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\af2\afs20 \ltrch\fcs0 \f2\fs20\insrsid2826225 .
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\hich\af2\dbch\af31505\loch\f2 furthe}{\rtlch\fcs1 \af2\afs20 \ltrch\fcs0 \f2\fs20\up2\insrsid2826225 \hich\af2\dbch\af31505\loch\f2 r}{\rtlch\fcs1 \af2\afs20 \ltrch\fcs0 \f2\fs20\expnd-1\expndtw-8\up2\insrsid2826225 \hich\af2\dbch\af31505\loch\f2  }{
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\par }\pard \ltrpar\ql \li120\ri167\sb1\sl239\slmult1\nowidctlpar\tx3360\tx7200\wrapdefault\faauto\rin167\lin120\itap0 {\rtlch\fcs1 \af2\afs20 \ltrch\fcs0 \f2\fs20\expnd0\expndtw1\insrsid2826225 \hich\af2\dbch\af31505\loch\f2 car}{\rtlch\fcs1 \af2\afs20 
\ltrch\fcs0 \f2\fs20\insrsid2826225 \hich\af2\dbch\af31505\loch\f2 e}{\rtlch\fcs1 \af2\afs20 \ltrch\fcs0 \f2\fs20\expnd-1\expndtw-5\insrsid2826225 \hich\af2\dbch\af31505\loch\f2  }{\rtlch\fcs1 \af2\afs20 \ltrch\fcs0 
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\hich\af2\dbch\af31505\loch\f2 *
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\hich\af2\dbch\af31505\loch\f2 l}{\rtlch\fcs1 \af2\afs20 \ltrch\fcs0 \f2\fs20\insrsid2826225 \hich\af2\dbch\af31505\loch\f2  }{\rtlch\fcs1 \af2\afs20 \ltrch\fcs0 \f2\fs20\expnd0\expndtw1\charscalex99\insrsid2826225 \hich\af2\dbch\af31505\loch\f2 Insuranc}
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\hich\af2\dbch\af31505\loch\f2 l}{\rtlch\fcs1 \af2\afs20 \ltrch\fcs0 \f2\fs20\insrsid2826225 \hich\af2\dbch\af31505\loch\f2  }{\rtlch\fcs1 \af2\afs20 \ltrch\fcs0 \f2\fs20\expnd0\expndtw1\charscalex99\insrsid2826225 \hich\af2\dbch\af31505\loch\f2 Insuranc}
{\rtlch\fcs1 \af2\afs20 \ltrch\fcs0 \f2\fs20\charscalex99\insrsid2826225 \hich\af2\dbch\af31505\loch\f2 e}{\rtlch\fcs1 \af2\afs20 \ltrch\fcs0 \f2\fs20\insrsid2826225 \hich\af2\dbch\af31505\loch\f2  }{\rtlch\fcs1 \af2\afs20 \ltrch\fcs0 
\f2\fs20\expnd0\expndtw1\charscalex99\insrsid2826225 \hich\af2\dbch\af31505\loch\f2 Company}{\rtlch\fcs1 \af2\afs20 \ltrch\fcs0 \f2\fs20\charscalex99\insrsid2826225 \hich\af2\dbch\af31505\loch\f2 :}{\rtlch\fcs1 \af2\afs20 \ltrch\fcs0 
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\af2\afs20 \ltrch\fcs0 \f2\fs20\insrsid2826225 
\par }\pard \ltrpar\ql \li0\ri0\sl-200\slmult0\nowidctlpar\wrapdefault\faauto\rin0\lin0\itap0 {\rtlch\fcs1 \af2\afs20 \ltrch\fcs0 \f2\fs20\insrsid2826225 
\par 
\par }\pard \ltrpar\ql \li0\ri0\sb6\sl-240\slmult0\nowidctlpar\wrapdefault\faauto\rin0\lin0\itap0 {\rtlch\fcs1 \af2\afs24 \ltrch\fcs0 \f2\fs24\insrsid2826225 
\par }\pard \ltrpar\ql \li120\ri-20\sb49\sl-210\slmult0\nowidctlpar\tx5640\wrapdefault\faauto\rin-20\lin120\itap0 {\rtlch\fcs1 \af0 \ltrch\fcs0 \lang1024\langfe1024\noproof\insrsid2121007 
{\shpgrp{\*\shpinst\shpleft6235\shptop230\shpright7084\shpbottom269\shpfhdr0\shpbxpage\shpbxignore\shpbypara\shpbyignore\shpwr3\shpwrk0\shpfblwtxt1\shpz2\shplid1029{\sp{\sn groupLeft}{\sv 6235}}{\sp{\sn groupTop}{\sv 230}}{\sp{\sn groupRight}{\sv 7084}}
{\sp{\sn groupBottom}{\sv 269}}{\sp{\sn fFlipH}{\sv 0}}{\sp{\sn fFlipV}{\sv 0}}{\sp{\sn lidRegroup}{\sv 0}}{\sp{\sn posrelh}{\sv 1}}{\sp{\sn posrelv}{\sv 2}}{\sp{\sn dhgt}{\sv 251652096}}{\sp{\sn fLayoutInCell}{\sv 0}}{\sp{\sn fBehindDocument}{\sv 1}}
{\sp{\sn fPseudoInline}{\sv 0}}{\sp{\sn fLayoutInCell}{\sv 0}}{\shp{\*\shpinst\shplid1030{\sp{\sn relLeft}{\sv 6239}}{\sp{\sn relTop}{\sv 264}}{\sp{\sn relRight}{\sv 7079}}{\sp{\sn relBottom}{\sv 284}}{\sp{\sn fRelFlipH}{\sv 0}}{\sp{\sn fRelFlipV}{\sv 0}}
{\sp{\sn shapeType}{\sv 0}}{\sp{\sn rotation}{\sv 0}}{\sp{\sn geoRight}{\sv 840}}{\sp{\sn geoBottom}{\sv 20}}{\sp{\sn shapePath}{\sv 4}}{\sp{\sn pVerticies}{\sv 8;2;(0,0);(839,0)}}{\sp{\sn pSegmentInfo}{\sv 2;5;16384;45824;1;45824
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{\shp{\*\shpinst\shpleft5999\shptop-215\shpright10679\shpbottom-195\shpfhdr0\shpbxpage\shpbxignore\shpbypara\shpbyignore\shpwr3\shpwrk0\shpfblwtxt1\shpz3\shplid1032{\sp{\sn shapeType}{\sv 0}}{\sp{\sn fFlipH}{\sv 0}}{\sp{\sn fFlipV}{\sv 0}}
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{\sp{\sn fFilled}{\sv 0}}{\sp{\sn lineColor}{\sv 0}}{\sp{\sn lineType}{\sv 0}}{\sp{\sn lineWidth}{\sv 6312}}{\sp{\sn fArrowheadsOK}{\sv 1}}{\sp{\sn fLine}{\sv 1}}{\sp{\sn lidRegroup}{\sv 0}}{\sp{\sn posrelh}{\sv 1}}{\sp{\sn posrelv}{\sv 2}}
{\sp{\sn dhgt}{\sv 251653120}}{\sp{\sn fLayoutInCell}{\sv 0}}{\sp{\sn fBehindDocument}{\sv 1}}{\sp{\sn fPseudoInline}{\sv 0}}{\sp{\sn fLayoutInCell}{\sv 0}}}{\shprslt{\*\do\dobxpage\dobypara\dodhgt3\dppolyline\dppolycount2\dpptx0\dppty0\dpptx4679\dppty0
