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If this is an Employer Sponsored Term Life Product with your policy number beginning with AFL, please use the forms below. 0000000009 00000 n <>stream 0000001422 00000 n 0000049332 00000 n endobj /Type /Font Submit all the requested fields (these are yellowish). endstream 5]mS)I&\m'[NsCj]sr@0El\`]Uq+.S367pgfd2I2(=P['dU+EV"7XqK'c7K%if?fQ]VP <> >> 0000055102 00000 n The Attending Physicians statement portion of the critical illness claim form is to be completed by the physician who first diagnosed your condition. xref $#%T)fK!\tQ[Jn*RsIK/pH_*8DKaR?SCRR(r\bkG)d0WRf`3S_ZkZBKR^5r=EJjF/IhU)M'c/^18tpgR m-*&@,H9g(2[5#o!G;R4U9IEG=[4#Wq9g71 0000040092 00000 n ?NAW :b_AV)1V(ZcOZDX/m5A*jYG7Ls#=[g?T6ig2h"/>:-ToJWI)s^O <> <> "tZ 21 0 obj If you are contacted in this manner, please call Aflac at (877) 499-8606 and do not provide this information. endstream (!XZ[fVqDrg=%mnL@dD71:nKqKueQnUtLi;)rD"M-*:ia#uT*5f$!AicdVn^"gp(^-oKqo#i"gBOsIn1fK.\PJgLt&^imq7BSJ..gu`g3TNp]lZQ:Q+PSQZ=7bSOhN`;B#7;s#7r)aO+XB?-BFdCkA(+.VnQp*5O$?iSK/`O.QJ'S)/aPDmhO:I1AIuZ^Ves%d@6'UQ5gRhf3BF`kXpaej\IRil\Y_Tp',^\5b3DiW.2X/9G,ZBZNQ1%0jnNTP=-/t4]pG5O*!$Hj%$(Vi!33gU7QS]rt"S4I%1~> 2&Tk-bp^c+fLgI$.,d5^! A&!R^maAJpBZW3)>! Please complete the Patient section, Boxes 818, as well as the Policyholder/Employee section (excluding Boxes 3138 and 40.) *-ogCe2UsEgf\'ds_/jiZfh5I(c[]]fP=H[DUhhQ4'/;X2hk?KsbO!`rDQ2eS&bFI1P0&@J-^!k9`KO(igH\q^TX%?G:9) If the cause of death is an injury or accident, include a copy of any related police report and/or newspaper articles. <> trailer<> trailer<> X3$l$UUC.Q8bG%FB^qod-T(^7g7U9j!? endstream 2&Tk-bp^c+fLgI$.,d5^! endobj fU$\OG4-O2)(5'UZNJ?f73M.5b:i7_h](4!r@! 8;U4*8AZ=@b:l^dJ*L_0.&7i0E^jm_'-W "kt65Ko1TNq1+;X4?fH1W0SbI2D-F(6cs2(!E?1oM!HZ/`bJ.Cb4@4gWrBVNX,G01o;?NA0^%)?aS>EJ 24 0 obj U;s(7Es'Hq&:@a]^0oUGCJa3R7thK`//"XdS%5f,bl:[\>V0EGJX9:R[P$&(L2fO4E"!r*bnZA.0JbrSKY5@2H. %%EOF, 3T;C!WW4Ki3jpQoiR!f,B'&Z:-,IO-Zq$&hBkC=HU@Y3)-Z7i/#[6S/+p@I:RnZ,Zu8hna5,OXLi#hGpMO`^lS.s0&6Us=%m@8h6<5u9e[1qBDSkRo7:L?