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Form not working ..

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Joined: 24 Jun 2015
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Post Options Post Options   Quote mrx888 Quote  Post ReplyReply Direct Link To This Post Topic: Form not working ..
    Posted: 24 Jun 2015 at 6:42pm
Can someone please help me, why my form is not working.. the fields dont scroll down.  Below is the xml code.  .. please help, thanks in advance.

<?xml version="1.0" encoding="UTF-8"?>
<?xfa generator="AdobeLiveCycleDesignerES_V8.2.1.3144.1.471865" APIVersion="2.8.8118.0"?>
<xdp:xdp xmlns:xdp="http://ns.adobe.com/xdp/" timeStamp="2015-06-24T17:23:29Z">
<template xmlns="http://www.xfa.org/schema/xfa-template/2.4/">
   <?formServer defaultPDFRenderFormat acrobat7.0.5static?>
   <subform name="topmostSubform" layout="tb" locale="en_US">
      <pageSet>
         <pageArea id="PageArea1" name="PageArea1">
            <contentArea name="ContentArea1" x="0pt" y="0pt" w="612pt" h="792pt"/>
            <medium short="612pt" long="792pt" stock="custom"/>
            <?templateDesigner expand 1?></pageArea>
         <?templateDesigner expand 1?></pageSet>
      <desc>
         <text name="title">1112 Claim Summary</text>
         <text name="creator">Clegg_Annmarie</text>
      </desc>
      <subform name="Page1" x="0pt" y="0pt" w="612pt" h="792pt">
         <bind match="none"/>
         <draw name="T0" w="29.863mm" minH="0.283in" y="7.112mm" x="160.274mm">
            <value>
               <exData contentType="text/html">
                  <body xmlns="http://www.w3.org/1999/xhtml" xmlns:xfa="http://www.xfa.org/schema/xfa-data/1.0/" xfa:APIVersion="2.7.0.0"><p style="font-family:'Times New Roman';letter-spacing:0in">Agenda Item CC:<span style="xfa-spacerun:yes"> </span></p></body>
               </exData>
            </value>
            <ui>
               <textEdit/>
            </ui>
            <para vAlign="middle"/>
            <font size="12pt" typeface="Times-Roman"/>
            <traversal>
               <traverse ref="T3[0]"/>
            </traversal>
         </draw>
         <draw name="T3" w="51.055mm" h="9.313mm" y="16.84mm" x="138.962mm">
            <value>
               <exData contentType="text/html">
                  <body xmlns="http://www.w3.org/1999/xhtml" xmlns:xfa="http://www.xfa.org/schema/xfa-data/1.0/" xfa:APIVersion="2.7.0.0"><p style="font-family:'Times New Roman';letter-spacing:0in"><span style="xfa-spacerun:yes">                   </span>Agenda Item EC:</p></body>
               </exData>
            </value>
            <ui>
               <textEdit/>
            </ui>
            <para vAlign="middle"/>
            <font size="12pt" typeface="Times-Roman"/>
            <traversal>
               <traverse ref="T5[0]"/>
            </traversal>
         </draw>
         <draw name="T5" w="0.798in" minH="0.425in" y="21.565mm" x="98.425mm">
            <value>
               <text>ASCIP</text>
            </value>
            <ui>
               <textEdit/>
            </ui>
            <para vAlign="middle"/>
            <font weight="bold" size="18pt" typeface="Times"/>
            <traversal>
               <traverse ref="T6[0]"/>
            </traversal>
         </draw>
         <draw name="T6" w="3.838in" minH="0.374in" y="32.258mm" x="59.817mm">
            <value>
               <text>CONFIDENTIAL CLAIM SUMMARY</text>
            </value>
            <ui>
               <textEdit/>
            </ui>
            <para vAlign="middle"/>
            <font weight="bold" size="15.8pt" typeface="Times"/>
            <traversal>
               <traverse ref="T7[0]"/>
            </traversal>
         </draw>
         <draw name="T7" w="12.382mm" minH="0.283in" y="42.164mm" x="12.7mm">
            <value>
               <text>Claim:</text>
            </value>
            <ui>
               <textEdit/>
            </ui>
            <para vAlign="middle"/>
            <font weight="bold" size="12pt" typeface="Times"/>
            <traversal>
