Apple Reference & Presentation Library 5 (Internal Edition)

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MacBinary | 1990-03-14 | 31.1 KB | [STCK/KCFM]
open in:
MacOS 8.1 extracted |
Win98 extracted |
DOS extracted
view JSON data |
view as text

This file was processed as: MacBinary (archive/macBinary).

You can browse this item here: Personal Leave Worksheet
Confidence	Program	Detection	Match Type	Support
`10%`	dexvert	MacBinary `(archive/macBinary)`	fallback	Supported
`100%`	file	MacBinary II, inited, Wed Mar 14 12:04:17 1990, modified Wed Mar 14 12:04:23 1990, creator 'KCFM', type 'STCK', 30638 bytes "Personal Leave Worksheet" , at 0x782e 922 bytes resource	default (weak)
`99%`	file	data	default
`100%`	TrID	MacBinary 2	default (weak)
`100%`	dexmagic	Picasso 64 Image	default (weak)
`100%`	siegfried	fmt/1762 MacBinary (II)	default
`100%`	lsar	MacBinary	default
id metadata
key	value
macFileType	`[STCK]`
macFileCreator	`[KCFM]`
hex view
+--------+-------------------------+-------------------------+--------+--------+
|00000000| 00 18 50 65 72 73 6f 6e | 61 6c 20 4c 65 61 76 65 |..Person|al Leave|
|00000010| 20 57 6f 72 6b 73 68 65 | 65 74 00 00 00 00 00 00 | Workshe|et......|
|00000020| 00 00 00 00 00 00 00 00 | 00 00 00 00 00 00 00 00 |........|........|
|00000030| 00 00 00 00 00 00 00 00 | 00 00 00 00 00 00 00 00 |........|........|
|00000040| 00 53 54 43 4b 4b 43 46 | 4d 01 00 00 00 00 00 00 |.STCKKCF|M.......|
|00000050| 00 00 00 00 00 77 ae 00 | 00 03 9a a2 24 2a 11 a2 |.....w..|....$*..|
|00000060| 24 2a 17 00 00 00 00 00 | 00 00 00 00 00 00 00 00 |$*......|........|
|00000070| 00 00 00 00 00 00 00 00 | 00 00 81 81 e3 34 00 00 |........|.....4..|
|00000080| 00 0c 00 02 00 00 00 30 | 00 00 50 92 00 00 01 de |.......0|..P.....|
|00000090| 00 00 3c 72 00 00 3c 74 | 00 00 76 3a 00 00 00 00 |..<r..<t|..v:....|
|000000a0| 00 00 00 00 00 00 00 00 | 00 00 00 00 00 00 00 00 |........|........|
|000000b0| 09 90 0c 60 00 02 00 01 | 00 00 00 00 00 01 00 00 |...`....|........|
|000000c0| 00 00 00 00 00 03 00 01 | 00 01 00 03 00 00 00 48 |........|.......H|
|000000d0| 00 48 00 00 00 00 03 08 | 02 40 ff f8 ff ee 03 10 |.H......|.@......|
|000000e0| 02 52 03 47 05 28 03 fc | 00 02 00 00 00 48 00 48 |.R.G.(..|.....H.H|
|000000f0| 00 00 00 00 03 08 02 40 | 00 01 00 00 00 64 00 00 |.......@|.....d..|
|00000100| 00 01 00 01 01 01 00 00 | 00 01 27 0f 00 01 00 01 |........|..'.....|
|00000110| 00 00 00 00 00 00 00 00 | 00 00 00 00 00 02 00 19 |........|........|
|00000120| 01 90 00 00 00 00 00 70 | 00 00 00 00 00 00 00 00 |.......p|........|
|00000130| 00 00 00 00 00 00 00 00 | 00 00 00 00 00 00 00 00 |........|........|
|00000140| 00 00 00 00 01 25 00 01 | 00 06 00 06 40 38 00 00 |.....%..|....@8..|
|00000150| 00 00 00 00 40 38 00 00 | 00 00 00 00 00 2c 00 03 |....@8..|.....,..|
|00000160| 00 01 00 01 00 00 00 03 | 01 26 01 26 00 3c 00 38 |........|.&.&.<.8|
|00000170| 00 01 00 14 00 01 00 0a | 00 01 5f da 00 00 00 15 |........|.._.....|
|00000180| 00 01 00 0c 00 00 00 00 | 00 00 00 00 00 00 00 00 |........|........|
|00000190| 00 00 00 00 00 00 00 00 | 00 00 00 03 00 00 ff ff |........|........|
|000001a0| ff ff ff ff ff ff 00 01 | 00 01 00 4d e5 4e 00 4d |........|...M.N.M|
|000001b0| e5 54 00 4a 75 e8 00 4a | 75 e8 00 00 00 00 00 00 |.T.Ju..J|u.......|
|000001c0| 00 01 00 01 00 01 00 01 | 00 01 00 01 00 00 00 00 |........|........|
|000001d0| 00 00 00 01 00 00 00 00 | 00 00 00 00 00 00 00 90 |........|........|
|000001e0| 00 07 00 00 00 01 09 90 | 0c 60 00 20 00 48 0c 3d |........|.`. .H.=|
|000001f0| 09 45 00 00 00 00 00 00 | 00 00 00 00 00 00 00 00 |.E......|........|
|00000200| 00 00 00 00 00 00 00 00 | 00 00 00 00 00 00 00 00 |........|........|
|00000210| 00 00 00 00 00 00 00 00 | 00 00 00 00 00 00 00 00 |........|........|
|00000220| 00 00 00 00 00 00 00 00 | 00 00 00 00 00 00 00 00 |........|........|
|00000230| 00 00 00 00 00 00 00 00 | 00 00 00 00 00 00 00 00 |........|........|
|00000240| 00 00 00 00 00 00 00 00 | 00 00 00 00 00 00 00 00 |........|........|
|00000250| 00 00 00 00 00 00 00 00 | 00 00 00 00 00 00 00 03 |........|........|