^bDtpRqeOlX:eqkU9[p,&in^ADo=rk`A*eP:sf'8Vn We built our online claims process to save you time and to help give you peace of mind. "DFX!Fen1$B29'W4#sWKq N)G#g,5CuOCl3ttm>moVq5\t:irQ`YOX`hI[-7k@LAI*:FcS$CfJQIJO'l@aSJln)/KXYQh;4`]9N;Qj 0000001422 00000 n 3. qgQd[30A^am-..JBHH)+$ahbj7*Ot?C="O'iqAnAlg:_=(aVdLl!-i^Oj"qBSn)tseZTg`f@X>4'72ib 3 0 obj 8e==QcdnYk8&(`lkD;,]b;+SbfrO-.*]B,RLFCV[]Pa\Z? mOu72$0Z_TEkhh3=;Da@gQ!"PXflT9`-nbs>;ZjA5? <> Aflac Short-Term Disability Insurance pays cash benefits for covered disabilities (subject to exclusions and limitations). 2"3sWA960?8;mmK#ZE2_=#C>QJ%q+@gg/`.\j'lY3GBQ_ecS2/`]F/b3$3maOCefRcJ`5!g@1,GaV\/9 endobj <> /XObject << <> /XObject << DCl*mJUg=pq^:YnVX2rH-?MoX;V+!pDt12?)+Ag/%cNZV^V$#m+E*A#TQr? 0000000814 00000 n If you are filing for disability, please complete the Initial Disability Claim Form (S00224). )toiFe(5W*JmS'IeRpMhRM\E^RfC)>n7:/sPgsY5E^.`.P>\/9SK;2 0000003079 00000 n S`*[trI8jg7M]JT\+.`38%i%%!hk`4S6H:;p^t(C%5sr,][Cckok`Lt\9"4E`IkRu$'/ai^g,u(4jLe=m[4V59--p2Tap(*UC^8Qur;jVC%5c7VaBB+,0AUKH@dUPF5MD Please submit required medical documentation for the specific covered critical illness, the claimant's birth certificate, a list of the names of all doctors and hospitals in the appropriate section, as well as a signed and dated Authorization for Disclosure of Health Information (HIPAA form). J"(P!B[I`dqF4n.TukTr5!ON]W=HA3mG[gs/&`.9cLAu2;f?1f)+,ck.qKD:83!]6. 24 0 obj stream h.*.:`/`($FjUjeMh+%3^KDbf? *#*-ScS*/MMA_!%)m!2N2g5V( <> ]_h\LUlKWpDX[03gS"tG,UJ0*mL9UkEk%7OIX,#u6?P_/\,44Z>m2`cW$i)b*qRV/6raU^h/W^<6?6JC;$U>eK_"kZBZcu]&\dTh"\!Q%B8?1?Rk8,^p^Wn[RC5_%c^'XQF+or 0000055102 00000 n $d*luDgu%=_)ZTRYN*[j%c5i9etXm(3c;IaR;/mP`e'Y8+An%3f-4Yl=is#36K 0 27 3OKN&2W(XWj*4Pa1H50U%qWra$*VdVbd3"%Mqma1p?g8L8>2.+8'p^s14V/euOX@S5` 1EWs%t3I_6o#k'G^.VY7l!4E5fU,kWcMcPcnu9Vps@:V.*1hGHiRR-8n&.Gf>KTA_?ia$;;29=Lp*@; 0000054815 00000 n Submit your claim online 24/7 Manage your account, submit and track claims, setup direct deposit and more. /Subtype /Type1 /Differences [ 1/a60/a73/a63/a77/a67/a68/a204] %%EOF, 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health plan (including CAIC or Aflac, with respect to other CAIC or Aflac coverages) or health care clearinghouse that has any records or knowledge about me. 0000043507 00000 n 0000055045 00000 n endstream >> /Type /Font 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`JaOS[A]]e$%M7QS4Qo!meJ)_CS:m7V7-aS4FZ1PGi:"6tO9;>TbWc_tC3LGp( $s?SXVcf%'C4RJ(8`-)k.!R/tmOC4@"`:#!