               <traverse ref="T8[0]"/>
            </traversal>
         </draw>
         <draw name="T8" w="28.576mm" minH="0.283in" y="50.292mm" x="12.7mm">
            <value>
               <text>Claim Number: </text>
            </value>
            <ui>
               <textEdit/>
            </ui>
            <para vAlign="middle"/>
            <font weight="bold" size="12pt" typeface="Times"/>
            <traversal>
               <traverse ref="T9[0]"/>
            </traversal>
         </draw>
         <draw name="T9" w="24.078mm" minH="0.283in" y="50.292mm" x="114.3mm">
            <value>
               <text>Review Date:</text>
            </value>
            <ui>
               <textEdit/>
            </ui>
            <para vAlign="middle"/>
            <font weight="bold" size="12pt" typeface="Times"/>
            <traversal>
               <traverse ref="T10[0]"/>
            </traversal>
         </draw>
         <draw name="T10" w="19.05mm" minH="0.283in" y="58.42mm" x="12.7mm">
            <value>
               <text>Loss Date: </text>
            </value>
            <ui>
               <textEdit/>
            </ui>
            <para vAlign="middle"/>
            <font weight="bold" size="12pt" typeface="Times"/>
            <traversal>
               <traverse ref="T11[0]"/>
            </traversal>
         </draw>
         <draw name="T11" w="28.892mm" minH="0.283in" y="58.42mm" x="114.3mm">
            <value>
               <text>Excess Notified:</text>
            </value>
            <ui>
               <textEdit/>
            </ui>
            <para vAlign="middle"/>
            <font weight="bold" size="12pt" typeface="Times"/>
            <traversal>
               <traverse ref="T12[0]"/>
            </traversal>
         </draw>
         <draw name="T12" w="31.062mm" minH="0.283in" y="66.548mm" x="12.7mm">
            <value>
               <text>Defense Counsel: </text>
            </value>
            <ui>
               <textEdit/>
            </ui>
            <para vAlign="middle"/>
            <font weight="bold" size="12pt" typeface="Times"/>
            <traversal>
               <traverse ref="T13[0]"/>
            </traversal>
         </draw>
         <draw name="T13" w="31.802mm" minH="0.283in" y="66.548mm" x="114.3mm">
            <value>
               <text>Plaintiff Counsel:</text>
            </value>
            <ui>
               <textEdit/>
            </ui>
            <para vAlign="middle"/>
            <font weight="bold" size="12pt" typeface="Times"/>
            <traversal>
               <traverse ref="T14[0]"/>
            </traversal>
         </draw>
         <draw name="T14" w="8.308mm" minH="0.283in" y="74.752mm" x="12.7mm">
            <value>
               <text>SIR:</text>
            </value>
            <ui>
               <textEdit/>
            </ui>
            <para vAlign="middle"/>
            <font weight="bold" size="12pt" typeface="Times"/>
            <traversal>
               <traverse ref="T15[0]"/>
            </traversal>
         </draw>
         <draw name="T15" w="41.38mm" minH="0.283in" y="74.752mm" x="114.3mm">
            <value>
               <text>Expenses Paid to Date:</text>
            </value>
            <ui>
               <textEdit/>
            </ui>
            <para vAlign="middle"/>
            <font weight="bold" size="12pt" typeface="Times"/>
            <traversal>
               <traverse ref="T16[0]"/>
            </traversal>
         </draw>
         <draw name="T16" w="37.148mm" minH="0.283in" y="82.906mm" x="12.7mm">
            <value>
               <text>Indemnity Reserves:</text>
            </value>
            <ui>
               <textEdit/>
            </ui>
            <para vAlign="middle"/>
            <font weight="bold" size="12pt" typeface="Times"/>
            <traversal>
               <traverse ref="T17[0]"/>
            </traversal>
         </draw>
         <draw name="T17" w="33.507mm" minH="0.283in" y="82.906mm" x="114.3mm">
            <value>