|00000260| 00 00 00 34 00 24 00 4c | 0b d0 09 44 00 01 00 01 |...4.$.L|...D....|
|00000270| 00 03 00 01 ff ff ff ff | ff ff ff ff 00 00 00 00 |........|........|
|00000280| 00 00 00 00 00 00 00 01 | 00 28 00 28 00 28 00 28 |........|.(.(.(.(|
|00000290| 00 00 00 00 00 00 00 00 | 00 01 00 00 00 b2 01 d1 |........|........|
|000002a0| 00 70 02 61 02 6e 00 01 | 00 01 00 00 00 15 00 00 |.p.a.n..|........|
|000002b0| 00 0c 00 00 00 03 00 03 | 00 00 00 01 00 03 00 01 |........|........|
|000002c0| 00 00 00 03 00 01 ff ff | ff ff ff ff ff ff 00 00 |........|........|
|000002d0| 00 00 00 00 00 00 00 00 | 00 03 00 00 ff ff ff ff |........|........|
|000002e0| ff ff ff ff 00 90 00 90 | 00 3c 00 34 00 00 01 03 |........|.<.4....|
|000002f0| 00 09 00 01 00 00 00 00 | 00 00 00 00 00 00 00 00 |........|........|
|00000300| 00 00 00 00 00 02 01 d2 | 00 71 02 0d 02 6e 01 01 |........|.q...n..|
|00000310| 01 01 00 14 00 0a 00 80 | 00 00 00 03 00 03 00 01 |........|........|
|00000320| 00 13 53 4f 43 49 41 4c | 20 53 45 43 55 52 49 54 |..SOCIAL| SECURIT|
|00000330| 59 20 4e 4f 2e 50 00 00 | 00 16 00 01 00 00 00 00 |Y NO.P..|........|
|00000340| 00 0c 00 09 00 14 00 00 | 00 0a 00 00 00 00 00 00 |........|........|
|00000350| 00 07 00 00 00 78 00 38 | 01 3c 00 a4 09 20 00 01 |.....x.8|.<... ..|
|00000360| 00 01 ff ff ff ff ff ff | ff ff 00 01 00 00 00 00 |........|........|
|00000370| 00 00 00 02 00 38 01 3c | 00 a4 09 20 00 00 00 00 |.....8.<|... ....|
|00000380| 00 14 00 0e 00 01 00 00 | 00 03 00 03 00 01 00 23 |........|.......#|
|00000390| 50 45 52 53 4f 4e 41 4c | 20 4c 45 41 56 45 20 4f |PERSONAL| LEAVE O|
|000003a0| 46 20 41 42 53 45 4e 43 | 45 20 57 4f 52 4b 53 48 |F ABSENC|E WORKSH|
|000003b0| 45 45 54 00 00 00 00 16 | 00 01 00 00 00 00 00 0f |EET.....|........|
|000003c0| 00 0c 00 14 01 00 00 0e | 00 00 00 00 00 00 00 0d |........|........|
|000003d0| 00 00 00 cc 00 5c 00 94 | 00 d0 00 fc 00 01 00 00 |.....\..|........|
|000003e0| 00 00 00 00 00 00 00 02 | 00 07 00 00 00 56 00 5c |........|.....V.\|
|000003f0| 00 94 00 d0 00 fa 00 01 | 00 00 ff ff ff ff ff ff |........|........|
|00000400| ff ff 00 01 00 00 00 00 | 00 00 00 02 00 5c 00 94 |........|.....\..|
|00000410| 00 d0 00 fa 00 00 00 00 | 00 14 00 18 00 00 00 00 |........|........|
|00000420| 00 03 00 03 00 01 00 01 | f0 00 00 00 00 16 00 01 |........|........|
|00000430| 00 00 00 00 00 18 00 12 | 00 14 00 00 00 18 00 00 |........|........|
|00000440| 00 00 00 00 00 07 00 00 | 00 56 00 a1 00 df 00 ba |........|.V......|
|00000450| 00 fc 00 01 00 00 ff ff | ff ff ff ff ff ff 00 01 |........|........|
|00000460| 00 00 00 00 00 00 00 02 | 00 a1 00 df 00 ba 00 fc |........|........|
|00000470| 00 00 00 00 00 14 00 04 | 00 00 00 00 00 03 00 03 |........|........|
|00000480| 00 01 00 01 a8 00 00 00 | 00 16 00 01 00 00 00 00 |........|........|
|00000490| 00 05 00 04 00 14 00 00 | 00 04 00 00 00 00 00 00 |........|........|
|000004a0| 00 01 00 00 00 ac 00 b1 | 07 dc 01 41 09 20 00 01 |........|...A. ..|
|000004b0| 00 01 00 00 00 15 00 00 | 00 0c 00 00 00 03 00 03 |........|........|
|000004c0| 00 00 00 01 00 03 00 01 | 00 00 00 03 00 01 ff ff |........|........|
|000004d0| ff ff ff ff ff ff 00 00 | 00 00 00 00 00 00 00 00 |........|........|
|000004e0| 00 03 00 00 ff ff ff ff | ff ff ff ff 00 90 00 90 |........|........|
|000004f0| 00 3c 00 34 00 00 00 f4 | 00 02 00 01 00 00 00 00 |.<.4....|........|
|00000500| 00 00 00 00 00 00 00 00 | 00 00 00 00 00 02 00 b2 |........|........|
|00000510| 07 dd 00 ed 09 20 01 01 | 01 01 00 14 00 0a 00 80 |..... ..|........|
|00000520| 00 00 00 03 00 03 00 01 | 00 0d 45 4d 50 4c 4f 59 |........|..EMPLOY|
|00000530| 45 45 20 20 4e 4f 2e d0 | 00 00 00 16 00 01 00 00 |EE  NO..|........|
|00000540| 00 00 00 0c 00 09 00 14 | 00 00 00 0a 00 00 00 00 |........|........|
|00000550| 00 00 00 01 00 00 00 a2 | 00 b1 06 98 01 41 07 dc |........|.....A..|
|00000560| 00 01 00 01 00 00 00 15 | 00 00 00 0c 00 00 00 03 |........|........|
|00000570| 00 03 00 00 00 01 00 03 | 00 01 00 00 00 03 00 01 |........|........|
|00000580| ff ff ff ff ff ff ff ff | 00 00 00 00 00 00 00 00 |........|........|
|00000590| 00 00 00 03 00 00 ff ff | ff ff ff ff ff ff 00 88 |........|........|
