btn/MK<>/P 6 0 R/Rect[562 588 576 600]/Subtype/Widget/T(CancelNonRenew_CancelNonRenewTimeAfternoonOrEveningIndicator_A)/TU(Check the box \(if applicable\): Indicates the effective time of the cancellation is in the afternoon or evening \(PM\). )/Type/Annot>> endobj 39 0 obj <>>>/DA(/F2 8 Tf 0 g)/F 4/Ff 8388608/FT/Tx/MaxLen 10/P 6 0 R/Q 1/Rect[425 564 504 576]/Subtype/Widget/T(Policy_EffectiveDate_A)/TU(Enter date: The effective date of the policy. The date that the terms and conditions of the policy commence. \(MM/DD/YYYY\) )/Type/Annot>> endobj 40 0 obj <>>>/DA(/F2 8 Tf 0 g)/F 4/Ff 8388608/FT/Tx/MaxLen 10/P 6 0 R/Q 1/Rect[511 564 590 576]/Subtype/Widget/T(Policy_ExpirationDate_A)/TU(Enter date: The date on which the terms and conditions of the policy will expire. \(MM/DD/YYYY\) )/Type/Annot>> endobj 41 0 obj <>/N<1 118 0 R>>>>/AS/Off/F 4/Ff 8388608/FT/Btn/MK<>/P 6 0 R/Rect[25 546 40 558]/Subtype/Widget/T(CancelNonRenew_CancellationRequestIndicator_A)/TU(Check the box \(if applicable\): Indicates this is a cancellation request. )/Type/Annot>> endobj 42 0 obj <>/N<1 121 0 R>>>>/AS/Off/F 4/Ff 8388608/FT/Btn/MK<>/P 6 0 R/Rect[180 546 194 558]/Subtype/Widget/T(CancelNonRenew_PolicyReleaseIndicator_A)/TU(Check the box \(if applicable\): Indicates this is a policy release statement. When this document is used as a Policy Release, an insured should have a witness sign and date the form before returning it to the agent. )/Type/Annot>> endobj 43 0 obj <> endobj 44 0 obj <>>>/DA(/F2 8 Tf 0 g)/F 4/Ff 8388608/FT/Tx/MaxLen 10/P 6 0 R/Q 1/Rect[248 444 306 456]/Subtype/Widget/T(Form_Witness_SignatureDate_A)/TU(Enter date: The date the witness signed the form. )/Type/Annot>> endobj 45 0 obj <> endobj 46 0 obj <>>>/DA(/F2 8 Tf 0 g)/F 4/Ff 8388608/FT/Tx/MaxLen 10/P 6 0 R/Q 1/Rect[529 444 587 456]/Subtype/Widget/T(NamedInsured_SignatureDate_A)/TU(Enter date: The date the form was signed by the applicant or named insured. \(MM/DD/YYYY\) )/Type/Annot>> endobj 47 0 obj <> endobj 48 0 obj <>>>/DA(/F2 8 Tf 0 g)/F 4/Ff 8388608/FT/Tx/MaxLen 10/P 6 0 R/Q 1/Rect[248 420 306 432]/Subtype/Widget/T(Form_Witness_SignatureDate_B)/TU(Enter date: The date the witness signed the form. )/Type/Annot>> endobj 49 0 obj <> endobj 50 0 obj <>>>/DA(/F2 8 Tf 0 g)/F 4/Ff 8388608/FT/Tx/MaxLen 10/P 6 0 R/Q 1/Rect[529 420 587 432]/Subtype/Widget/T(NamedInsured_SignatureDate_B)/TU(Enter date: The date the form was signed by the applicant or named insured. \(MM/DD/YYYY\) )/Type/Annot>> endobj 51 0 obj <> endobj 52 0 obj <> endobj 53 0 obj <> endobj 54 0 obj <> endobj 55 0 obj <> endobj 56 0 obj <>/N<1 124 0 R>>>>/AS/Off/F 4/Ff 8388608/FT/Btn/MK<>/P 6 0 R/Rect[29 372 43 384]/Subtype/Widget/T(AdditionalInterest_Interest_LienholderIndicator_A)/TU(Check the box \(if applicable\): Indicates the additional interest type is a lien holder. )/Type/Annot>> endobj 57 0 obj <>/N<1 127 0 R>>>>/AS/Off/F 4/Ff 8388608/FT/Btn/MK<>/P 6 0 R/Rect[90 372 104 384]/Subtype/Widget/T(AdditionalInterest_Interest_MortgageeIndicator_A)/TU(Check the box \(if applicable\): Indicates the additional interest type is a mortgagee. )/Type/Annot>> endobj 58 0 obj <>/N<1 130 0 