               <exData contentType="text/html">
                  <body xmlns="http://www.w3.org/1999/xhtml" xmlns:xfa="http://www.xfa.org/schema/xfa-data/1.0/" xfa:APIVersion="2.7.0.0"><p style="font-family:'Times New Roman';text-decoration:none;letter-spacing:0in">Expense Reserves:</p></body>
               </exData>
            </value>
            <ui>
               <textEdit/>
            </ui>
            <para vAlign="middle"/>
            <font weight="bold" size="12pt" typeface="Times"/>
            <traversal>
               <traverse ref="T18[0]"/>
            </traversal>
         </draw>
         <draw name="T18" w="33.124mm" minH="0.283in" y="98.873mm" x="12.702mm">
            <value>
               <text>Action Requested:</text>
            </value>
            <ui>
               <textEdit/>
            </ui>
            <para vAlign="middle"/>
            <font weight="bold" size="12pt" typeface="Times"/>
            <traversal>
               <traverse ref="#draw[18]"/>
            </traversal>
         </draw>
         <draw name="R19" w="540pt" h="0.48pt" y="107.519mm" x="12.7mm">
            <value>
               <rectangle>
                  <edge presence="hidden"/>
                  <fill>
                     <color value="0,0,0"/>
                  </fill>
                  <corner radius="5.08mm"/>
               </rectangle>
            </value>
         </draw>
         <field name="Text1" w="22.532mm" h="6.973mm" y="7.343mm" x="190.54mm">
            <ui>
               <textEdit>
                  <margin/>
               </textEdit>
            </ui>
            <para vAlign="middle"/>
            <font size="12pt" typeface="Helvetica"/>
            <traversal>
               <traverse ref="Text2[0]"/>
            </traversal>
         </field>
         <field name="Text2" w="22.746mm" h="7.207mm" y="16.765mm" x="190.539mm">
            <ui>
               <textEdit>
                  <margin/>
               </textEdit>
            </ui>
            <para vAlign="middle"/>
            <font size="12pt" typeface="Helvetica"/>
            <traversal>
               <traverse ref="Text3[0]"/>
            </traversal>
         </field>
         <field name="Text3" w="508.465pt" h="19.573pt" y="42.492mm" x="25.136mm">
            <ui>
               <textEdit>
                  <margin/>
               </textEdit>
            </ui>
            <para vAlign="middle"/>
            <font size="12pt" typeface="times"/>
            <traversal>
               <traverse ref="Text4[0]"/>
            </traversal>
         </field>
         <field name="Text4" w="65.755mm" h="6.515mm" y="50.301mm" x="41.434mm">
            <ui>
               <textEdit>
                  <margin/>
               </textEdit>
            </ui>
            <para vAlign="middle"/>
            <font size="12pt" typeface="Times New Roman"/>
            <traversal>
               <traverse ref="Text5[0]"/>
            </traversal>
         </field>
         <field name="Text5" w="214.293pt" h="18.361pt" y="58.618mm" x="31.734mm">
            <ui>
               <textEdit>
                  <margin/>
               </textEdit>
            </ui>
            <para vAlign="middle"/>
            <font size="12pt" typeface="Times New Roman"/>
            <traversal>
               <traverse ref="Text6[0]"/>
            </traversal>
         </field>
         <field name="Text6" w="64.257mm" h="6.515mm" y="66.652mm" x="43.927mm">
            <ui>
               <textEdit>
                  <margin/>
               </textEdit>
            </ui>
            <para vAlign="middle"/>
            <font size="12pt" typeface="Times New Roman"/>
            <traversal>
               <traverse ref="Text7[0]"/>
            </traversal>
         </field>
         <field name="Text7" w="86.51mm" h="6.374mm" y="75.247mm" x="21.343mm">
            <ui>
               <textEdit>
                  <margin/>
               </textEdit>
            </ui>
            <para vAlign="middle"/>
            <font size="12pt" typeface="Times New Roman"/>