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{\shp{\*\shpinst\shpleft7079\shptop235\shpright9839\shpbottom255\shpfhdr0\shpbxpage\shpbxignore\shpbypara\shpbyignore\shpwr3\shpwrk0\shpfblwtxt1\shpz4\shplid1033{\sp{\sn shapeType}{\sv 0}}{\sp{\sn fFlipH}{\sv 0}}{\sp{\sn fFlipV}{\sv 0}}
{\sp{\sn rotation}{\sv 0}}{\sp{\sn geoRight}{\sv 2760}}{\sp{\sn geoBottom}{\sv 20}}{\sp{\sn shapePath}{\sv 4}}{\sp{\sn pVerticies}{\sv 8;2;(0,0);(2759,0)}}{\sp{\sn pSegmentInfo}{\sv 2;5;16384;45824;1;45824;32768}}{\sp{\sn fFillOK}{\sv 1}}
{\sp{\sn fFilled}{\sv 0}}{\sp{\sn lineColor}{\sv 0}}{\sp{\sn lineType}{\sv 0}}{\sp{\sn lineWidth}{\sv 6312}}{\sp{\sn fArrowheadsOK}{\sv 1}}{\sp{\sn fLine}{\sv 1}}{\sp{\sn lidRegroup}{\sv 0}}{\sp{\sn posrelh}{\sv 1}}{\sp{\sn posrelv}{\sv 2}}
{\sp{\sn dhgt}{\sv 251654144}}{\sp{\sn fLayoutInCell}{\sv 0}}{\sp{\sn fBehindDocument}{\sv 1}}{\sp{\sn fPseudoInline}{\sv 0}}{\sp{\sn fLayoutInCell}{\sv 0}}}{\shprslt{\*\do\dobxpage\dobypara\dodhgt4\dppolyline\dppolycount2\dpptx0\dppty0\dpptx2759\dppty0
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\hich\af2\dbch\af31505\loch\f2 l}{\rtlch\fcs1 \af2\afs20 \ltrch\fcs0 \f2\fs20\expnd-1\expndtw-8\insrsid2826225 \hich\af2\dbch\af31505\loch\f2  }{\rtlch\fcs1 \af2\afs20 \ltrch\fcs0 \f2\fs20\expnd0\expndtw1\insrsid2826225 \hich\af2\dbch\af31505\loch\f2 
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\hich\af2\dbch\af31505\loch\f2 (}{\rtlch\fcs1 \af2\afs20 \ltrch\fcs0 \f2\fs20\ul\charscalex99\insrsid2826225 \hich\af2\dbch\af31505\loch\f2  }{\rtlch\fcs1 \af2\afs20 \ltrch\fcs0 \f2\fs20\ul\insrsid2826225 \tab }{\rtlch\fcs1 \af2\afs20 \ltrch\fcs0 
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\hich\af2\dbch\af31505\loch\f2  }{\rtlch\fcs1 \af2\afs20 \ltrch\fcs0 \f2\fs20\ul\insrsid2826225 \tab }{\rtlch\fcs1 \af2\afs20 \ltrch\fcs0 \f2\fs20\insrsid2826225 
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\f2\fs20\expnd-1\expndtw-8\insrsid2826225 \hich\af2\dbch\af31505\loch\f2  }{\rtlch\fcs1 \af2\afs20 \ltrch\fcs0 \f2\fs20\insrsid2826225 \hich\af2\dbch\af31505\loch\f2 *
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\af2\afs20 \ltrch\fcs0 \f2\fs20\charscalex99\insrsid2826225 \hich\af2\dbch\af31505\loch\f2 e}{\rtlch\fcs1 \af2\afs20 \ltrch\fcs0 \f2\fs20\insrsid2826225 \hich\af2\dbch\af31505\loch\f2  }{\rtlch\fcs1 \af2\afs20 \ltrch\fcs0 
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\hich\af2\dbch\af31505\loch\f2  }{\rtlch\fcs1 \af2\afs20 \ltrch\fcs0 \f2\fs20\expnd0\expndtw1\charscalex99\insrsid2826225 \hich\af2\dbch\af31505\loch\f2 Denta}{\rtlch\fcs1 \af2\afs20 \ltrch\fcs0 \f2\fs20\charscalex99\insrsid2826225 
\hich\af2\dbch\af31505\loch\f2 l}{\rtlch\fcs1 \af2\afs20 \ltrch\fcs0 \f2\fs20\insrsid2826225 \hich\af2\dbch\af31505\loch\f2  }{\rtlch\fcs1 \af2\afs20 \ltrch\fcs0 \f2\fs20\expnd0\expndtw1\charscalex99\insrsid2826225 \hich\af2\dbch\af31505\loch\f2 Insuranc}
{\rtlch\fcs1 \af2\afs20 \ltrch\fcs0 \f2\fs20\charscalex99\insrsid2826225 \hich\af2\dbch\af31505\loch\f2 e}{\rtlch\fcs1 \af2\afs20 \ltrch\fcs0 \f2\fs20\insrsid2826225 \hich\af2\dbch\af31505\loch\f2  }{\rtlch\fcs1 \af2\afs20 \ltrch\fcs0 
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\par }\pard \ltrpar\ql \li120\ri-20\sb49\sl-210\slmult0\nowidctlpar\tx9340\wrapdefault\faauto\rin-20\lin120\itap0 {\rtlch\fcs1 \af2\afs20 \ltrch\fcs0 \f2\fs20\expnd0\expndtw1\charscalex99\insrsid2826225 \hich\af2\dbch\af31505\loch\f2 Addres}{\rtlch\fcs1 
\af2\afs20 \ltrch\fcs0 \f2\fs20\charscalex99\insrsid2826225 \hich\af2\dbch\af31505\loch\f2 s}{\rtlch\fcs1 \af2\afs20 \ltrch\fcs0 \f2\fs20\insrsid2826225 \hich\af2\dbch\af31505\loch\f2  }{\rtlch\fcs1 \af2\afs20 \ltrch\fcs0 
\f2\fs20\expnd0\expndtw1\charscalex99\insrsid2826225 \hich\af2\dbch\af31505\loch\f2 o}{\rtlch\fcs1 \af2\afs20 \ltrch\fcs0 \f2\fs20\charscalex99\insrsid2826225 \hich\af2\dbch\af31505\loch\f2 f}{\rtlch\fcs1 \af2\afs20 \ltrch\fcs0 \f2\fs20\insrsid2826225 
\hich\af2\dbch\af31505\loch\f2  }{\rtlch\fcs1 \af2\afs20 \ltrch\fcs0 \f2\fs20\expnd0\expndtw1\charscalex99\insrsid2826225 \hich\af2\dbch\af31505\loch\f2 Denta}{\rtlch\fcs1 \af2\afs20 \ltrch\fcs0 \f2\fs20\charscalex99\insrsid2826225 
\hich\af2\dbch\af31505\loch\f2 l}{\rtlch\fcs1 \af2\afs20 \ltrch\fcs0 \f2\fs20\insrsid2826225 \hich\af2\dbch\af31505\loch\f2  }{\rtlch\fcs1 \af2\afs20 \ltrch\fcs0 \f2\fs20\expnd0\expndtw1\charscalex99\insrsid2826225 \hich\af2\dbch\af31505\loch\f2 Insuranc}