|000005a0| 00 88 00 3c 00 38 00 00 | 00 f5 00 01 00 01 00 00 |...<.8..|........|
|000005b0| 00 00 00 00 00 00 00 00 | 00 00 00 00 00 00 00 02 |........|........|
|000005c0| 00 b2 06 99 00 ed 07 dc | 01 01 01 01 00 14 00 0a |........|........|
|000005d0| 00 80 00 00 00 03 00 03 | 00 01 00 04 44 41 54 45 |........|....DATE|
|000005e0| 00 00 00 16 00 01 00 00 | 00 00 00 0c 00 09 00 14 |........|........|
|000005f0| 00 00 00 0a 00 00 00 00 | 00 00 00 01 00 00 00 a8 |........|........|
|00000600| 01 41 04 df 01 d1 05 de | 00 01 00 01 00 00 00 15 |.A......|........|
|00000610| 00 00 00 0c 00 00 00 03 | 00 03 00 00 00 01 00 03 |........|........|
|00000620| 00 01 00 00 00 03 00 01 | ff ff ff ff ff ff ff ff |........|........|
|00000630| 00 00 00 00 00 00 00 00 | 00 00 00 03 00 00 ff ff |........|........|
|00000640| ff ff ff ff ff ff 00 90 | 00 90 00 3c 00 34 00 00 |........|...<.4..|
|00000650| 00 f6 00 06 00 01 00 00 | 00 00 00 00 00 00 00 00 |........|........|
|00000660| 00 00 00 00 00 00 00 02 | 01 42 04 e0 01 7d 05 de |........|.B...}..|
|00000670| 01 01 01 01 00 14 00 0a | 00 80 00 00 00 03 00 03 |........|........|
|00000680| 00 01 00 0a 4d 41 49 4c | 20 20 53 54 4f 50 00 00 |....MAIL|  STOP..|
|00000690| 00 16 00 01 00 00 00 00 | 00 0c 00 09 00 14 00 00 |........|........|
|000006a0| 00 0a 00 00 00 00 00 00 | 00 01 00 00 00 a8 01 41 |........|.......A|
|000006b0| 07 dc 01 d1 09 20 00 01 | 00 01 00 00 00 15 00 20 |..... ..|....... |
|000006c0| 00 0c 00 00 00 03 00 03 | 00 00 00 01 00 03 00 01 |........|........|
|000006d0| 00 00 00 03 00 01 ff ff | ff ff ff ff ff ff 00 00 |........|........|
|000006e0| 00 00 00 00 00 00 00 00 | 00 03 00 00 ff ff ff ff |........|........|
|000006f0| ff ff ff ff 00 94 00 94 | 00 3c 00 38 00 00 00 f7 |........|.<.8....|
|00000700| 00 08 00 01 00 00 00 00 | 00 00 00 00 00 00 00 00 |........|........|
|00000710| 00 00 00 00 00 02 01 42 | 07 dd 01 7d 09 20 01 01 |.......B|...}. ..|
|00000720| 01 01 00 14 00 0a 00 80 | 00 00 00 03 00 03 00 01 |........|........|
|00000730| 00 09 41 50 50 4c 45 4c | 49 4e 4b 5c 00 00 00 16 |..APPLEL|INK\....|
|00000740| 00 01 00 00 00 00 00 0c | 00 09 00 14 00 00 00 0a |........|........|
|00000750| 00 00 00 00 00 00 00 01 | 00 00 00 ac 01 41 05 de |........|.....A..|
|00000760| 01 d1 07 dc 00 01 00 01 | 00 00 00 15 00 00 00 0c |........|........|
|00000770| 00 00 00 03 00 03 00 01 | 00 01 00 03 00 01 00 00 |........|........|
|00000780| 00 03 00 01 ff ff ff ff | ff ff ff ff 00 00 00 00 |........|........|
|00000790| 00 00 00 00 00 00 00 03 | 00 00 ff ff ff ff ff ff |........|........|
|000007a0| ff ff 00 90 00 90 00 3c | 00 34 00 00 00 f8 00 07 |.......<|.4......|
|000007b0| 00 01 00 00 00 00 00 00 | 00 00 00 00 00 00 00 00 |........|........|
|000007c0| 00 00 00 02 01 42 05 df | 01 7d 07 dc 01 01 01 01 |.....B..|.}......|
|000007d0| 00 14 00 0a 00 80 00 00 | 00 03 00 03 00 01 00 0e |........|........|
|000007e0| 54 45 4c 45 50 48 4f 4e | 45 20 20 4e 4f 2e 00 00 |TELEPHON|E  NO...|
|000007f0| 00 16 00 01 00 00 00 00 | 00 0c 00 09 00 14 00 00 |........|........|
|00000800| 00 0a 00 00 00 00 00 00 | 00 01 00 00 00 a6 01 41 |........|.......A|
|00000810| 03 49 01 d1 04 14 00 01 | 00 01 00 00 00 15 00 00 |.I......|........|
|00000820| 00 0c 00 00 00 03 00 03 | 00 00 00 01 00 03 00 01 |........|........|
|00000830| 00 00 00 03 00 01 ff ff | ff ff ff ff ff ff 00 00 |........|........|
|00000840| 00 00 00 00 00 00 00 00 | 00 03 00 00 ff ff ff ff |........|........|
|00000850| ff ff ff ff 00 70 00 70 | 00 3c 00 34 00 00 00 f9 |.....p.p|.<.4....|
|00000860| 00 04 00 01 00 00 00 00 | 00 00 00 00 00 00 00 00 |........|........|
|00000870| 00 00 00 00 00 02 01 42 | 03 4a 01 7d 04 14 01 01 |.......B|.J.}....|
|00000880| 01 01 00 14 00 0a 00 80 | 00 00 00 03 00 03 00 01 |........|........|
|00000890| 00 08 44 49 56 2e 20 4e | 4f 2e 00 00 00 16 00 01 |..DIV. N|O.......|
|000008a0| 00 00 00 00 00 0c 00 09 | 00 14 00 00 00 0a 00 00 |........|........|
|000008b0| 00 00 00 00 00 01 00 00 | 00 a8 01 41 04 14 01 d1 |........|...A....|
|000008c0| 04 df 00 01 00 01 00 00 | 00 15 00 00 00 0c 00 00 |........|........|