            <traversal>
               <traverse ref="Text8[0]"/>
            </traversal>
         </field>
         <field name="Text8" w="57.624mm" h="6.652mm" y="83.009mm" x="50.023mm">
            <ui>
               <textEdit>
                  <margin/>
               </textEdit>
            </ui>
            <para vAlign="middle"/>
            <font size="12pt" typeface="Times New Roman"/>
            <traversal>
               <traverse ref="Text9[0]"/>
            </traversal>
         </field>
         <field name="Text9" w="158.636mm" h="6.793mm" y="98.941mm" x="45.728mm">
            <ui>
               <textEdit>
                  <margin/>
               </textEdit>
            </ui>
            <para vAlign="middle"/>
            <font size="12pt" typeface="Times New Roman"/>
            <traversal>
               <traverse ref="Text10[0]"/>
            </traversal>
         </field>
         <field name="Text10" w="65.755mm" h="7.219mm" y="50.27mm" x="138.378mm">
            <ui>
               <textEdit>
                  <margin/>
               </textEdit>
            </ui>
            <para vAlign="middle"/>
            <font size="12pt" typeface="Times New Roman"/>
            <traversal>
               <traverse ref="Text11[0]"/>
            </traversal>
         </field>
         <field name="Text11" w="61.048mm" h="7.144mm" y="58.472mm" x="143.246mm">
            <ui>
               <textEdit>
                  <margin/>
               </textEdit>
            </ui>
            <para vAlign="middle"/>
            <font size="12pt" typeface="Times New Roman"/>
            <traversal>
               <traverse ref="Text12[0]"/>
            </traversal>
         </field>
         <field name="Text12" w="58.052mm" h="7.179mm" y="66.57mm" x="146.156mm">
            <ui>
               <textEdit>
                  <margin/>
               </textEdit>
            </ui>
            <para vAlign="middle"/>
            <font size="12pt" typeface="Times New Roman"/>
            <traversal>
               <traverse ref="Text13[0]"/>
            </traversal>
         </field>
         <field name="Text13" w="48.638mm" h="7.113mm" y="74.824mm" x="155.68mm">
            <ui>
               <textEdit>
                  <margin/>
               </textEdit>
            </ui>
            <para vAlign="middle"/>
            <font size="12pt" typeface="Times New Roman"/>
            <traversal>
               <traverse ref="Text14[0]"/>
            </traversal>
         </field>
         <field name="Text14" w="56.778mm" h="7.198mm" y="82.92mm" x="147.902mm">
            <ui>
               <textEdit>
                  <margin/>
               </textEdit>
            </ui>
            <para vAlign="middle"/>
            <font size="12pt" typeface="Times New Roman"/>
            <traversal>
               <traverse ref="T0[0]"/>
            </traversal>
         </field>
         <traversal>
            <traverse ref="Text1[0]" operation="first"/>
         </traversal>
         <draw name="T16" w="28.194mm" minH="0.283in" y="90.767mm" x="12.498mm">
            <value>
               <exData contentType="text/html">
                  <body xmlns="http://www.w3.org/1999/xhtml" xmlns:xfa="http://www.xfa.org/schema/xfa-data/1.0/" xfa:APIVersion="2.7.0.0"><p style="font-family:'Times New Roman';text-decoration:none;letter-spacing:0in">Total Incurred:</p></body>
               </exData>
            </value>
            <ui>
               <textEdit/>
            </ui>
            <para vAlign="middle"/>
            <font weight="bold" size="12pt" typeface="Times"/>
            <traversal>
               <traverse ref="Text8[1]"/>
            </traversal>
         </draw>
         <field name="Text8" w="57.624mm" h="6.788mm" y="90.907mm" x="41.02mm">
            <ui>
               <textEdit>
                  <margin/>
               </textEdit>
            </ui>
            <para vAlign="middle"/>
            <font size="12pt" typeface="Times New Roman"/>
            <traversal>
               <traverse ref="#subform[0].TextField2[0]"/>