{\rtlch\fcs1 \af2\afs20 \ltrch\fcs0 \f2\fs20\charscalex99\insrsid2826225 \hich\af2\dbch\af31505\loch\f2 e}{\rtlch\fcs1 \af2\afs20 \ltrch\fcs0 \f2\fs20\insrsid2826225 \hich\af2\dbch\af31505\loch\f2  }{\rtlch\fcs1 \af2\afs20 \ltrch\fcs0 
\f2\fs20\expnd0\expndtw1\charscalex99\insrsid2826225 \hich\af2\dbch\af31505\loch\f2 Company}{\rtlch\fcs1 \af2\afs20 \ltrch\fcs0 \f2\fs20\charscalex99\insrsid2826225 \hich\af2\dbch\af31505\loch\f2 :}{\rtlch\fcs1 \af2\afs20 \ltrch\fcs0 
\f2\fs20\insrsid2826225 \hich\af2\dbch\af31505\loch\f2  }{\rtlch\fcs1 \af2\afs20 \ltrch\fcs0 \f2\fs20\ul\charscalex99\insrsid2826225 \hich\af2\dbch\af31505\loch\f2  }{\rtlch\fcs1 \af2\afs20 \ltrch\fcs0 \f2\fs20\ul\insrsid2826225 \tab }{\rtlch\fcs1 
\af2\afs20 \ltrch\fcs0 \f2\fs20\insrsid2826225 
\par }\pard \ltrpar\ql \li0\ri0\sl-200\slmult0\nowidctlpar\wrapdefault\faauto\rin0\lin0\itap0 {\rtlch\fcs1 \af2\afs20 \ltrch\fcs0 \f2\fs20\insrsid2826225 
\par }\pard \ltrpar\ql \li0\ri0\sb2\sl-220\slmult0\nowidctlpar\wrapdefault\faauto\rin0\lin0\itap0 {\rtlch\fcs1 \af2 \ltrch\fcs0 \f2\insrsid2826225 
\par }\pard \ltrpar\ql \li120\ri-20\sb49\sl-210\slmult0\nowidctlpar\tx5260\tx5520\tx8380\wrapdefault\faauto\rin-20\lin120\itap0 {\rtlch\fcs1 \af2\afs20 \ltrch\fcs0 \f2\fs20\expnd0\expndtw1\charscalex99\insrsid2826225 \hich\af2\dbch\af31505\loch\f2 Telephon}{
\rtlch\fcs1 \af2\afs20 \ltrch\fcs0 \f2\fs20\charscalex99\insrsid2826225 \hich\af2\dbch\af31505\loch\f2 e}{\rtlch\fcs1 \af2\afs20 \ltrch\fcs0 \f2\fs20\insrsid2826225 \hich\af2\dbch\af31505\loch\f2  }{\rtlch\fcs1 \af2\afs20 \ltrch\fcs0 
\f2\fs20\expnd0\expndtw1\charscalex99\insrsid2826225 \hich\af2\dbch\af31505\loch\f2 o}{\rtlch\fcs1 \af2\afs20 \ltrch\fcs0 \f2\fs20\charscalex99\insrsid2826225 \hich\af2\dbch\af31505\loch\f2 f}{\rtlch\fcs1 \af2\afs20 \ltrch\fcs0 \f2\fs20\insrsid2826225 
\hich\af2\dbch\af31505\loch\f2  }{\rtlch\fcs1 \af2\afs20 \ltrch\fcs0 \f2\fs20\expnd0\expndtw1\charscalex99\insrsid2826225 \hich\af2\dbch\af31505\loch\f2 Denta}{\rtlch\fcs1 \af2\afs20 \ltrch\fcs0 \f2\fs20\charscalex99\insrsid2826225 
\hich\af2\dbch\af31505\loch\f2 l}{\rtlch\fcs1 \af2\afs20 \ltrch\fcs0 \f2\fs20\insrsid2826225 \hich\af2\dbch\af31505\loch\f2  }{\rtlch\fcs1 \af2\afs20 \ltrch\fcs0 \f2\fs20\expnd0\expndtw1\charscalex99\insrsid2826225 \hich\af2\dbch\af31505\loch\f2 Insuranc}
{\rtlch\fcs1 \af2\afs20 \ltrch\fcs0 \f2\fs20\charscalex99\insrsid2826225 \hich\af2\dbch\af31505\loch\f2 e}{\rtlch\fcs1 \af2\afs20 \ltrch\fcs0 \f2\fs20\insrsid2826225 \hich\af2\dbch\af31505\loch\f2  }{\rtlch\fcs1 \af2\afs20 \ltrch\fcs0 
\f2\fs20\expnd0\expndtw1\charscalex99\insrsid2826225 \hich\af2\dbch\af31505\loch\f2 Company}{\rtlch\fcs1 \af2\afs20 \ltrch\fcs0 \f2\fs20\charscalex99\insrsid2826225 \hich\af2\dbch\af31505\loch\f2 :}{\rtlch\fcs1 \af2\afs20 \ltrch\fcs0 
\f2\fs20\insrsid2826225 \hich\af2\dbch\af31505\loch\f2  }{\rtlch\fcs1 \af2\afs20 \ltrch\fcs0 \f2\fs20\expnd0\expndtw1\charscalex99\insrsid2826225\charrsid14054210 \hich\af2\dbch\af31505\loch\f2 (}{\rtlch\fcs1 \af2\afs20 \ltrch\fcs0 
\f2\fs20\charscalex99\insrsid2826225\charrsid14054210 \hich\af2\dbch\af31505\loch\f2  }{\rtlch\fcs1 \af2\afs20 \ltrch\fcs0 \f2\fs20\insrsid2826225\charrsid14054210 \tab }{\rtlch\fcs1 \af2\afs20 \ltrch\fcs0 
\f2\fs20\expnd0\expndtw1\charscalex99\insrsid2826225\charrsid14054210 \hich\af2\dbch\af31505\loch\f2 )}{\rtlch\fcs1 \af2\afs20 \ltrch\fcs0 \f2\fs20\ul\charscalex99\insrsid2826225 \hich\af2\dbch\af31505\loch\f2  }{\rtlch\fcs1 \af2\afs20 \ltrch\fcs0 
\f2\fs20\ul\charscalex99\insrsid14054210 \hich\af2\dbch\af31505\loch\f2 __}{\rtlch\fcs1 \af2\afs20 \ltrch\fcs0 \f2\fs20\ul\insrsid2826225 \tab }{\rtlch\fcs1 \af2\afs20 \ltrch\fcs0 \f2\fs20\insrsid2826225 
\par }\pard \ltrpar\ql \li0\ri0\sb2\sl-190\slmult0\nowidctlpar\wrapdefault\faauto\rin0\lin0\itap0 {\rtlch\fcs1 \af2\afs19 \ltrch\fcs0 \f2\fs19\insrsid2826225 
\par }\pard \ltrpar\ql \li120\ri-20\sb49\nowidctlpar\tx6820\wrapdefault\faauto\rin-20\lin120\itap0 {\rtlch\fcs1 \af2\afs20 \ltrch\fcs0 \f2\fs20\expnd0\expndtw1\charscalex99\insrsid2826225 \hich\af2\dbch\af31505\loch\f2 Policy/I}{\rtlch\fcs1 \af2\afs20 
\ltrch\fcs0 \f2\fs20\charscalex99\insrsid2826225 \hich\af2\dbch\af31505\loch\f2 D}{\rtlch\fcs1 \af2\afs20 \ltrch\fcs0 \f2\fs20\insrsid2826225 \hich\af2\dbch\af31505\loch\f2  }{\rtlch\fcs1 \af2\afs20 \ltrch\fcs0 