|000008d0| 00 03 00 03 00 00 00 01 | 00 03 00 01 00 00 00 03 |........|........|
|000008e0| 00 01 ff ff ff ff ff ff | ff ff 00 00 00 00 00 00 |........|........|
|000008f0| 00 00 00 00 00 03 00 00 | ff ff ff ff ff ff ff ff |........|........|
|00000900| 00 90 00 90 00 3c 00 34 | 00 00 00 fa 00 05 00 01 |.....<.4|........|
|00000910| 00 00 00 00 00 00 00 00 | 00 00 00 00 00 00 00 00 |........|........|
|00000920| 00 02 01 42 04 15 01 7d | 04 df 01 01 01 01 00 14 |...B...}|........|
|00000930| 00 0a 00 80 00 00 00 03 | 00 03 00 01 00 09 44 45 |........|......DE|
|00000940| 50 54 2e 20 4e 4f 2e 00 | 00 00 00 16 00 01 00 00 |PT. NO..|........|
|00000950| 00 00 00 0c 00 09 00 14 | 00 00 00 0a 00 00 00 00 |........|........|
|00000960| 00 00 00 01 00 00 00 ac | 01 41 00 70 01 d1 03 49 |........|.A.p...I|
|00000970| 00 01 00 01 00 00 00 15 | 00 00 00 0c 00 00 00 03 |........|........|
|00000980| 00 03 00 2a 00 01 00 03 | 00 01 00 00 00 03 00 01 |...*....|........|
|00000990| ff ff ff ff ff ff ff ff | 00 00 00 00 00 00 00 00 |........|........|
|000009a0| 00 00 00 03 00 00 ff ff | ff ff ff ff ff ff 01 98 |........|........|
|000009b0| 01 98 00 3c 00 38 00 00 | 00 fb 00 03 00 01 00 00 |...<.8..|........|
|000009c0| 00 00 00 00 00 00 00 00 | 00 00 00 00 00 00 00 02 |........|........|
|000009d0| 01 42 00 71 01 7d 03 49 | 01 01 01 01 00 14 00 0a |.B.q.}.I|........|
|000009e0| 00 80 00 00 00 03 00 03 | 00 01 00 0e 45 4d 50 4c |........|....EMPL|
|000009f0| 4f 59 45 45 20 20 4e 41 | 4d 45 00 00 00 16 00 01 |OYEE  NA|ME......|
|00000a00| 00 00 00 00 00 0c 00 09 | 00 14 00 00 00 0a 00 00 |........|........|
|00000a10| 00 00 00 00 00 02 00 00 | 00 22 00 b1 07 dc 00 ee |........|."......|
|00000a20| 07 dc 00 01 00 01 00 03 | 00 00 00 00 00 00 00 00 |........|........|
|00000a30| 00 00 00 00 00 00 00 00 | 00 00 00 00 00 02 00 00 |........|........|
|00000a40| 00 22 01 40 07 dc 01 7e | 07 dc 00 01 00 01 00 03 |.".@...~|........|
|00000a50| 00 00 00 00 00 00 00 00 | 00 00 00 00 00 00 00 00 |........|........|
|00000a60| 00 00 00 00 00 02 00 00 | 00 22 01 3e 05 de 01 7c |........|.".>...||
|00000a70| 05 de 00 01 00 01 00 03 | 00 00 00 00 00 00 00 00 |........|........|
|00000a80| 00 00 00 00 00 00 00 00 | 00 00 00 00 00 02 00 00 |........|........|
|00000a90| 00 22 01 40 04 de 01 7e | 04 de 00 01 00 01 00 03 |.".@...~|........|
|00000aa0| 00 00 00 00 00 00 00 00 | 00 00 00 00 00 00 00 00 |........|........|
|00000ab0| 00 00 00 00 00 02 00 00 | 00 22 01 3e 04 14 01 7c |........|.".>...||
|00000ac0| 04 14 00 01 00 01 00 03 | 00 00 00 00 00 00 00 00 |........|........|
|00000ad0| 00 00 00 00 00 00 00 00 | 00 00 00 00 00 07 00 00 |........|........|
|00000ae0| 00 68 0b f4 00 4c 0c 3c | 02 38 00 01 00 01 ff ff |.h...L.<|.8......|
|00000af0| ff ff ff ff ff ff 00 01 | 00 00 00 00 00 00 00 02 |........|........|
|00000b00| 0b f4 00 4c 0c 3c 02 38 | 00 00 00 00 00 14 00 0e |...L.<.8|........|
|00000b10| 00 20 00 00 00 01 00 03 | 00 01 00 14 41 70 70 6c |. ......|....Appl|
|00000b20| 65 20 43 6f 6d 70 75 74 | 65 72 2c 20 49 6e 63 2e |e Comput|er, Inc.|
|00000b30| 00 00 00 16 00 01 00 00 | 00 00 00 0f 00 0c 00 14 |........|........|
|00000b40| 20 00 00 0e 00 00 00 00 | 00 00 00 07 00 00 00 60 | .......|.......`|
|00000b50| 0b f4 08 3c 0c 3c 09 44 | 00 01 00 01 ff ff ff ff |...<.<.D|........|
|00000b60| ff ff ff ff 00 01 00 00 | 00 00 00 00 00 02 0b f4 |........|........|
|00000b70| 08 3c 0c 3c 09 44 00 00 | 00 00 00 14 00 0a 00 00 |.<.<.D..|........|
|00000b80| 00 00 00 02 00 03 00 01 | 00 0c 48 52 32 30 30 20 |........|..HR200 |
|00000b90| 28 33 2f 39 30 29 00 00 | 00 16 00 01 00 00 00 00 |(3/90)..|........|
|00000ba0| 00 0c 00 09 00 14 00 00 | 00 0a 00 00 00 00 00 00 |........|........|
|00000bb0| 00 01 00 00 00 aa 01 d1 | 05 de 02 61 09 20 00 01 |........|...a. ..|
|00000bc0| 00 01 00 00 00 15 00 00 | 00 0c 00 00 00 03 00 03 |........|........|
|00000bd0| 00 00 00 01 00 03 00 01 | 00 00 00 03 00 01 ff ff |........|........|
|00000be0| ff ff ff ff ff ff 00 00 | 00 00 00 00 00 00 00 00 |........|........|
|00000bf0| 00 03 00 00 ff ff ff ff | ff ff ff ff 00 90 00 90 |........|........|