            </traversal>
         </field>
         <draw h="18.106mm" w="194.735mm" y="257.456mm" x="12.065mm">
            <font typeface="Times New Roman" baselineShift="0pt"/>
            <para hAlign="justify" spaceAbove="0pt" spaceBelow="0pt" textIndent="0pt" marginLeft="0pt" marginRight="0pt"/>
            <value>
               <text>"This Memorandum is a confidential document distributed in, and for review only in Closed Session.  It is to be returned at the conclusion of Closed Session.  No copies are to be retained in order to preserve confidentiality.  No matter discussed in Closed Session, and no memoranda distributed and reviewed in Closed Session, may be discussed or shown to any party pursuant to Government Code Section 54963."</text>
            </value>
            <ui>
               <textEdit/>
            </ui>
            <margin leftInset="0.5mm" rightInset="0.5mm" topInset="0.5mm" bottomInset="0.5mm"/>
            <traversal>
               <traverse ref="T16[1]"/>
            </traversal>
         </draw>
         <break beforeTarget="#PageArea1" before="pageArea"/>
         <subform x="12.7mm" y="118.935mm" w="192.265mm" minH="45mm" layout="tb">
            <field name="TextField1" minH="9mm" w="192.026mm" anchorType="middleCenter">
               <ui>
                  <textEdit multiLine="1">
                     <border presence="hidden">
                        <?templateDesigner StyleID aped0?></border>
                     <margin/>
                  </textEdit>
               </ui>
               <font typeface="Myriad Pro"/>
               <margin topInset="1mm" bottomInset="1mm" leftInset="1mm" rightInset="1mm"/>
               <para vAlign="middle"/>
               <caption reserve="27.515mm">
                  <font typeface="Myriad Pro"/>
                  <para vAlign="middle"/>
                  <value>
                     <text>CLAIM SUMMARY:</text>
                  </value>
               </caption>
            </field>
            <field name="TextField2" minH="9mm" w="191.911mm" anchorType="middleCenter">
               <ui>
                  <textEdit multiLine="1">
                     <border>
                        <?templateDesigner StyleID aped3?>
                        <edge stroke="lowered"/>
                     </border>
                     <margin/>
                  </textEdit>
               </ui>
               <font typeface="Myriad Pro"/>
               <margin topInset="1mm" bottomInset="1mm" leftInset="1mm" rightInset="1mm"/>
               <para vAlign="middle"/>
               <caption reserve="39.29mm">
                  <font typeface="Myriad Pro"/>
                  <para vAlign="middle"/>
                  <value>
                     <text>EVALUATION OF INJURIES:</text>
                  </value>
               </caption>
               <traversal>
                  <traverse ref="TextField3[0]"/>
               </traversal>
            </field>
            <field name="TextField3" minH="9mm" w="192.265mm" anchorType="middleCenter">
               <ui>
                  <textEdit multiLine="1">
                     <border>
                        <?templateDesigner StyleID aped3?>
                        <edge stroke="lowered"/>
                     </border>
                     <margin/>
                  </textEdit>
               </ui>
               <font typeface="Myriad Pro"/>
               <margin topInset="1mm" bottomInset="1mm" leftInset="1mm" rightInset="1mm"/>
               <para vAlign="middle"/>
               <caption reserve="41.54mm">
                  <font typeface="Myriad Pro"/>
                  <para vAlign="middle"/>
                  <value>
                     <text>EVALUATION OF DAMAGES:</text>
                  </value>
               </caption>
               <traversal>
                  <traverse ref="TextField4[0]"/>
               </traversal>
            </field>
            <field name="TextField4" minH="9mm" w="192.265mm" anchorType="middleCenter">
               <ui>