\f2\fs20\expnd0\expndtw1\charscalex99\insrsid2826225 \hich\af2\dbch\af31505\loch\f2 Number}{\rtlch\fcs1 \af2\afs20 \ltrch\fcs0 \f2\fs20\charscalex99\insrsid2826225 \hich\af2\dbch\af31505\loch\f2 :}{\rtlch\fcs1 \af2\afs20 \ltrch\fcs0 
\f2\fs20\insrsid2826225 \hich\af2\dbch\af31505\loch\f2  }{\rtlch\fcs1 \af2\afs20 \ltrch\fcs0 \f2\fs20\ul\charscalex99\insrsid2826225 \hich\af2\dbch\af31505\loch\f2  }{\rtlch\fcs1 \af2\afs20 \ltrch\fcs0 \f2\fs20\ul\insrsid2826225 \tab }{\rtlch\fcs1 
\af2\afs20 \ltrch\fcs0 \f2\fs20\insrsid2826225 
\par \sect }\sectd \ltrsect\marglsxn1300\margrsxn1580\linex0\headery1445\footery0\colno1\colw9360\sectdefaultcl\sftnbj \pard\plain \ltrpar\ql \li0\ri0\sb4\sl-200\slmult0\nowidctlpar\wrapdefault\faauto\rin0\lin0\itap0 \rtlch\fcs1 \af0\afs22\alang1025 
\ltrch\fcs0 \fs22\lang1033\langfe1033\loch\af31506\hich\af31506\dbch\af31505\cgrid\langnp1033\langfenp1033 {\rtlch\fcs1 \af2\afs20 \ltrch\fcs0 \f2\fs20\insrsid2826225 
\par }\pard \ltrpar\ql \li140\ri-20\sb49\sl-210\slmult0\nowidctlpar\tx4320\tx4580\tx7440\wrapdefault\faauto\rin-20\lin140\itap0 {\rtlch\fcs1 \af2\afs20 \ltrch\fcs0 \f2\fs20\expnd0\expndtw1\charscalex99\insrsid2826225 \hich\af2\dbch\af31505\loch\f2 Telephon}{
\rtlch\fcs1 \af2\afs20 \ltrch\fcs0 \f2\fs20\charscalex99\insrsid2826225 \hich\af2\dbch\af31505\loch\f2 e}{\rtlch\fcs1 \af2\afs20 \ltrch\fcs0 \f2\fs20\insrsid2826225 \hich\af2\dbch\af31505\loch\f2  }{\rtlch\fcs1 \af2\afs20 \ltrch\fcs0 
\f2\fs20\expnd0\expndtw1\charscalex99\insrsid2826225 \hich\af2\dbch\af31505\loch\f2 Confirmatio}{\rtlch\fcs1 \af2\afs20 \ltrch\fcs0 \f2\fs20\charscalex99\insrsid2826225 \hich\af2\dbch\af31505\loch\f2 n}{\rtlch\fcs1 \af2\afs20 \ltrch\fcs0 
\f2\fs20\insrsid2826225 \hich\af2\dbch\af31505\loch\f2  }{\rtlch\fcs1 \af2\afs20 \ltrch\fcs0 \f2\fs20\expnd0\expndtw1\charscalex99\insrsid2826225 \hich\af2\dbch\af31505\loch\f2 Number}{\rtlch\fcs1 \af2\afs20 \ltrch\fcs0 
\f2\fs20\charscalex99\insrsid2826225 \hich\af2\dbch\af31505\loch\f2 :}{\rtlch\fcs1 \af2\afs20 \ltrch\fcs0 \f2\fs20\insrsid2826225 \hich\af2\dbch\af31505\loch\f2  }{\rtlch\fcs1 \af2\afs20 \ltrch\fcs0 
\f2\fs20\expnd0\expndtw1\charscalex99\insrsid8746413\charrsid8746413 \hich\af2\dbch\af31505\loch\f2 (}{\rtlch\fcs1 \af2\afs20 \ltrch\fcs0 \f2\fs20\insrsid2826225 \tab }{\rtlch\fcs1 \af2\afs20 \ltrch\fcs0 
\f2\fs20\ul\expnd0\expndtw1\charscalex99\insrsid2826225 \hich\af2\dbch\af31505\loch\f2 )}{\rtlch\fcs1 \af2\afs20 \ltrch\fcs0 \f2\fs20\ul\charscalex99\insrsid2826225 \hich\af2\dbch\af31505\loch\f2  }{\rtlch\fcs1 \af2\afs20 \ltrch\fcs0 
\f2\fs20\ul\charscalex99\insrsid8746413 \hich\af2\dbch\af31505\loch\f2 _}{\rtlch\fcs1 \af2\afs20 \ltrch\fcs0 \f2\fs20\ul\insrsid2826225 \tab }{\rtlch\fcs1 \af2\afs20 \ltrch\fcs0 \f2\fs20\ul\insrsid6964143 \tab }{\rtlch\fcs1 \af2\afs20 \ltrch\fcs0 
\f2\fs20\insrsid2826225 
\par }\pard \ltrpar\ql \li0\ri0\sb2\sl-190\slmult0\nowidctlpar\wrapdefault\faauto\rin0\lin0\itap0 {\rtlch\fcs1 \af2\afs19 \ltrch\fcs0 \f2\fs19\insrsid2826225 
\par }\pard \ltrpar\ql \li140\ri167\sb49\sl241\slmult1\nowidctlpar\tx4340\wrapdefault\faauto\rin167\lin140\itap0 {\rtlch\fcs1 \af2\afs20 \ltrch\fcs0 \f2\fs20\insrsid2826225 \hich\af2\dbch\af31505\loch\f2 *}{\rtlch\fcs1 \af2\afs20 \ltrch\fcs0 
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\hich\af2\dbch\af31505\loch\f2 s}{\rtlch\fcs1 \af2\afs20 \ltrch\fcs0 \f2\fs20\expnd-1\expndtw-5\insrsid2826225 \hich\af2\dbch\af31505\loch\f2  }{\rtlch\fcs1 \af2\afs20 \ltrch\fcs0 \f2\fs20\expnd0\expndtw1\insrsid2826225 \hich\af2\dbch\af31505\loch\f2 
insuranc}{\rtlch\fcs1 \af2\afs20 \ltrch\fcs0 \f2\fs20\insrsid2826225 \hich\af2\dbch\af31505\loch\f2 e}{\rtlch\fcs1 \af2\afs20 \ltrch\fcs0 \f2\fs20\expnd-2\expndtw-11\insrsid2826225 \hich\af2\dbch\af31505\loch\f2  }{\rtlch\fcs1 \af2\afs20 \ltrch\fcs0 
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\af2\afs20 \ltrch\fcs0 \f2\fs20\expnd0\expndtw-4\insrsid2826225 \hich\af2\dbch\af31505\loch\f2  }{\rtlch\fcs1 \af2\afs20 \ltrch\fcs0 \f2\fs20\expnd0\expndtw1\insrsid2826225 \hich\af2\dbch\af31505\loch\f2 required}{\rtlch\fcs1 \af2\afs20 \ltrch\fcs0 
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\hich\af2\dbch\af31505\loch\f2 e}{\rtlch\fcs1 \af2\afs20 \ltrch\fcs0 \f2\fs20\expnd0\expndtw-4\insrsid2826225 \hich\af2\dbch\af31505\loch\f2  }{\rtlch\fcs1 \af2\afs20 \ltrch\fcs0 \f2\fs20\expnd0\expndtw1\insrsid2826225 \hich\af2\dbch\af31505\loch\f2 
informatio}{\rtlch\fcs1 \af2\afs20 \ltrch\fcs0 \f2\fs20\insrsid2826225 \hich\af2\dbch\af31505\loch\f2 n}{\rtlch\fcs1 \af2\afs20 \ltrch\fcs0 \f2\fs20\expnd-2\expndtw-13\insrsid2826225 \hich\af2\dbch\af31505\loch\f2  }{\rtlch\fcs1 \af2\afs20 \ltrch\fcs0 