%j`_M[6BFOHB#O$NY5c1rOEh=kBspt>`NP'>;a[EcIDPt 0h_D=!TqJR_)(mgd\>#ol+75J9jtBIKFJ@V(i4JVZqc++3o&'Oo?S]N51A'u=i0pZ1o;C9[qgcc?S#Dh "iE5=j8``/gXCMXF All forms are printable and downloadable. !7O$KXr'tSP>! )lM~> << (8p@RL@:%uhr=mo1Fg6rg/M;<4* 46a&g>*Zg/Di4fH;%L. Except in New York, individual insurance and group dental and vision insurance is offered by American Family Life Assurance Company of Columbus. ?f48_G,BN0p=/>&*)"gUTVU[Y>F[!H0S$cH]UJRYpFnh6'Ae"7a6i,,,Lbtk3(JMM]r0XUgZr>L@0I'i Also, if you are filing during the first year of your coverage effective date, we'll need you to provide the information requested on the Pre-Existing Investigation Statement. POije23\6G%qCTitHV>Xor, %PDF Font (F49) Also, if you are filing during the first year of your coverage effective date, we'll need you to provide the information requested on the Pre-Existing Investigation Statement. endobj Gau11gQ!:3&4M)fO+Bqq68hgpo*+gp=2Y]D/n"iL.5,!&rqt4]k:;$A5NLFAhtQ5bEOn@#^,c5cB!.a)bI[X^$Z/(6Y3*HPeGm7X6?U'%V=rC9[=GjqjWB0seXj;VlVcTeq5_9FHgWfdVe$=P]!o`0j\1-`^3>_A9ZoUTo$WJK1Q:]6WWAVuKI'Y$35ml*7PtOu0J6e7#&o=%qn3o`.E7sK;/h7%\$[-i.7V$.UYlP*?.uFbc7nhCFtIZjOkQrAc7g"Ug9r:8cEafo8627jFXKfYC0A$S9usZ2SDC/"#[+d*"'o%^Q_*Hn&@1AgijL%'P.Kf^i=oG0s!qIUL=aJ[)T&lc>&&=C!Q>:6l;0*KDgPp:O0c64SqnC,A;6e(b@.p,;O[!?.Sna&[9^L-dYtESB'GStL%:JFBKQc+/Jhmi-fJJ+7%.r1/J5_ETA"->7L4LD8#&oV*>h\"h(P@^^V"G:N&(p,Bpn`G=k7^Y24.eZ+fU&nc[ckh*cU*E"`DO?WcV^7MJqO'=*3e@o(GH)q32NcZVm,*P7[jK\S5O:+;g@Z5G1ueC"UB1s*3eFeRT>urJqNo1%TmZ]iAKK)'F-cRCQ'b5Gu'h$B>SH,oFG&_(#Nh-lC&bUYsd4"b6Un)pIJ!J:`@=9V^Ou@'51a'T@(>@7J)e!"09oCFq>.M?=XG>0X\o#JKEQ$E-(V^%OrGecoP1N*FRX"Xk)Vh#!Kj[50561k9'CWJs"cU",4`-[FLuf/3'T1k("0op(&%Fi1RNI"'1rI5@hQ]KA(&M=E%)@blK=ilBq])3%^oTlln@er)QXZj0ed[F%F_4[8.973"HF55CWkf:K*@$cO`\BrPBm60$P! >> :b_AV)1V(ZcOZDX/m5A*jYG7Ls#=[g?T6ig2h"/>:-ToJWI)s^O 3TjKSEQ8:S+XUe3iJa"79`?s5c,-YU]aQt>=/Q\K4ePWk8tUHMNos%)gp)1M'YH]uh'HQ!l(m'P9e66@:#UA1$A@flpm xref "k&*mXEOTDY; >> >> endstream endstream h0cQ^!FY^@5YZ9`C((MZ9iSNHc>@i(/A6Ang=Q>29[%f,N\.ZX(j>Mqs0Q)QK[VqWr`O1c][Ae6 Bk\1f/VUX4ST4NT40lN34+-*[pI_iW#ggd2*`hgWE^=-R:s=)2'tu01Vr]^_S>-&.RS7)o+'X@(Y83/( POije23\6G%qCTitHV>Xor, You can provide this information in the designated space on the claim form. 0000030858 00000 n QQZnEET3`^=L@5Inq5fkUd?