                  <textEdit multiLine="1">
                     <border>
                        <?templateDesigner StyleID aped3?>
                        <edge stroke="lowered"/>
                     </border>
                     <margin/>
                  </textEdit>
               </ui>
               <font typeface="Myriad Pro"/>
               <margin topInset="1mm" bottomInset="1mm" leftInset="1mm" rightInset="1mm"/>
               <para vAlign="middle"/>
               <caption reserve="42.07mm">
                  <font typeface="Myriad Pro"/>
                  <para vAlign="middle"/>
                  <value>
                     <text>EVALUATION OF LIABILITIES:</text>
                  </value>
               </caption>
               <traversal>
                  <traverse ref="TextField5[0]"/>
               </traversal>
            </field>
            <field name="TextField5" minH="9mm" w="192.144mm" anchorType="middleCenter">
               <ui>
                  <textEdit multiLine="1">
                     <border>
                        <?templateDesigner StyleID aped3?>
                        <edge stroke="lowered"/>
                     </border>
                     <margin/>
                  </textEdit>
               </ui>
               <font typeface="Myriad Pro"/>
               <margin topInset="1mm" bottomInset="1mm" leftInset="1mm" rightInset="1mm"/>
               <para vAlign="middle"/>
               <caption reserve="43.125mm">
                  <font typeface="Myriad Pro"/>
                  <para vAlign="middle"/>
                  <value>
                     <text>DEFENSE STATUS SUMMARY:</text>
                  </value>
               </caption>
               <traversal>
                  <traverse ref="TextField6[0]"/>
               </traversal>
            </field>
            <field name="TextField6" minH="9mm" w="192.029mm" anchorType="middleCenter">
               <ui>
                  <textEdit multiLine="1">
                     <border>
                        <?templateDesigner StyleID aped3?>
                        <edge stroke="lowered"/>
                     </border>
                     <margin/>
                  </textEdit>
               </ui>
               <font typeface="Myriad Pro"/>
               <margin topInset="1mm" bottomInset="1mm" leftInset="1mm" rightInset="1mm"/>
               <para vAlign="middle"/>
               <caption reserve="16.8mm">
                  <font typeface="Myriad Pro"/>
                  <para vAlign="middle"/>
                  <value>
                     <text>SUMMARY:</text>
                  </value>
               </caption>
               <traversal>
                  <traverse ref="TextField1[0]"/>
               </traversal>
            </field>
            <keep intact="contentArea"/>
            <?templateDesigner expand 1?></subform>
         <?templateDesigner expand 1?></subform>
      <subform name="Page2" x="0pt" y="0pt" w="612pt" h="792pt">
         <bind match="none"/>
         <draw name="T0" x="0.5in" y="0.28in" w="0.498in" minH="0.283in">
            <value>
               <text>Page 2</text>
            </value>
            <ui>
               <textEdit/>
            </ui>
            <para vAlign="middle"/>
            <font size="12pt" typeface="Times-Roman"/>
         </draw>
         <field name="Text16" x="13.173mm" y="16.463mm" w="538.792pt" h="714.504pt">
            <ui>
               <textEdit multiLine="1">
                  <margin/>
               </textEdit>
            </ui>
            <font size="12pt" typeface="Helvetica"/>
            <traversal>
               <traverse ref="T0[0]"/>
            </traversal>
         </field>
         <traversal>
            <traverse ref="Text16[0]" operation="first"/>
         </traversal>
         <break beforeTarget="#PageArea1" before="pageArea" startNew="1"/>
         <?templateDesigner expand 1?></subform>
      <proto/>
      <?templateDesigner expand 1?></subform>
   <?originalXFAVersion http://www.xfa.org/schema/xfa-template/2.4/?>