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\hich\af2\dbch\af31505\loch\f2  }{\rtlch\fcs1 \af2\afs20 \ltrch\fcs0 \f2\fs20\expnd0\expndtw1\insrsid2826225 \hich\af2\dbch\af31505\loch\f2 ma}{\rtlch\fcs1 \af2\afs20 \ltrch\fcs0 \f2\fs20\insrsid2826225 \hich\af2\dbch\af31505\loch\f2 y}{\rtlch\fcs1 
\af2\afs20 \ltrch\fcs0 \f2\fs20\expnd0\expndtw-4\insrsid2826225 \hich\af2\dbch\af31505\loch\f2  }{\rtlch\fcs1 \af2\afs20 \ltrch\fcs0 \f2\fs20\expnd0\expndtw1\insrsid2826225 \hich\af2\dbch\af31505\loch\f2 b}{\rtlch\fcs1 \af2\afs20 \ltrch\fcs0 
\f2\fs20\insrsid2826225 \hich\af2\dbch\af31505\loch\f2 e }{\rtlch\fcs1 \af2\afs20 \ltrch\fcs0 \f2\fs20\expnd0\expndtw1\insrsid2826225 \hich\af2\dbch\af31505\loch\f2 require}{\rtlch\fcs1 \af2\afs20 \ltrch\fcs0 \f2\fs20\insrsid2826225 
\hich\af2\dbch\af31505\loch\f2 d}{\rtlch\fcs1 \af2\afs20 \ltrch\fcs0 \f2\fs20\expnd-2\expndtw-10\insrsid2826225 \hich\af2\dbch\af31505\loch\f2  }{\rtlch\fcs1 \af2\afs20 \ltrch\fcs0 \f2\fs20\expnd0\expndtw1\insrsid2826225 \hich\af2\dbch\af31505\loch\f2 t}{
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\f2\fs20\expnd0\expndtw1\insrsid2826225 \hich\af2\dbch\af31505\loch\f2 obtai}{\rtlch\fcs1 \af2\afs20 \ltrch\fcs0 \f2\fs20\insrsid2826225 \hich\af2\dbch\af31505\loch\f2 n}{\rtlch\fcs1 \af2\afs20 \ltrch\fcs0 \f2\fs20\expnd-1\expndtw-7\insrsid2826225 
\hich\af2\dbch\af31505\loch\f2  }{\rtlch\fcs1 \af2\afs20 \ltrch\fcs0 \f2\fs20\expnd0\expndtw1\insrsid2826225 \hich\af2\dbch\af31505\loch\f2 non-emergenc}{\rtlch\fcs1 \af2\afs20 \ltrch\fcs0 \f2\fs20\insrsid2826225 \hich\af2\dbch\af31505\loch\f2 y}{
\rtlch\fcs1 \af2\afs20 \ltrch\fcs0 \f2\fs20\expnd-3\expndtw-16\insrsid2826225 \hich\af2\dbch\af31505\loch\f2  }{\rtlch\fcs1 \af2\afs20 \ltrch\fcs0 \f2\fs20\expnd0\expndtw1\insrsid2826225 \hich\af2\dbch\af31505\loch\f2 care}{\rtlch\fcs1 \af2\afs20 
\ltrch\fcs0 \f2\fs20\insrsid2826225 .
\par }\pard \ltrpar\ql \li0\ri0\sb6\sl-220\slmult0\nowidctlpar\wrapdefault\faauto\rin0\lin0\itap0 {\rtlch\fcs1 \af2 \ltrch\fcs0 \f2\insrsid2826225 
\par }\pard \ltrpar\ql \li140\ri-20\sl-210\slmult0\nowidctlpar\wrapdefault\faauto\rin-20\lin140\itap0 {\rtlch\fcs1 \af0 \ltrch\fcs0 \lang1024\langfe1024\noproof\insrsid2121007 
{\shp{\*\shpinst\shpleft1440\shptop411\shpright10679\shpbottom431\shpfhdr0\shpbxpage\shpbxignore\shpbypara\shpbyignore\shpwr3\shpwrk0\shpfblwtxt1\shpz5\shplid1034{\sp{\sn shapeType}{\sv 0}}{\sp{\sn fFlipH}{\sv 0}}{\sp{\sn fFlipV}{\sv 0}}
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\hich\af2\dbch\af31505\loch\f2 Sec}{\rtlch\fcs1 \af2\afs20 \ltrch\fcs0 \f2\fs20\insrsid2826225 .}{\rtlch\fcs1 \af2\afs20 \ltrch\fcs0 \f2\fs20\expnd-1\expndtw-5\insrsid2826225 \hich\af2\dbch\af31505\loch\f2  }{\rtlch\fcs1 \af2\afs20 \ltrch\fcs0 
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\rtlch\fcs1 \af2\afs20 \ltrch\fcs0 \f2\fs20\expnd0\expndtw1\insrsid2826225 \hich\af2\dbch\af31505\loch\f2 th}{\rtlch\fcs1 \af2\afs20 \ltrch\fcs0 \f2\fs20\insrsid2826225 \hich\af2\dbch\af31505\loch\f2 e }{\rtlch\fcs1 \af2\afs20 \ltrch\fcs0 
\f2\fs20\expnd0\expndtw1\insrsid2826225 \hich\af2\dbch\af31505\loch\f2 requeste}{\rtlch\fcs1 \af2\afs20 \ltrch\fcs0 \f2\fs20\insrsid2826225 \hich\af2\dbch\af31505\loch\f2 d}{\rtlch\fcs1 \af2\afs20 \ltrch\fcs0 \f2\fs20\expnd-2\expndtw-11\insrsid2826225 
\hich\af2\dbch\af31505\loch\f2  }{\rtlch\fcs1 \af2\afs20 \ltrch\fcs0 \f2\fs20\expnd0\expndtw1\insrsid2826225 \hich\af2\dbch\af31505\loch\f2 informatio}{\rtlch\fcs1 \af2\afs20 \ltrch\fcs0 \f2\fs20\insrsid2826225 \hich\af2\dbch\af31505\loch\f2 n}{
\rtlch\fcs1 \af2\afs20 \ltrch\fcs0 \f2\fs20\expnd-2\expndtw-13\insrsid2826225 \hich\af2\dbch\af31505\loch\f2  }{\rtlch\fcs1 \af2\afs20 \ltrch\fcs0 \f2\fs20\expnd0\expndtw1\insrsid2826225 \hich\af2\dbch\af31505\loch\f2 wil}{\rtlch\fcs1 \af2\afs20 
\ltrch\fcs0 \f2\fs20\insrsid2826225 \hich\af2\dbch\af31505\loch\f2 l}{\rtlch\fcs1 \af2\afs20 \ltrch\fcs0 \f2\fs20\expnd-1\expndtw-5\insrsid2826225 \hich\af2\dbch\af31505\loch\f2  }{\rtlch\fcs1 \af2\afs20 \ltrch\fcs0 
\f2\fs20\expnd0\expndtw1\insrsid2826225 \hich\af2\dbch\af31505\loch\f2 preclud}{\rtlch\fcs1 \af2\afs20 \ltrch\fcs0 \f2\fs20\insrsid2826225 \hich\af2\dbch\af31505\loch\f2 e}{\rtlch\fcs1 \af2\afs20 \ltrch\fcs0 \f2\fs20\expnd-2\expndtw-10\insrsid2826225 
\hich\af2\dbch\af31505\loch\f2  }{\rtlch\fcs1 \af2\afs20 \ltrch\fcs0 \f2\fs20\expnd0\expndtw1\insrsid2826225 \hich\af2\dbch\af31505\loch\f2 you}{\rtlch\fcs1 \af2\afs20 \ltrch\fcs0 \f2\fs20\insrsid2826225 \hich\af2\dbch\af31505\loch\f2 r}{\rtlch\fcs1 