|00000c00| 00 3c 00 34 00 00 01 00 | 00 0c 00 01 00 00 00 00 |.<.4....|........|
|00000c10| 00 00 00 00 00 00 00 00 | 00 00 00 00 00 02 01 d2 |........|........|
|00000c20| 05 df 02 0d 09 20 01 01 | 01 01 00 14 00 0a 00 80 |..... ..|........|
|00000c30| 00 00 00 03 00 03 00 01 | 00 0c 48 4f 4d 45 20 41 |........|..HOME A|
|00000c40| 44 44 52 45 53 53 00 00 | 00 16 00 01 00 00 00 00 |DDRESS..|........|
|00000c50| 00 0c 00 09 00 14 00 00 | 00 0a 00 00 00 00 00 00 |........|........|
|00000c60| 00 01 00 00 00 aa 01 d1 | 04 6c 02 61 05 de 00 01 |........|.l.a....|
|00000c70| 00 01 00 00 00 15 00 00 | 00 0c 00 00 00 03 00 03 |........|........|
|00000c80| 00 00 00 01 00 03 00 01 | 00 00 00 03 00 01 ff ff |........|........|
|00000c90| ff ff ff ff ff ff 00 00 | 00 00 00 00 00 00 00 00 |........|........|
|00000ca0| 00 03 00 00 ff ff ff ff | ff ff ff ff 00 90 00 90 |........|........|
|00000cb0| 00 3c 00 34 00 00 01 01 | 00 0b 00 01 00 00 00 00 |.<.4....|........|
|00000cc0| 00 00 00 00 00 00 00 00 | 00 00 00 00 00 02 01 d2 |........|........|
|00000cd0| 04 6d 02 0d 05 de 01 01 | 01 01 00 14 00 0a 00 80 |.m......|........|
|00000ce0| 00 00 00 03 00 03 00 01 | 00 0c 45 4d 50 4c 4f 59 |........|..EMPLOY|
|00000cf0| 45 45 20 41 47 45 00 00 | 00 16 00 01 00 00 00 00 |EE AGE..|........|
|00000d00| 00 0c 00 09 00 14 00 00 | 00 0a 00 00 00 00 00 00 |........|........|
|00000d10| 00 02 00 00 00 22 01 ce | 02 6c 02 0c 02 6c 00 01 |....."..|.l...l..|
|00000d20| 00 01 00 03 00 00 00 00 | 00 00 00 00 00 00 00 00 |........|........|
|00000d30| 00 00 00 00 00 00 00 00 | 00 02 00 00 00 22 01 ce |........|....."..|
|00000d40| 04 6a 02 0c 04 6a 00 01 | 00 01 00 03 00 00 00 00 |.j...j..|........|
|00000d50| 00 00 00 00 00 00 00 00 | 00 00 00 00 00 00 00 00 |........|........|
|00000d60| 00 02 00 00 00 22 01 cc | 05 de 02 0c 05 de 00 01 |....."..|........|
|00000d70| 00 01 00 03 00 00 00 00 | 00 00 00 00 00 00 00 00 |........|........|
|00000d80| 00 00 00 00 00 00 00 00 | 00 07 00 00 00 64 02 8c |........|.....d..|
|00000d90| 00 70 02 bb 02 80 00 01 | 00 01 ff ff ff ff ff ff |.p......|........|
|00000da0| ff ff 00 01 00 00 00 00 | 00 00 00 02 02 8c 00 70 |........|.......p|
|00000db0| 02 bb 02 80 00 00 00 00 | 00 14 00 0c 00 01 00 00 |........|........|
|00000dc0| 00 01 00 01 00 01 00 10 | 50 41 59 4d 45 4e 54 20 |........|PAYMENT |
|00000dd0| 53 43 48 45 44 55 4c 45 | 00 00 00 16 00 01 00 00 |SCHEDULE|........|
|00000de0| 00 00 00 0c 00 09 00 14 | 01 00 00 0c 00 00 00 00 |........|........|
|00000df0| 00 00 00 07 00 00 00 62 | 02 d0 04 14 02 fc 05 7c |.......b|.......||
|00000e00| 00 01 00 01 ff ff ff ff | ff ff ff ff 00 01 00 00 |........|........|
|00000e10| 00 00 00 00 00 02 02 d0 | 04 14 02 fc 05 7c 00 00 |........|.....|..|
|00000e20| 00 00 00 14 00 0c 00 00 | 00 00 00 01 00 01 00 01 |........|........|
|00000e30| 00 0d 44 49 52 45 43 54 | 49 4f 4e 53 3a 20 20 01 |..DIRECT|IONS:  .|
|00000e40| 00 00 00 16 00 01 00 00 | 00 00 00 0c 00 09 00 14 |........|........|
|00000e50| 00 00 00 0c 00 00 00 00 | 00 00 00 07 00 00 02 44 |........|.......D|
|00000e60| 03 24 01 0c 04 58 08 70 | 00 01 00 01 ff ff ff ff |.$...X.p|........|
|00000e70| ff ff ff ff 00 01 00 00 | 00 00 00 00 00 02 03 24 |........|.......$|
|00000e80| 01 0c 04 58 08 70 00 00 | 00 00 00 14 00 0c 00 00 |...X.p..|........|
|00000e90| 00 00 00 01 00 01 00 05 | 01 f0 53 54 45 50 20 31 |........|..STEP 1|
|00000ea0| 3a 20 20 54 6f 20 63 6f | 6e 74 69 6e 75 65 20 79 |:  To co|ntinue y|
|00000eb0| 6f 75 72 20 63 75 72 72 | 65 6e 74 20 6d 65 64 69 |our curr|ent medi|
|00000ec0| 63 61 6c 20 62 65 6e 65 | 66 69 74 73 2c 20 63 68 |cal bene|fits, ch|
|00000ed0| 6f 6f 73 65 20 79 6f 75 | 72 20 6d 6f 6e 74 68 6c |oose you|r monthl|
|00000ee0| 79 20 70 72 65 6d 69 75 | 6d 20 66 72 6f 6d 20 74 |y premiu|m from t|
|00000ef0| 68 65 20 09 09 09 09 09 | 09 09 09 09 09 09 09 09 |he .....|........|
|00000f00| 09 09 09 09 09 09 09 09 | 09 09 09 61 70 70 72 6f |........|...appro|
|00000f10| 70 72 69 61 74 65 20 63 | 6f 76 65 72 61 67 65 20 |priate c|overage |
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|00000f30| 65 78 61 6d 70 6c 65 2c | 20 41 70 70 6c 65 20 50 |example,| Apple P|