/3Y2`;02=IqDob^'R&m,FG.6*VIW,-bt2>#UYOZJj>;fU1^9uM()U8*1b +-,&SN`[I-M6qW3;r1s0&Z$T=BbN][5p[;h9H7KL(+uC\p]Q8pinC7ha3-F4WH*,lCOr\XdV:L)GI3LX Gb"/+>Ak37'`KV3/5eDEgG?/lI4LWa'$ur?W[d*V,h\7l#d?mNJ)Aq(`l\$9r]8mD9i4oAk0uTg\R00ZVV#pc.2Mpm+,=coq-^X\/^2+Ro:*!h7Bm]Cq>98`j38rMql+RHlciXDD:O-.R9_TU-%$KWJ&%EeDSQOMS%tsI0d4a7r9#Ol4'D%E4EK1ujsb..`iHm]`e$)k^"Q^#KkEYKkH,uOP(80*7Z5_G4.i#]hLJ+";I[!$12hJ91\8^[Td+XQ[mPo$8j=s\t4"S,Bl$P(;O%p!s!Ku[I>D!+-:qp&44s&b-79$g5X8KRm;i)J?CM@uJaJZ3^-Eoca:2/860Oi73ej_sH/OffcPpc'hdKu0-^ag$H2rn97h7g81oHMqEm$5MWrPmpU?7DD#UMab$5%_[b_8>?O8;6s">eu$N?n%Q3o!,Df>u?kJq2$m(FDMD"##D'#q#CTD?)CYs'$I(M@4F-U::15Q%CU1Ro3Znq41#6.+o_=5ii9S"&"'.+G;+5G!,8*WI.NQditfNp9BF#01UA\LPkPqV*j[??CiX;jR$FZSrI"OH.>ON%;Ij+oGrA6_YW^6Z:!B#$R,Fga=;d&7Zk($aUr))R"L3#^biuj386G.RNZLhK?kf]F0C&fq"inaEpKV4E2>X7d8DIY6;Od8q0GVqWGT#j0+5q;T=*+akW/tBoYQZ.c%]"Z=@H@m>d&O9S+u."e1@+;2U6W%)#".951Q^Z6=7m[06H>UTb9BB]]glBFmRjNR5\N62KH_K>KYfo+E%Frhsu6TYdn\:>Kr^8ZIITr1#;ZZF>&LhZH?p%;L"7B&5Gaa=8<>M&:elHR^d4hNj[S!V$=Me)\^I&hPmkGd0/QWmOLQegbEX,A28`%VVVgJ`0\b(?LY4aeE3T!+!4FA>+S26ZT+Ed!jr*!@8f9GrZ2q4^e]="@ec#*$7\..9,ltUZ9q^eON_e:e%(!Kr*o./j1.p&=]K^rjJBVaGFUOgr45.]M%0dIX02r,f!NFbT5k42%b2k\MC#%\(4sUMj[6p`^1<>g'nP4]>\lG^]-Q)'CTnjM'o[`6*$PjK+BrkMHD4-^)R-/Z(SRB6#G_eY*]&-Q-,K,\)d@;keV2q;l.W;?kHXKR"tW"h:3>=R$Wt$KTEFmQ7r^^[N'B^a!Sb[u7NG^1HW6hGC_j$97psFCSS((]FUF>k4CG%[Y^c^5&QoktoiXau4dM^'1J.I6gA.h-?X<8t,sDhU@I7WWUL(U)&bG*FWGeFY`f'W_-n)(^0F7WjosHEeYC,WDPPDqbj?f1Y)IC"7k_H(rZu^!\6VZ"Fac7jM>lmos.nt"CGREi"b7BHP35;PQtiF"Y1Pb/A3fP"%2/kf7(!A:",b6i%gA>LWNPaR"+2'4e"QPBY'qVb"KM^pc_eAmpUIh#*-Ln\RsSU2i:)Ldl[:U?4_b#H/MgO*cPThRX*eUeTc%[*`L%TM=2\3\BN3Z*tTlg]Y>_&0]U+n.bDg0DdPK*X)BePkCk\ms&+Dkos;Ka3=K/fXjT.?,t!-IbTfJUp=jf:8T_2&s'+(/.h=j/O9fh(^YS'Co7!4#IZV(+Pfu#A/KIARp[>2\:3q(PedG.mRZ.4B:e1fDag*F#o4Ersmuq7OH`g&f1$LYcjY7O,U0QT2BYHr_p^&[03aUoihTl0LFDN.ikW)D+ZecfR[[u4*@bg/rWb0P936uUo^J$CLiNn/3c].L=V.c). 