   <?templateDesigner SaveTaggedPDF 1?>
   <?templateDesigner SavePDFWithEmbeddedFonts 1?>
   <?templateDesigner FormTargetVersion 24?>
   <?templateDesigner Zoom 69?>
   <?templateDesigner Rulers horizontal:1, vertical:1, guidelines:1, crosshairs:0?></template>
<config xmlns="http://www.xfa.org/schema/xci/1.0/">
   <agent name="designer">
      <destination>pdf</destination>
      <pdf>
         <!--  [0..n]  -->
         <fontInfo/>
      </pdf>
   </agent>
   <present>
      <!--  [0..n]  -->
      <pdf>
         <!--  [0..n]  -->
         <version>1.65</version>
      </pdf>
      <common/>
      <xdp>
         <packets>*</packets>
      </xdp>
      <output/>
   </present>
   <psMap>
      <font typeface="Cambria" psName="Cambria" weight="normal" posture="normal"/>
   </psMap>
   <?originalXFAVersion http://www.xfa.org/schema/xci/2.8/?></config>
<xfa:datasets xmlns:xfa="http://www.xfa.org/schema/xfa-data/1.0/">
   <xfa:data xfa:dataNode="dataGroup"/>
</xfa:datasets>
<localeSet xmlns="http://www.xfa.org/schema/xfa-locale-set/2.1/">
   <locale name="en_US" desc="English (United States)">
      <calendarSymbols name="gregorian">
         <monthNames>
            <month>January</month>
            <month>February</month>
            <month>March</month>
            <month>April</month>
            <month>May</month>
            <month>June</month>
            <month>July</month>
            <month>August</month>
            <month>September</month>
            <month>October</month>
            <month>November</month>
            <month>December</month>
         </monthNames>
         <monthNames abbr="1">
            <month>Jan</month>
            <month>Feb</month>
            <month>Mar</month>
            <month>Apr</month>
            <month>May</month>
            <month>Jun</month>
            <month>Jul</month>
            <month>Aug</month>
            <month>Sep</month>
            <month>Oct</month>
            <month>Nov</month>
            <month>Dec</month>
         </monthNames>
         <dayNames>
            <day>Sunday</day>
            <day>Monday</day>
            <day>Tuesday</day>
            <day>Wednesday</day>
            <day>Thursday</day>
            <day>Friday</day>
            <day>Saturday</day>
         </dayNames>
         <dayNames abbr="1">
            <day>Sun</day>
            <day>Mon</day>
            <day>Tue</day>
            <day>Wed</day>
            <day>Thu</day>
            <day>Fri</day>
            <day>Sat</day>
         </dayNames>
         <meridiemNames>
            <meridiem>AM</meridiem>
            <meridiem>PM</meridiem>
         </meridiemNames>
         <eraNames>
            <era>BC</era>
            <era>AD</era>
         </eraNames>
      </calendarSymbols>
      <datePatterns>
         <datePattern name="full">EEEE, MMMM D, YYYY</datePattern>
         <datePattern name="long">MMMM D, YYYY</datePattern>
         <datePattern name="med">MMM D, YYYY</datePattern>
         <datePattern name="short">M/D/YY</datePattern>
      </datePatterns>
      <timePatterns>
         <timePattern name="full">h:MM:SS A Z</timePattern>
         <timePattern name="long">h:MM:SS A Z</timePattern>
         <timePattern name="med">h:MM:SS A</timePattern>
         <timePattern name="short">h:MM A</timePattern>
      </timePatterns>
      <dateTimeSymbols>GyMdkHmsSEDFwWahKzZ</dateTimeSymbols>
      <numberPatterns>
         <numberPattern name="numeric">z,zz9.zzz</numberPattern>
         <numberPattern name="currency">$z,zz9.99|($z,zz9.99)</numberPattern>
         <numberPattern name="percent">z,zz9%</numberPattern>
      </numberPatterns>
      <numberSymbols>
         <numberSymbol name="decimal">.</numberSymbol>
         <numberSymbol name="grouping">,</numberSymbol>
         <numberSymbol name="percent">%</numberSymbol>
         <numberSymbol name="minus">-</numberSymbol>
         <numberSymbol name="zero">0</numberSymbol>
      </numberSymbols>
      <currencySymbols>
         <currencySymbol name="symbol">$</currencySymbol>
         <currencySymbol name="isoname">USD</currencySymbol>