R>>>>/AS/Off/F 4/Ff 8388608/FT/Btn/MK<>/P 6 0 R/Rect[151 372 166 384]/Subtype/Widget/T(AdditionalInterest_Interest_LossPayeeIndicator_A)/TU(Check the box \(if applicable\): Indicates the additional interest type is a loss payee. )/Type/Annot>> endobj 59 0 obj <>/N<1 133 0 R>>>>/AS/Off/F 4/Ff 8388608/FT/Btn/MK<>/P 6 0 R/Rect[212 372 227 384]/Subtype/Widget/T(AdditionalInterest_Interest_LendersLossPayableIndicator_A)/TU(Check the box \(if applicable\): Indicates the additional interest type is a lender's loss payable. )/Type/Annot>> endobj 60 0 obj <> endobj 61 0 obj <> endobj 62 0 obj <>>>/DA(/F2 8 Tf 0 g)/F 4/Ff 8388608/FT/Tx/MaxLen 10/P 6 0 R/Q 1/Rect[529 384 587 396]/Subtype/Widget/T(AdditionalInterest_SignatureDate_A)/TU(Enter date: The date the form was signed by the additional interest. )/Type/Annot>> endobj 63 0 obj <> endobj 64 0 obj <> endobj 65 0 obj <> endobj 66 0 obj <> endobj 67 0 obj <> endobj 68 0 obj <>/N<1 136 0 R>>>>/AS/Off/F 4/Ff 8388608/FT/Btn/MK<>/P 6 0 R/Rect[29 336 43 348]/Subtype/Widget/T(AdditionalInterest_Interest_LienholderIndicator_B)/TU(Check the box \(if applicable\): Indicates the additional interest type is a lien holder. )/Type/Annot>> endobj 69 0 obj <>/N<1 139 0 R>>>>/AS/Off/F 4/Ff 8388608/FT/Btn/MK<>/P 6 0 R/Rect[90 336 104 348]/Subtype/Widget/T(AdditionalInterest_Interest_MortgageeIndicator_B)/TU(Check the box \(if applicable\): Indicates the additional interest type is a mortgagee. )/Type/Annot>> endobj 70 0 obj <>/N<1 142 0 R>>>>/AS/Off/F 4/Ff 8388608/FT/Btn/MK<>/P 6 0 R/Rect[151 336 166 348]/Subtype/Widget/T(AdditionalInterest_Interest_LossPayeeIndicator_B)/TU(Check the box \(if applicable\): Indicates the additional interest type is a loss payee. )/Type/Annot>> endobj 71 0 obj <>/N<1 145 0 R>>>>/AS/Off/F 4/Ff 8388608/FT/Btn/MK<>/P 6 0 R/Rect[212 336 227 348]/Subtype/Widget/T(AdditionalInterest_Interest_LendersLossPayableIndicator_B)/TU(Check the box \(if applicable\): Indicates the additional interest type is a lender's loss payable. )/Type/Annot>> endobj 72 0 obj <> endobj 73 0 obj <> endobj 74 0 obj <>>>/DA(/F2 8 Tf 0 g)/F 4/Ff 8388608/FT/Tx/MaxLen 10/P 6 0 R/Q 1/Rect[529 348 587 360]/Subtype/Widget/T(AdditionalInterest_SignatureDate_B)/TU(Enter date: The date the form was signed by the additional interest. )/Type/Annot>> endobj 75 0 obj <>/N<1 148 0 R>>>>/AS/Off/F 4/Ff 8388608/FT/Btn/MK<>/P 6 0 R/Rect[18 276 32 288]/Subtype/Widget/T(CancelNonRenew_NotTakenIndicator_A)/TU(Check the box \(if applicable\): Indicates the policy is being cancelled because it was not taken. )/Type/Annot>> endobj 76 0 obj <>/N<1 151 0 R>>>>/AS/Off/F 4/Ff 8388608/FT/Btn/MK<>/P 6 0 R/Rect[18 264 32 276]/Subtype/Widget/T(CancelNonRenew_InsuredRequestIndicator_A)/TU(Check the box \(if applicable\): Indicates the policy is being cancelled due to the insured's request. )/Type/Annot>> endobj 77 0 obj <>/N<1 154 0 R>>>>/AS/Off/F 4/Ff 8388608/FT/Btn/MK<>/P 6 0 R/Rect[18 252 32 264]/Subtype/Widget/T(CancelNonRenew_RewrittenIndicator_A)/TU(Check the box \(if applicable\): Indicates the policy is being cancelled because it was rewritten. 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