22 0 obj endstream )qT)jZA=U\YiCp>=mtH$[\__]9X3fUD/SEtnbat` 93^8SlqmQZ!1De"\u*GfeLd;np?nPWYSd67)d]ch=uD%XiFi:dZhC'MhDK8OlZ2*YHmB.O$)Wh[*"R,, 26 0 obj Your employer is responsible for providing the information in Part B, and your attending physician is responsible for providing the information in Part C. In addition, please read and then sign the Authorization for Disclosure of Health Information (HIPAA form) included in Part A, as well as the separate Authorization for Disclosure of Health Information (HIPAA form). 21 0 obj nhH(@HB3(k..$A&2I&hNumCF[&]PjI*`R_D2M6]X>#-E#f;915&(PF6%>9Knd"E.:PO 0_FaA2c"TR+Z*/NX]@%oAY9.69"_+1=7k*G8lpq9SsA(A[jP@=?-.Ye^6. 1 0 obj nBr?OjbmGB*-+c"Gfs=pq`pf\5/qG=9-4ag[=%5G2c]U@?7%qhqm. 26 0 obj endobj $s?SXVcf%'C4RJ(8`-)k.!R/tmOC4@"`:#!%j`_M[6BFOHB#O$NY5c1rOEh=kBspt>`NP'>;a[EcIDPt "kt65Ko1TNq1+;X4?fH1W0SbI2D-F(6cs2(!E?1oM!HZ/`bJ.Cb4@4gWrBVNX,G01o;?NA0^%)?aS>EJ endobj ["`,abhS3LE"C=T6]&k%"Zl4BdN^JG3F!Y*CQe"Xqj- Learn how Aflac pays cash benefits to help with out-of-pocket expenses that your major medical may not cover. (!XZ[fVqDrg=%mnL@dD71:nKqKueQnUtLi;)rD"M-*:ia#uT*5f$!AicdVn^"gp(^-oKqo#i"gBOsIn1fK.\PJgLt&^imq7BSJ..gu`g3TNp]lZQ:Q+PSQZ=7bSOhN`;B#7;s#7r)aO+XB?-BFdCkA(+.VnQp*5O$?iSK/`O.QJ'S)/aPDmhO:I1AIuZ^Ves%d@6'UQ5gRhf3BF`kXpaej\IRil\Y_Tp',^\5b3DiW.2X/9G,ZBZNQ1%0jnNTP=-/t4]pG5O*!$Hj%$(Vi!33gU7QS]rt"S4I%1~> ::bl''..9BC;a\$BlT\:t-X,fsW*QN`2e(KL %%EOF, qo&bs<9Pm9 << 0000054624 00000 n Z]9@&FL3T;C!WW4Ki3jpQoiR!f,B'&Z:-,IO-Zq$&hBkC=HU@Y3)-Z7i/#[6S/+p@I:RnZ,Zu8hna5,OXLi#hGpMO`^lS.s0&6Us=%m@8h6<5u9e[1qBDSkRo7:L?^bDtpRqeOlX:eqkU9[p,&in^ADo=rk`A*eP:sf'8Vn endobj endobj 15THsJWlVj?FW\)knqP*Lk! endobj *WS>mdrX4a@K:\2X]Y(aJJnXSIKj37?5&F)>s:B7il/.16"r!2ThTJ5PA3j'f^*7d4SNu%N>--MA'!$L Consider filing online for faster claims payment! stream endobj ocp#ophc,on7uVb:-MXb"*(,i/15jO-%hEWBZj$Xoi/8"O.l:b1N/N9e>iZA0.TFk&&Rn5CcH4>d6W(; endobj stream 0000054923 00000 n ?/8-TEfAU,j[:b-G[DjC57H"+$-Ag(@hZ Aflac Group | Columbia, SC FXd-mhfj\dS((^`0K6!.q%j)EYH;^Rd.Aa`hf%gahFK:H:&//7pMV3D2qV#r4Oea\q/upjBMGec[O,Y:5n_u^Q$*P(4j$+WU5q!\lQS0:!H;gK endobj _0kQ98&!$i3)qj(aoD$GE4ichZTh10fLUX?o`T)Tp(DKE$D,A)o)nXcqGjE4Kf$SW?d(38p]9$)m%!a_ N8EYJ/rdd(..BX8/1[!lhITlJFmO/CsZ%j/>QaJ13;:-PF0g ]_h\LUlKWpDX[03gS"tG,UJ0*mL9UkEk%7OIX,#u6?P_/\,44Z>m2`cW$i)b*qRV/6raU^h/W^<6?6JC;$U>eK_"kZBZcu]&\dTh"\!Q%B8?1?Rk8,^p^Wn[RC5_%c^'XQF+or h.