         <currencySymbol name="decimal">.</currencySymbol>
      </currencySymbols>
      <typefaces>
         <typeface name="Myriad Pro"/>
         <typeface name="Minion Pro"/>
         <typeface name="Courier Std"/>
         <typeface name="Adobe Pi Std"/>
         <typeface name="Adobe Hebrew"/>
         <typeface name="Adobe Arabic"/>
         <typeface name="Adobe Thai"/>
         <typeface name="Kozuka Gothic Pro-VI M"/>
         <typeface name="Kozuka Mincho Pro-VI R"/>
         <typeface name="Adobe Ming Std L"/>
         <typeface name="Adobe Song Std L"/>
         <typeface name="Adobe Myungjo Std M"/>
      </typefaces>
   </locale>
   <?originalXFAVersion http://www.xfa.org/schema/xfa-locale-set/2.1/?></localeSet>
<PDFSecurity xmlns="http://ns.adobe.com/xtd/" print="1" printHighQuality="1" change="1" modifyAnnots="1" formFieldFilling="1" documentAssembly="1" contentCopy="1" accessibleContent="1" metadata="1"/>
<form xmlns="http://www.xfa.org/schema/xfa-form/2.8/" checksum="5SEZVnrpsOK47Ra9VK0uT26Ocqo=">
   <subform name="topmostSubform">
      <instanceManager name="_Page1"/>
      <subform name="Page1">
         <field name="Text1"/>
         <field name="Text2"/>
         <field name="Text3"/>
         <field name="Text4"/>
         <field name="Text5"/>
         <field name="Text6"/>
         <field name="Text7"/>
         <field name="Text8"/>
         <field name="Text9"/>
         <field name="Text10"/>
         <field name="Text11"/>
         <field name="Text12"/>
         <field name="Text13"/>
         <field name="Text14"/>
         <field name="Text8"/>
         <instanceManager name="_"/>
         <subform>
            <field name="TextField1"/>
            <field name="TextField2"/>
            <field name="TextField3"/>
            <field name="TextField4"/>
            <field name="TextField5"/>
            <field name="TextField6"/>
         </subform>
      </subform>
      <instanceManager name="_Page2"/>
      <subform name="Page2">
         <field name="Text16"/>
      </subform>
      <pageSet>
         <pageArea name="PageArea1"/>
         <pageArea name="PageArea1"/>
      </pageSet>
   </subform>
</form>
<x:xmpmeta xmlns:x="adobe:ns:meta/" x:xmptk="Adobe XMP Core 4.2.1-c041 52.337767, 2008/04/13-15:41:00        ">
   <rdf:RDF xmlns:rdf="http://www.w3.org/1999/02/22-rdf-syntax-ns#">
      <rdf:Description xmlns:xmp="http://ns.adobe.com/xap/1.0/" rdf:about="">
         <xmp:CreateDate>2012-04-24T22:51:42Z</xmp:CreateDate>
         <xmp:CreatorTool>Adobe LiveCycle Designer ES 8.2</xmp:CreatorTool>
         <xmp:ModifyDate>2015-06-19T09:08:28-07:00</xmp:ModifyDate>
         <xmp:MetadataDate>2015-06-24T17:23:29Z</xmp:MetadataDate>
      </rdf:Description>
      <rdf:Description xmlns:pdf="http://ns.adobe.com/pdf/1.3/" rdf:about="">
         <pdf:Keywords/>
         <pdf:Producer>Adobe LiveCycle Designer ES 8.2</pdf:Producer>
      </rdf:Description>
      <rdf:Description xmlns:dc="http://purl.org/dc/elements/1.1/" rdf:about="">
         <dc:format>application/pdf</dc:format>
         <dc:creator>
            <rdf:Seq>
               <rdf:li>Clegg_Annmarie</rdf:li>
            </rdf:Seq>
         </dc:creator>
         <dc:title>
            <rdf:Alt>
               <rdf:li xml:lang="x-default">1112 Claim Summary</rdf:li>
            </rdf:Alt>
         </dc:title>
      </rdf:Description>
      <rdf:Description xmlns:adhocwf="http://ns.adobe.com/AcrobatAdhocWorkflow/1.0/" rdf:about="">
         <adhocwf:state>1</adhocwf:state>
         <adhocwf:version>1.1</adhocwf:version>
      </rdf:Description>
      <rdf:Description xmlns:xmpMM="http://ns.adobe.com/xap/1.0/mm/" rdf:about="">
         <xmpMM:DocumentID>uuid:5bd24562-7f4f-4c21-9a8e-228a3af821fb</xmpMM:DocumentID>
         <xmpMM:InstanceID>uuid:fbd9a97f-30a1-4cc8-9c4b-038f69e03c1f</xmpMM:InstanceID>
      </rdf:Description>
   </rdf:RDF>
</x:xmpmeta>
<xfdf xmlns="http://ns.adobe.com/xfdf/" xml:space="preserve">
   <annots/>
</xfdf></xdp:xdp>
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