\af2\afs20 \ltrch\fcs0 \f2\fs20\expnd-1\expndtw-5\insrsid2826225 \hich\af2\dbch\af31505\loch\f2  }{\rtlch\fcs1 \af2\afs20 \ltrch\fcs0 \f2\fs20\expnd0\expndtw1\insrsid2826225 \hich\af2\dbch\af31505\loch\f2 participatio}{\rtlch\fcs1 \af2\afs20 \ltrch\fcs0 
\f2\fs20\insrsid2826225 \hich\af2\dbch\af31505\loch\f2 n}{\rtlch\fcs1 \af2\afs20 \ltrch\fcs0 \f2\fs20\expnd-3\expndtw-16\insrsid2826225 \hich\af2\dbch\af31505\loch\f2  }{\rtlch\fcs1 \af2\afs20 \ltrch\fcs0 \f2\fs20\expnd0\expndtw1\insrsid2826225 
\hich\af2\dbch\af31505\loch\f2 i}{\rtlch\fcs1 \af2\afs20 \ltrch\fcs0 \f2\fs20\insrsid2826225 \hich\af2\dbch\af31505\loch\f2 n}{\rtlch\fcs1 \af2\afs20 \ltrch\fcs0 \f2\fs20\expnd0\expndtw-2\insrsid2826225 \hich\af2\dbch\af31505\loch\f2  }{\rtlch\fcs1 
\af2\afs20 \ltrch\fcs0 \f2\fs20\expnd0\expndtw1\insrsid2826225 \hich\af2\dbch\af31505\loch\f2 th}{\rtlch\fcs1 \af2\afs20 \ltrch\fcs0 \f2\fs20\insrsid2826225 \hich\af2\dbch\af31505\loch\f2 e}{\rtlch\fcs1 \af2\afs20 \ltrch\fcs0 
\f2\fs20\expnd0\expndtw-4\insrsid2826225 \hich\af2\dbch\af31505\loch\f2  }{\rtlch\fcs1 \af2\afs20 \ltrch\fcs0 \f2\fs20\expnd0\expndtw1\insrsid2826225 \hich\af2\dbch\af31505\loch\f2 activit}{\rtlch\fcs1 \af2\afs20 \ltrch\fcs0 \f2\fs20\insrsid2826225 
\hich\af2\dbch\af31505\loch\f2 y }{\rtlch\fcs1 \af2\afs20 \ltrch\fcs0 \f2\fs20\expnd0\expndtw1\insrsid2826225 \hich\af2\dbch\af31505\loch\f2 specifie}{\rtlch\fcs1 \af2\afs20 \ltrch\fcs0 \f2\fs20\insrsid2826225 \hich\af2\dbch\af31505\loch\f2 d}{
\rtlch\fcs1 \af2\afs20 \ltrch\fcs0 \f2\fs20\expnd-2\expndtw-11\insrsid2826225 \hich\af2\dbch\af31505\loch\f2  }{\rtlch\fcs1 \af2\afs20 \ltrch\fcs0 \f2\fs20\expnd0\expndtw1\insrsid2826225 \hich\af2\dbch\af31505\loch\f2 above}{\rtlch\fcs1 \af2\afs20 
\ltrch\fcs0 \f2\fs20\insrsid2826225 .
\par }\pard \ltrpar\ql \li0\ri0\sb8\sl-130\slmult0\nowidctlpar\wrapdefault\faauto\rin0\lin0\itap0 {\rtlch\fcs1 \af2\afs13 \ltrch\fcs0 \f2\fs13\insrsid2826225 
\par \ltrrow}\trowd \irow0\irowband0\ltrrow\ts11\trrh-425\trleft100\trftsWidth1\tblind100\tblindtype3 \clvertalt\clbrdrt\brdrnone \clbrdrl\brdrnone \clbrdrb\brdrnone \clbrdrr\brdrnone \cltxlrtb\clftsWidth3\clwWidth1180\clshdrawnil \cellx1280\clvertalt\clbrdrt
\brdrnone \clbrdrl\brdrnone \clbrdrb\brdrnone \clbrdrr\brdrnone \cltxlrtb\clftsWidth3\clwWidth1820\clshdrawnil \cellx3100\clvertalt\clbrdrt\brdrnone \clbrdrl\brdrnone \clbrdrb\brdrnone \clbrdrr\brdrnone \cltxlrtb\clftsWidth3\clwWidth4759\clshdrawnil 
\cellx7859\pard \ltrpar\ql \li40\ri-20\sb89\nowidctlpar\intbl\wrapdefault\faauto\rin-20\lin40 {\rtlch\fcs1 \af2\afs20 \ltrch\fcs0 \f2\fs20\expnd0\expndtw1\insrsid2826225 \hich\af2\dbch\af31505\loch\f2 Student\hich\f2 \rquote }{\rtlch\fcs1 \af2\afs20 
\ltrch\fcs0 \f2\fs20\insrsid2826225 \hich\af2\dbch\af31505\loch\f2 s}{\rtlch\fcs1 \af0\afs24 \ltrch\fcs0 \f0\fs24\insrsid2826225 \cell }\pard \ltrpar\ql \li60\ri-20\sb89\nowidctlpar\intbl\wrapdefault\faauto\rin-20\lin60 {\rtlch\fcs1 \af2\afs20 
\ltrch\fcs0 \f2\fs20\expnd0\expndtw1\insrsid2826225 \hich\af2\dbch\af31505\loch\f2 Signature}{\rtlch\fcs1 \af2\afs20 \ltrch\fcs0 \f2\fs20\insrsid2826225 \hich\af2\dbch\af31505\loch\f2 :}{\rtlch\fcs1 \af0\afs24 \ltrch\fcs0 \f0\fs24\insrsid2826225 \cell 
}\pard \ltrpar\ql \li40\ri-20\sb89\nowidctlpar\intbl\tx4700\wrapdefault\faauto\rin-20\lin40 {\rtlch\fcs1 \af2\afs20 \ltrch\fcs0 \f2\fs20\ul\charscalex99\insrsid2826225 \hich\af2\dbch\af31505\loch\f2  }{\rtlch\fcs1 \af2\afs20 \ltrch\fcs0 
\f2\fs20\ul\insrsid2826225 \tab }{\rtlch\fcs1 \af0\afs24 \ltrch\fcs0 \f0\fs24\insrsid2826225 \cell }\pard \ltrpar\ql \li0\ri0\sa200\sl276\slmult1\widctlpar\intbl\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin0 {\rtlch\fcs1 \af0\afs24 \ltrch\fcs0 
\f0\fs24\insrsid2826225 \trowd \irow0\irowband0\ltrrow\ts11\trrh-425\trleft100\trftsWidth1\tblind100\tblindtype3 \clvertalt\clbrdrt\brdrnone \clbrdrl\brdrnone \clbrdrb\brdrnone \clbrdrr\brdrnone \cltxlrtb\clftsWidth3\clwWidth1180\clshdrawnil \cellx1280
\clvertalt\clbrdrt\brdrnone \clbrdrl\brdrnone \clbrdrb\brdrnone \clbrdrr\brdrnone \cltxlrtb\clftsWidth3\clwWidth1820\clshdrawnil \cellx3100\clvertalt\clbrdrt\brdrnone \clbrdrl\brdrnone \clbrdrb\brdrnone \clbrdrr\brdrnone 
\cltxlrtb\clftsWidth3\clwWidth4759\clshdrawnil \cellx7859\row \ltrrow}\trowd \irow1\irowband1\ltrrow\ts11\trrh-452\trleft100\trftsWidth1\tblind100\tblindtype3 \clvertalt\clbrdrt\brdrnone \clbrdrl\brdrnone \clbrdrb\brdrnone \clbrdrr\brdrnone 