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|00001e80| 00 00 00 00 00 01 00 00 | 00 a6 0e fb 02 1c 0f 51 |........|.......Q|
|00001e90| 04 5c 00 01 00 01 00 00 | 00 15 00 00 00 0c 00 00 |.\......|........|
|00001ea0| 00 03 00 03 00 01 00 01 | 00 04 00 00 00 00 00 00 |........|........|
|00001eb0| 00 01 00 00 00 00 00 00 | 00 00 00 00 00 00 00 00 |........|........|
|00001ec0| 00 00 00 01 00 03 00 00 | ff ff ff ff ff ff ff ff |........|........|
|00001ed0| 00 d0 01 f4 00 34 00 34 | 00 00 01 0b 00 13 00 01 |.....4.4|........|
|00001ee0| 00 00 00 00 00 00 00 00 | 00 00 00 00 00 00 00 00 |........|........|
|00001ef0| 00 02 0e fb 02 68 0f 52 | 04 5d 01 00 81 81 00 14 |.....h.R|.]......|
|00001f00| 00 0c 00 00 00 00 00 01 | 00 03 00 01 00 07 24 35 |........|......$5|
|00001f10| 30 2c 30 30 30 10 00 00 | 00 16 00 01 00 00 00 00 |0,000...|........|
|00001f20| 00 0c 00 09 00 14 00 00 | 00 0c 00 00 00 00 00 00 |........|........|
|00001f30| 00 01 00 00 00 ae 0f 6e | 02 1c 0f c4 04 5c 00 01 |.......n|.....\..|
|00001f40| 00 01 00 00 00 15 00 00 | 00 0c 00 00 00 03 00 03 |........|........|
|00001f50| 00 01 00 01 00 04 00 00 | 00 00 00 00 00 01 00 00 |........|........|
|00001f60| 00 00 00 00 00 00 00 00 | 00 00 00 00 00 00 00 01 |........|........|
|00001f70| 00 03 00 00 ff ff ff ff | ff ff ff ff 00 d0 01 f4 |........|........|
|00001f80| 00 34 00 34 00 00 01 0c | 00 14 00 01 00 00 00 00 |.4.4....|........|
|00001f90| 00 00 00 00 00 00 00 00 | 00 00 00 00 00 02 0f 6e |........|.......n|
|00001fa0| 02 68 0f c5 04 5d 01 00 | 81 81 00 14 00 0c 00 00 |.h...]..|........|
|00001fb0| 00 00 00 01 00 03 00 01 | 00 10 31 58 20 41 6e 6e |........|..1X Ann|
|00001fc0| 75 61 6c 20 53 61 6c 61 | 72 79 00 00 00 16 00 01 |ual Sala|ry......|
|00001fd0| 00 00 00 00 00 0c 00 09 | 00 14 00 00 00 0c 00 00 |........|........|
|00001fe0| 00 00 00 00 00 01 00 00 | 00 ae 0e 88 05 34 0e de |........|.....4..|
|00001ff0| 07 74 00 01 00 01 00 00 | 00 15 00 00 00 0c 00 00 |.t......|........|
|00002000| 00 03 00 03 00 01 00 01 | 00 04 00 00 00 00 00 00 |........|........|
|00002010| 00 01 00 00 00 00 00 00 | 00 00 00 00 00 00 00 00 |........|........|
|00002020| 00 00 00 01 00 03 00 00 | ff ff ff ff ff ff ff ff |........|........|
|00002030| 00 d0 01 f4 00 34 00 34 | 00 00 01 0d 00 15 00 01 |.....4.4|........|
|00002040| 00 00 00 00 00 00 00 00 | 00 00 00 00 00 00 00 00 |........|........|
|00002050| 00 02 0e 88 05 80 0e df | 07 75 01 00 81 81 00 14 |........|.u......|
|00002060| 00 0c 00 00 00 00 00 01 | 00 03 00 01 00 10 32 58 |........|......2X|
|00002070| 20 41 6e 6e 75 61 6c 20 | 53 61 6c 61 72 79 00 00 | Annual |Salary..|
|00002080| 00 16 00 01 00 00 00 00 | 00 0c 00 09 00 14 00 00 |........|........|
|00002090| 00 0c 00 00 00 00 00 00 | 00 01 00 00 00 ae 0e fb |........|........|
|000020a0| 05 34 0f 51 07 74 00 01 | 00 01 00 00 00 15 00 00 |.4.Q.t..|........|
|000020b0| 00 0c 00 00 00 03 00 03 | 00 01 00 01 00 04 00 00 |........|........|
|000020c0| 00 00 00 00 00 01 00 00 | 00 00 00 00 00 00 00 00 |........|........|
|000020d0| 00 00 00 00 00 00 00 01 | 00 03 00 00 ff ff ff ff |........|........|
|000020e0| ff ff ff ff 00 d0 01 f4 | 00 34 00 34 00 00 01 0e |........|.4.4....|
|000020f0| 00 16 00 01 00 00 00 00 | 00 00 00 00 00 00 00 00 |........|........|
|00002100| 00 00 00 00 00 02 0e fb | 05 80 0f 52 07 75 01 00 |........|...R.u..|
|00002110| 81 81 00 14 00 0c 00 00 | 00 00 00 01 00 03 00 01 |........|........|
|00002120| 00 10 33 58 20 41 6e 6e | 75 61 6c 20 53 61 6c 61 |..3X Ann|ual Sala|
|00002130| 72 79 00 00 00 16 00 01 | 00 00 00 00 00 0c 00 09 |ry......|........|
|00002140| 00 14 00 00 00 0c 00 00 | 00 00 00 00 00 01 00 00 |........|........|
|00002150| 00 ae 0f 6e 05 34 0f c4 | 07 74 00 01 00 01 00 00 |...n.4..|.t......|
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|000021b0| 00 00 00 00 00 00 00 00 | 00 02 0f 6e 05 80 0f c5 |........|...n....|
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|000021d0| 00 03 00 01 00 10 34 58 | 20 41 6e 6e 75 61 6c 20 |......4X| Annual |
|000021e0| 53 61 6c 61 72 79 00 00 | 00 16 00 01 00 00 00 00 |Salary..|........|