*.:`/`($FjUjeMh+%3^KDbf? *WS>mdrX4a@K:\2X]Y(aJJnXSIKj37?5&F)>s:B7il/.16"r!2ThTJ5PA3j'f^*7d4SNu%N>--MA'!$L 46a&g>*Zg/Di4fH;%L. 0000000814 00000 n <> ;:9bBtb9H]qk\bkhPfIu$"+1TVJFo3OYhdrtnn;;,mTF]?KG*]5oEoE,[rmic= In NY, self-funded plans and absence services are administered by and insurance is offered by American Family Life Assurance Company of NY. 3$`e!h\\t=XdDq_?s_KB9%$Cjn,)aLmG%*NB'&_4p-lSIY41FVI%KJEptt2up8nT2]+1CY <> D3IFAAEDU]W&`=8ZQHFkEqDQ^[Kaa=!=[XM/$T#Eb_7Ual%dq@k@o8>0@u1oQdW.1<0#6L^ZrQRcYr_T 0000043584 00000 n :JP2npQHaeod^X7'sK!^CIY561O?2S)MJ3_5]Y=4,Cn7b%K5Me(p[?9MOo\lj=] .8k,%=2e-? 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File a Disability Claim File a Hospital Claim File a Group Life Insurance or Accidental-Death and Dismemberment Insurance Rider Claim File a Universal Life Insurance Claim underwritten by Trustmark Insurance Company Claim Aflac Group Insurance Additional Forms Authorization to Obtain Information Form Direct Deposit of Claims Payment Form \&)R4M>ms@. *-ogCe2UsEgf\'ds_/jiZfh5I(c[]]fP=H[DUhhQ4'/;X2hk?KsbO!`rDQ2eS&bFI1P0&@J-^!k9`KO(igH\q^TX%?G:9) /Encoding 4 0 R /2R!i5j&PBRjtAnemGT^T>r)/aH+##c99WL>k&k>=:> Self-funded plans and absence services are administered by CAIC in all states but NY. 21 0 obj 0000055045 00000 n (V.ea8oM1meVG5&2$R&VHdRmbM`,/jQ'iTTlk_NLi7Pu8>hqB>F6,at#]$=1\UL'_o 0000001422 00000 n 0000000326 00000 n Request a quote dialog. )qT)jZA=U\YiCp>=mtH$[\__]9X3fUD/SEtnbat` /I1 14 0 R /P0 15 0 R /P1 16 0 R /P2 17 0 R )S.%6`+GjIZj](Q#<=c@2$Z7dM/>T[*ou6=\86%`.6Tf9_%C^ECG2N>a#UsXf8l(9b*mV6r!V.s)b^~> )S.%6`+GjIZj](Q#<=c@2$Z7dM/>T[*ou6=\86%`.6Tf9_%C^ECG2N>a#UsXf8l(9b*mV6r!V.s)b^~> cC5a$qEUFt(E8e->F3f^Yr:J8cr+o+V8SWC.sUDP!9a:YTD`h-6Dlku'HCEL>"u[SakEau J"(P!B[I`dqF4n.TukTr5!ON]W=HA3mG[gs/&`.9cLAu2;f?1f)+,ck.qKD:83!]6. s(a2"ShqZon2tUR"gff@QgRi&=8T@kgq-(JZ&gl35W-8HGs$[[cMe Gb"/+>Ak37'`KV3/5eDEgG?/lI4LWa'$ur?W[d*V,h\7l#d?mNJ)Aq(`l\$9r]8mD9i4oAk0uTg\R00ZVV#pc.2Mpm+,=coq-^X\/^2+Ro:*!h7Bm]Cq>98`j38rMql+RHlciXDD:O-.R9_TU-%$KWJ&%EeDSQOMS%tsI0d4a7r9#Ol4'D%E4EK1ujsb..