\cltxlrtb\clftsWidth3\clwWidth1180\clshdrawnil \cellx1280\clvertalt\clbrdrt\brdrnone \clbrdrl\brdrnone \clbrdrb\brdrnone \clbrdrr\brdrnone \cltxlrtb\clftsWidth3\clwWidth1820\clshdrawnil \cellx3100\clvertalt\clbrdrt\brdrnone \clbrdrl\brdrnone \clbrdrb
\brdrnone \clbrdrr\brdrnone \cltxlrtb\clftsWidth3\clwWidth4759\clshdrawnil \cellx7859\pard \ltrpar\ql \li0\ri0\sb5\sl-110\slmult0\nowidctlpar\intbl\wrapdefault\faauto\rin0\lin0 {\rtlch\fcs1 \af0\afs11 \ltrch\fcs0 \f0\fs11\insrsid2826225 
\par }\pard \ltrpar\ql \li40\ri-20\nowidctlpar\intbl\wrapdefault\faauto\rin-20\lin40 {\rtlch\fcs1 \af2\afs20 \ltrch\fcs0 \f2\fs20\expnd0\expndtw1\insrsid2826225 \hich\af2\dbch\af31505\loch\f2 Student\hich\f2 \rquote }{\rtlch\fcs1 \af2\afs20 \ltrch\fcs0 
\f2\fs20\insrsid2826225 \hich\af2\dbch\af31505\loch\f2 s}{\rtlch\fcs1 \af0\afs24 \ltrch\fcs0 \f0\fs24\insrsid2826225 \cell }\pard \ltrpar\ql \li0\ri0\sb5\sl-110\slmult0\nowidctlpar\intbl\wrapdefault\faauto\rin0\lin0 {\rtlch\fcs1 \af0\afs11 \ltrch\fcs0 
\f0\fs11\insrsid2826225 
\par }\pard \ltrpar\ql \li60\ri-20\nowidctlpar\intbl\wrapdefault\faauto\rin-20\lin60 {\rtlch\fcs1 \af2\afs20 \ltrch\fcs0 \f2\fs20\expnd0\expndtw1\insrsid2826225 \hich\af2\dbch\af31505\loch\f2 Printe}{\rtlch\fcs1 \af2\afs20 \ltrch\fcs0 \f2\fs20\insrsid2826225 
\hich\af2\dbch\af31505\loch\f2 d}{\rtlch\fcs1 \af2\afs20 \ltrch\fcs0 \f2\fs20\expnd-1\expndtw-8\insrsid2826225 \hich\af2\dbch\af31505\loch\f2  }{\rtlch\fcs1 \af2\afs20 \ltrch\fcs0 \f2\fs20\expnd0\expndtw1\insrsid2826225 \hich\af2\dbch\af31505\loch\f2 Name
}{\rtlch\fcs1 \af2\afs20 \ltrch\fcs0 \f2\fs20\insrsid2826225 \hich\af2\dbch\af31505\loch\f2 :}{\rtlch\fcs1 \af0\afs24 \ltrch\fcs0 \f0\fs24\insrsid2826225 \cell }\pard \ltrpar\ql \li0\ri0\sb5\sl-110\slmult0\nowidctlpar\intbl\wrapdefault\faauto\rin0\lin0 {
\rtlch\fcs1 \af0\afs11 \ltrch\fcs0 \f0\fs11\insrsid2826225 
\par }\pard \ltrpar\ql \li40\ri-20\nowidctlpar\intbl\tx4700\wrapdefault\faauto\rin-20\lin40 {\rtlch\fcs1 \af2\afs20 \ltrch\fcs0 \f2\fs20\ul\charscalex99\insrsid2826225 \hich\af2\dbch\af31505\loch\f2  }{\rtlch\fcs1 \af2\afs20 \ltrch\fcs0 
\f2\fs20\ul\insrsid2826225 \tab }{\rtlch\fcs1 \af0\afs24 \ltrch\fcs0 \f0\fs24\insrsid2826225 \cell }\pard \ltrpar\ql \li0\ri0\sa200\sl276\slmult1\widctlpar\intbl\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin0 {\rtlch\fcs1 \af0\afs24 \ltrch\fcs0 
\f0\fs24\insrsid2826225 \trowd \irow1\irowband1\ltrrow\ts11\trrh-452\trleft100\trftsWidth1\tblind100\tblindtype3 \clvertalt\clbrdrt\brdrnone \clbrdrl\brdrnone \clbrdrb\brdrnone \clbrdrr\brdrnone \cltxlrtb\clftsWidth3\clwWidth1180\clshdrawnil \cellx1280
\clvertalt\clbrdrt\brdrnone \clbrdrl\brdrnone \clbrdrb\brdrnone \clbrdrr\brdrnone \cltxlrtb\clftsWidth3\clwWidth1820\clshdrawnil \cellx3100\clvertalt\clbrdrt\brdrnone \clbrdrl\brdrnone \clbrdrb\brdrnone \clbrdrr\brdrnone 
\cltxlrtb\clftsWidth3\clwWidth4759\clshdrawnil \cellx7859\row \ltrrow}\trowd \irow2\irowband2\lastrow \ltrrow\ts11\trrh-761\trleft100\trftsWidth1\tblind100\tblindtype3 \clvertalt\clbrdrt\brdrnone \clbrdrl\brdrnone \clbrdrb\brdrnone \clbrdrr\brdrnone 
\cltxlrtb\clftsWidth3\clwWidth1180\clshdrawnil \cellx1280\clvertalt\clbrdrt\brdrnone \clbrdrl\brdrnone \clbrdrb\brdrnone \clbrdrr\brdrnone \cltxlrtb\clftsWidth3\clwWidth1820\clshdrawnil \cellx3100\clvertalt\clbrdrt\brdrnone \clbrdrl\brdrnone \clbrdrb
\brdrs\brdrw10\brdrcf1 \clbrdrr\brdrnone \cltxlrtb\clftsWidth3\clwWidth4759\clshdrawnil \cellx7859\pard \ltrpar\ql \li0\ri0\nowidctlpar\intbl\wrapdefault\faauto\rin0\lin0 {\rtlch\fcs1 \af0\afs24 \ltrch\fcs0 \f0\fs24\insrsid2826225 \cell }\pard \ltrpar
\ql \li0\ri0\sb6\sl-110\slmult0\nowidctlpar\intbl\wrapdefault\faauto\rin0\lin0 {\rtlch\fcs1 \af0\afs11 \ltrch\fcs0 \f0\fs11\insrsid2826225 
\par }\pard \ltrpar\ql \li700\ri-20\nowidctlpar\intbl\wrapdefault\faauto\rin-20\lin700\pararsid8746413 {\rtlch\fcs1 \af2\afs20 \ltrch\fcs0 \f2\fs20\expnd0\expndtw1\insrsid2826225 \hich\af2\dbch\af31505\loch\f2 Address}{\rtlch\fcs1 \af2\afs20 \ltrch\fcs0 
\f2\fs20\insrsid2826225 \hich\af2\dbch\af31505\loch\f2 :}{\rtlch\fcs1 \af0\afs24 \ltrch\fcs0 \f0\fs24\insrsid2826225 \cell }\pard \ltrpar\ql \li0\ri0\sb6\sl-110\slmult0\nowidctlpar\intbl\wrapdefault\faauto\rin0\lin0 {\rtlch\fcs1 \af0\afs11 \ltrch\fcs0 
\f0\fs11\insrsid2826225 
\par }\pard \ltrpar\ql \li40\ri-20\nowidctlpar\intbl\tx4700\wrapdefault\faauto\rin-20\lin40 {\rtlch\fcs1 \af2\afs20 \ltrch\fcs0 \f2\fs20\ul\charscalex99\insrsid2826225 \hich\af2\dbch\af31505\loch\f2  }{\rtlch\fcs1 \af2\afs20 \ltrch\fcs0 