|000021f0| 00 0c 00 09 00 14 00 00 | 00 0c 00 00 00 00 00 00 |........|........|
|00002200| 00 07 00 00 00 5e 11 f4 | 00 70 12 23 01 b0 00 01 |.....^..|.p.#....|
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|00002230| 00 14 00 0c 00 01 00 00 | 00 01 00 01 00 01 00 0a |........|........|
|00002240| 41 44 26 44 20 43 4f 53 | 54 53 00 00 00 16 00 01 |AD&D COS|TS......|
|00002250| 00 00 00 00 00 0c 00 09 | 00 14 01 00 00 0c 00 00 |........|........|
|00002260| 00 00 00 00 00 07 00 00 | 00 8e 12 4c 01 0c 12 7b |........|...L...{|
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|00002280| 00 00 00 00 00 00 00 02 | 12 4c 01 0c 12 7b 05 70 |........|.L...{.p|
|00002290| 00 00 00 00 00 14 00 0c | 00 00 00 00 00 01 00 01 |........|........|
|000022a0| 00 01 00 39 50 6c 65 61 | 73 65 20 63 68 65 63 6b |...9Plea|se check|
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|000022f0| 00 0c 00 00 00 00 00 00 | 00 07 00 00 00 7c 13 10 |........|.....|..|
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|00002310| ff ff 00 01 00 00 00 00 | 00 00 00 02 13 10 01 0c |........|........|
|00002320| 13 3f 04 30 00 00 00 00 | 00 14 00 0c 00 00 00 00 |.?.0....|........|
|00002330| 00 01 00 01 00 01 00 28 | 50 6c 65 61 73 65 20 63 |.......(|Please c|
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|00002370| 00 00 00 0c 00 00 00 00 | 00 00 00 01 00 00 00 ae |........|........|
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|000023e0| 00 00 00 00 00 00 00 02 | 12 98 01 b8 12 ef 03 91 |........|........|
|000023f0| 01 00 81 81 00 14 00 0c | 00 00 00 00 00 01 00 03 |........|........|
|00002400| 00 01 00 10 32 58 20 41 | 6e 6e 75 61 6c 20 53 61 |....2X A|nnual Sa|
|00002410| 6c 61 72 79 00 00 00 16 | 00 01 00 00 00 00 00 0c |lary....|........|
|00002420| 00 09 00 14 00 00 00 0c | 00 00 00 00 00 00 00 01 |........|........|
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|00002440| 00 00 00 15 00 00 00 0c | 00 00 00 03 00 03 00 01 |........|........|
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|00002480| 00 34 00 00 01 12 00 1a | 00 01 00 00 00 00 00 00 |.4......|........|
|00002490| 00 00 00 00 00 00 00 00 | 00 00 00 02 12 98 03 e8 |........|........|
|000024a0| 12 ef 05 dd 01 00 81 81 | 00 14 00 0c 00 00 00 00 |........|........|
|000024b0| 00 01 00 03 00 01 00 10 | 34 58 20 41 6e 6e 75 61 |........|4X Annua|
|000024c0| 6c 20 53 61 6c 61 72 79 | 00 00 00 16 00 01 00 00 |l Salary|........|
|000024d0| 00 00 00 0c 00 09 00 14 | 00 00 00 0c 00 00 00 00 |........|........|
|000024e0| 00 00 00 01 00 00 00 ae | 12 98 05 df 12 ee 08 1f |........|........|
|000024f0| 00 01 00 01 00 00 00 15 | 00 00 00 0c 00 00 00 03 |........|........|
|00002500| 00 03 00 01 00 01 00 04 | 00 00 00 00 00 00 00 01 |........|........|
|00002510| 00 00 00 00 00 00 00 00 | 00 00 00 00 00 00 00 00 |........|........|
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|00002530| 01 f4 00 34 00 34 00 00 | 01 13 00 1b 00 01 00 00 |...4.4..|........|
|00002540| 00 00 00 00 00 00 00 00 | 00 00 00 00 00 00 00 02 |........|........|
|00002550| 12 98 06 2b 12 ef 08 20 | 01 00 81 81 00 14 00 0c |...+... |........|
|00002560| 00 00 00 00 00 01 00 03 | 00 01 00 10 36 58 20 41 |........|....6X A|
|00002570| 6e 6e 75 61 6c 20 53 61 | 6c 61 72 79 00 00 00 16 |nnual Sa|lary....|
|00002580| 00 01 00 00 00 00 00 0c | 00 09 00 14 00 00 00 0c |........|........|
|00002590| 00 00 00 00 00 00 00 01 | 00 00 00 a6 13 60 01 71 |........|.....`.q|
|000025a0| 13 b6 03 94 00 01 00 01 | 00 00 00 15 00 00 00 0c |........|........|
|000025b0| 00 00 00 03 00 03 00 01 | 00 01 00 04 00 00 00 00 |........|........|
|000025c0| 00 00 00 01 00 00 00 00 | 00 00 00 00 00 00 00 00 |........|........|
|000025d0| 00 00 00 00 00 01 00 03 | 00 00 ff ff ff ff ff ff |........|........|
|000025e0| ff ff 00 d0 01 d8 00 34 | 00 34 00 00 01 14 00 1c |.......4|.4......|
|000025f0| 00 01 00 00 00 00 00 00 | 00 00 00 00 00 00 00 00 |........|........|
|00002600| 00 00 00 02 13 60 01 bc | 13 b7 03 95 01 00 81 81 |.....`..|........|
|00002610| 00 14 00 0c 00 00 00 00 | 00 01 00 03 00 01 00 08 |........|........|