`iHm]`e$)k^"Q^#KkEYKkH,uOP(80*7Z5_G4.i#]hLJ+";I[!$12hJ91\8^[Td+XQ[mPo$8j=s\t4"S,Bl$P(;O%p!s!Ku[I>D!+-:qp&44s&b-79$g5X8KRm;i)J?CM@uJaJZ3^-Eoca:2/860Oi73ej_sH/OffcPpc'hdKu0-^ag$H2rn97h7g81oHMqEm$5MWrPmpU?7DD#UMab$5%_[b_8>?O8;6s">eu$N?n%Q3o!,Df>u?kJq2$m(FDMD"##D'#q#CTD?)CYs'$I(M@4F-U::15Q%CU1Ro3Znq41#6.+o_=5ii9S"&"'.+G;+5G!,8*WI.NQditfNp9BF#01UA\LPkPqV*j[??CiX;jR$FZSrI"OH.>ON%;Ij+oGrA6_YW^6Z:!B#$R,Fga=;d&7Zk($aUr))R"L3#^biuj386G.RNZLhK?kf]F0C&fq"inaEpKV4E2>X7d8DIY6;Od8q0GVqWGT#j0+5q;T=*+akW/tBoYQZ.c%]"Z=@H@m>d&O9S+u."e1@+;2U6W%)#".951Q^Z6=7m[06H>UTb9BB]]glBFmRjNR5\N62KH_K>KYfo+E%Frhsu6TYdn\:>Kr^8ZIITr1#;ZZF>&LhZH?p%;L"7B&5Gaa=8<>M&:elHR^d4hNj[S!V$=Me)\^I&hPmkGd0/QWmOLQegbEX,A28`%VVVgJ`0\b(?LY4aeE3T!+!4FA>+S26ZT+Ed!jr*!@8f9GrZ2q4^e]="@ec#*$7\..9,ltUZ9q^eON_e:e%(!Kr*o./j1.p&=]K^rjJBVaGFUOgr45.]M%0dIX02r,f!NFbT5k42%b2k\MC#%\(4sUMj[6p`^1<>g'nP4]>\lG^]-Q)'CTnjM'o[`6*$PjK+BrkMHD4-^)R-/Z(SRB6#G_eY*]&-Q-,K,\)d@;keV2q;l.W;?kHXKR"tW"h:3>=R$Wt$KTEFmQ7r^^[N'B^a!Sb[u7NG^1HW6hGC_j$97psFCSS((]FUF>k4CG%[Y^c^5&QoktoiXau4dM^'1J.I6gA.h-?X<8t,sDhU@I7WWUL(U)&bG*FWGeFY`f'W_-n)(^0F7WjosHEeYC,WDPPDqbj?f1Y)IC"7k_H(rZu^!\6VZ"Fac7jM>lmos.nt"CGREi"b7BHP35;PQtiF"Y1Pb/A3fP"%2/kf7(!A:",b6i%gA>LWNPaR"+2'4e"QPBY'qVb"KM^pc_eAmpUIh#*-Ln\RsSU2i:)Ldl[:U?4_b#H/MgO*cPThRX*eUeTc%[*`L%TM=2\3\BN3Z*tTlg]Y>_&0]U+n.bDg0DdPK*X)BePkCk\ms&+Dkos;Ka3=K/fXjT.?,t!-IbTfJUp=jf:8T_2&s'+(/.h=j/O9fh(^YS'Co7!4#IZV(+Pfu#A/KIARp[>2\:3q(PedG.mRZ.4B:e1fDag*F#o4Ersmuq7OH`g&f1$LYcjY7O,U0QT2BYHr_p^&[03aUoihTl0LFDN.ikW)D+ZecfR[[u4*@bg/rWb0P936uUo^J$CLiNn/3c].L=V.c). endstream 2 0 obj IgeDH7TM\#pU10L#Ss`6=>>>RJf3(u"SS*/4)kIZjBeggFpXisbnT"]8aV=2.gG!O"):K$0*DuMhDAGnARk37 '1L#-Ne#BOUYn.SL> 2 0 obj <> /XObject << endstream endobj endstream ;Y'TZ`#NiWQ endobj 0000035380 00000 n endstream YKROsZ>WYNLd_t?65*\J,Z?QVE?JeNB#Lrk^]8>,3&l. /Type /Font endstream @mT@XKG9gfV9sjgJ:!#'gnJe-hrK2RiqoM==]mG(t!Vd6O=URG3 0h_D=!TqJR_)(mgd\>#ol+75J9jtBIKFJ@V(i4JVZqc++3o&'Oo?S]N51A'u=i0pZ1o;C9[qgcc?S#Dh <> <> 6,k1;gaBDk.XY%J:F9As.#C&J>pqd^X_`2(g"7EVNm@*ELI1%cI endobj /I1 14 0 R /P0 15 0 R /P1 16 0 R /P2 17 0 R m);lB2NZG/rMHahB@? m);lB2NZG/rMHahB@? 0000055102 00000 n Products may not be available in all states and may vary depending on state law.