\f2\fs20\ul\insrsid2826225 \tab }{\rtlch\fcs1 \af0\afs24 \ltrch\fcs0 \f0\fs24\insrsid2826225 \cell }\pard \ltrpar\ql \li0\ri0\sa200\sl276\slmult1\widctlpar\intbl\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin0 {\rtlch\fcs1 \af0\afs24 \ltrch\fcs0 
\f0\fs24\insrsid2826225 \trowd \irow2\irowband2\lastrow \ltrrow\ts11\trrh-761\trleft100\trftsWidth1\tblind100\tblindtype3 \clvertalt\clbrdrt\brdrnone \clbrdrl\brdrnone \clbrdrb\brdrnone \clbrdrr\brdrnone \cltxlrtb\clftsWidth3\clwWidth1180\clshdrawnil 
\cellx1280\clvertalt\clbrdrt\brdrnone \clbrdrl\brdrnone \clbrdrb\brdrnone \clbrdrr\brdrnone \cltxlrtb\clftsWidth3\clwWidth1820\clshdrawnil \cellx3100\clvertalt\clbrdrt\brdrnone \clbrdrl\brdrnone \clbrdrb\brdrs\brdrw10\brdrcf1 \clbrdrr\brdrnone 
\cltxlrtb\clftsWidth3\clwWidth4759\clshdrawnil \cellx7859\row }\pard \ltrpar\ql \li0\ri0\sl-200\slmult0\nowidctlpar\wrapdefault\faauto\rin0\lin0\itap0 {\rtlch\fcs1 \af0\afs20 \ltrch\fcs0 \f0\fs20\insrsid2826225 
\par 
\par }\pard \ltrpar\ql \li0\ri0\sb17\sl-240\slmult0\nowidctlpar\wrapdefault\faauto\rin0\lin0\itap0 {\rtlch\fcs1 \af0\afs24 \ltrch\fcs0 \f0\fs24\insrsid2826225 
\par }\pard \ltrpar\ql \li1820\ri-20\sb49\sl-210\slmult0\nowidctlpar\tx3860\wrapdefault\faauto\rin-20\lin1820\itap0\pararsid6964143 {\rtlch\fcs1 \af0 \ltrch\fcs0 \lang1024\langfe1024\noproof\insrsid2121007 
{\shp{\*\shpinst\shpleft5097\shptop184\shpright9019\shpbottom255\shpfhdr0\shpbxpage\shpbxignore\shpbypara\shpbyignore\shpwr3\shpwrk0\shpfblwtxt1\shpz10\shplid1038{\sp{\sn shapeType}{\sv 0}}{\sp{\sn fFlipH}{\sv 0}}{\sp{\sn fFlipV}{\sv 0}}
{\sp{\sn rotation}{\sv 0}}{\sp{\sn geoRight}{\sv 2760}}{\sp{\sn geoBottom}{\sv 20}}{\sp{\sn shapePath}{\sv 4}}{\sp{\sn pVerticies}{\sv 8;2;(0,0);(2759,0)}}{\sp{\sn pSegmentInfo}{\sv 2;5;16384;45824;1;45824;32768}}{\sp{\sn fFillOK}{\sv 1}}
{\sp{\sn fFilled}{\sv 0}}{\sp{\sn lineColor}{\sv 0}}{\sp{\sn lineType}{\sv 0}}{\sp{\sn lineWidth}{\sv 6312}}{\sp{\sn fArrowheadsOK}{\sv 1}}{\sp{\sn fLine}{\sv 1}}{\sp{\sn lidRegroup}{\sv 0}}{\sp{\sn posrelh}{\sv 1}}{\sp{\sn posrelv}{\sv 2}}
{\sp{\sn dhgt}{\sv 251661312}}{\sp{\sn fLayoutInCell}{\sv 0}}{\sp{\sn fBehindDocument}{\sv 1}}{\sp{\sn fPseudoInline}{\sv 0}}{\sp{\sn fLayoutInCell}{\sv 0}}}{\shprslt{\*\do\dobxpage\dobypara\dodhgt10\dppolyline\dppolycount2\dpptx0\dppty0\dpptx3921\dppty0
\dpx5097\dpy184\dpxsize3922\dpysize71\dpfillfgcr255\dpfillfgcg255\dpfillfgcb255\dpfillbgcr255\dpfillbgcg255\dpfillbgcb255\dpfillpat0\dplinew9\dplinecor0\dplinecog0\dplinecob0}}}
{\shp{\*\shpinst\shpleft4440\shptop-218\shpright9119\shpbottom-198\shpfhdr0\shpbxpage\shpbxignore\shpbypara\shpbyignore\shpwr3\shpwrk0\shpfblwtxt1\shpz9\shplid1039{\sp{\sn shapeType}{\sv 0}}{\sp{\sn fFlipH}{\sv 0}}{\sp{\sn fFlipV}{\sv 0}}
{\sp{\sn rotation}{\sv 0}}{\sp{\sn geoRight}{\sv 4679}}{\sp{\sn geoBottom}{\sv 20}}{\sp{\sn shapePath}{\sv 4}}{\sp{\sn pVerticies}{\sv 8;2;(0,0);(4679,0)}}{\sp{\sn pSegmentInfo}{\sv 2;5;16384;45824;1;45824;32768}}{\sp{\sn fFillOK}{\sv 1}}
{\sp{\sn fFilled}{\sv 0}}{\sp{\sn lineColor}{\sv 0}}{\sp{\sn lineType}{\sv 0}}{\sp{\sn lineWidth}{\sv 6312}}{\sp{\sn fArrowheadsOK}{\sv 1}}{\sp{\sn fLine}{\sv 1}}{\sp{\sn lidRegroup}{\sv 0}}{\sp{\sn posrelh}{\sv 1}}{\sp{\sn posrelv}{\sv 2}}
{\sp{\sn dhgt}{\sv 251660288}}{\sp{\sn fLayoutInCell}{\sv 0}}{\sp{\sn fBehindDocument}{\sv 1}}{\sp{\sn fPseudoInline}{\sv 0}}{\sp{\sn fLayoutInCell}{\sv 0}}}{\shprslt{\*\do\dobxpage\dobypara\dodhgt9\dppolyline\dppolycount2\dpptx0\dppty0\dpptx4679\dppty0
\dpx4440\dpy-218\dpxsize4679\dpysize20\dpfillfgcr255\dpfillfgcg255\dpfillfgcb255\dpfillbgcr255\dpfillbgcg255\dpfillbgcb255\dpfillpat0\dplinew9\dplinecor0\dplinecog0\dplinecob0}}}}{\rtlch\fcs1 \af2\afs20 \ltrch\fcs0 \f2\fs20\expnd0\expndtw1\insrsid2826225 
\hich\af2\dbch\af31505\loch\f2 Telephones}{\rtlch\fcs1 \af2\afs20 \ltrch\fcs0 \f2\fs20\insrsid2826225 \hich\af2\dbch\af31505\loch\f2 :}{\rtlch\fcs1 \af2\afs20 \ltrch\fcs0 \f2\fs20\expnd-2\expndtw-12\insrsid2826225 \hich\af2\dbch\af31505\loch\f2  }{
\rtlch\fcs1 \af2\afs20 \ltrch\fcs0 \f2\fs20\insrsid8746413 \hich\af2\dbch\af31505\loch\f2 (}{\rtlch\fcs1 \af2\afs20 \ltrch\fcs0 \f2\fs20\insrsid6964143 \hich\af2\dbch\af31505\loch\f2   \hich\af2\dbch\af31505\loch\f2  )}{\rtlch\fcs1 \af2\afs20 \ltrch\fcs0 
\f2\fs20\insrsid2826225 
\par }{\rtlch\fcs1 \af2\afs20 \ltrch\fcs0 \f2\fs20\insrsid6964143 
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