|00002620| 45 6d 70 6c 6f 79 65 65 | 00 00 00 16 00 01 00 00 |Employee|........|
|00002630| 00 00 00 0c 00 09 00 14 | 00 00 00 0c 00 00 00 00 |........|........|
|00002640| 00 00 00 01 00 00 00 b4 | 13 60 03 9c 13 b6 05 d8 |........|.`......|
|00002650| 00 01 00 01 00 00 00 15 | 00 00 00 0c 00 00 00 03 |........|........|
|00002660| 00 03 00 01 00 01 00 04 | 00 00 00 00 00 00 00 01 |........|........|
|00002670| 00 00 00 00 00 00 00 00 | 00 00 00 00 00 00 00 00 |........|........|
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|00002690| 01 f4 00 34 00 34 00 00 | 01 15 00 1d 00 01 00 00 |...4.4..|........|
|000026a0| 00 00 00 00 00 00 00 00 | 00 00 00 00 00 00 00 02 |........|........|
|000026b0| 13 60 03 e4 13 b7 05 d9 | 01 00 81 81 00 14 00 0c |.`......|........|
|000026c0| 00 00 00 00 00 01 00 03 | 00 01 00 15 45 6d 70 6c |........|....Empl|
|000026d0| 6f 79 65 65 20 2b 20 43 | 68 69 6c 64 28 72 65 6e |oyee + C|hild(ren|
|000026e0| 29 09 00 00 00 16 00 01 | 00 00 00 00 00 0c 00 09 |).......|........|
|000026f0| 00 14 00 00 00 0c 00 00 | 00 00 00 00 00 01 00 00 |........|........|
|00002700| 00 b0 13 60 05 df 13 b6 | 08 1b 00 01 00 01 00 00 |...`....|........|
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|00002730| 00 00 00 00 00 00 00 00 | 00 00 00 01 00 03 00 00 |........|........|
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|00002750| 00 00 01 16 00 1e 00 01 | 00 00 00 00 00 00 00 00 |........|........|
|00002760| 00 00 00 00 00 00 00 00 | 00 02 13 60 06 27 13 b7 |........|...`.'..|
|00002770| 08 1c 01 00 81 81 00 14 | 00 0c 00 00 00 00 00 01 |........|........|
|00002780| 00 03 00 01 00 11 45 6d | 70 6c 6f 79 65 65 20 2b |......Em|ployee +|
|00002790| 20 46 61 6d 69 6c 79 00 | 00 00 00 16 00 01 00 00 | Family.|........|
|000027a0| 00 00 00 0c 00 09 00 14 | 00 00 00 0c 00 00 00 00 |........|........|
|000027b0| 00 00 00 07 00 00 00 62 | 14 b4 00 70 14 e3 03 28 |.......b|...p...(|
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|000027d0| 00 00 00 00 00 02 14 b4 | 00 70 14 e3 03 28 00 00 |........|.p...(..|
|000027e0| 00 00 00 14 00 0c 00 01 | 00 00 00 01 00 01 00 01 |........|........|
|000027f0| 00 0e 4d 4f 4e 54 48 4c | 59 20 54 4f 54 41 4c 20 |..MONTHL|Y TOTAL |
|00002800| 00 00 00 16 00 01 00 00 | 00 00 00 0c 00 09 00 14 |........|........|
|00002810| 01 00 00 0c 00 00 00 00 | 00 00 00 01 00 00 00 b2 |........|........|
|00002820| 14 04 03 80 14 70 06 10 | 00 01 00 01 00 00 00 15 |.....p..|........|
|00002830| 00 00 00 0c 00 00 00 03 | 00 02 00 84 00 01 00 05 |........|........|
|00002840| 00 00 00 00 00 04 00 01 | 00 00 00 00 00 00 00 00 |........|........|
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|00002860| ff ff ff ff ff ff 01 24 | 01 24 00 3c 00 30 00 00 |.......$|.$.<.0..|
|00002870| 01 17 00 00 00 00 00 00 | 00 00 00 00 00 00 00 00 |........|........|
|00002880| 00 00 00 00 00 00 00 02 | 14 40 03 80 14 71 06 11 |........|.@...q..|
|00002890| 00 01 81 81 00 14 00 0a | 00 01 00 00 00 03 00 01 |........|........|
|000028a0| 00 01 00 14 4d 6f 6e 74 | 68 6c 79 20 41 44 26 44 |....Mont|hly AD&D|
|000028b0| 20 50 72 65 6d 69 75 6d | 00 00 00 16 00 01 00 00 | Premium|........|
|000028c0| 00 00 00 0c 00 09 00 14 | 01 00 00 0a 00 00 00 00 |........|........|
|000028d0| 00 00 00 01 00 00 00 b2 | 16 f4 00 dc 17 60 03 6c |........|.....`.l|
|000028e0| 00 01 00 01 00 00 00 15 | 00 00 00 0c 00 00 00 03 |........|........|
|000028f0| 00 02 00 84 00 01 00 05 | 00 00 00 00 00 04 00 01 |........|........|
|00002900| 00 00 00 00 00 00 00 00 | 00 00 00 00 00 00 00 00 |........|........|
|00002910| 00 00 00 03 00 00 ff ff | ff ff ff ff ff ff 01 24 |........|.......$|
|00002920| 01 24 00 3c 00 30 00 00 | 01 18 00 00 00 00 00 00 |.$.<.0..|........|
|00002930| 00 00 00 00 00 00 00 00 | 00 00 00 00 00 00 00 02 |........|........|
|00002940| 17 30 00 dc 17 61 03 6d | 00 01 81 81 00 14 00 0a |.0...a.m|........|
|00002950| 00 01 00 00 00 03 00 01 | 00 01 00 14 4d 6f 6e 74 |........|....Mont|
|00002960| 68 6c 79 20 41 44 26 44 | 20 50 72 65 6d 69 75 6d |hly AD&D| Premium|
|00002970| 00 00 00 16 00 01 00 00 | 00 00 00 0c 00 09 00 14 |........|........|
|00002980| 01 00 00 0a 00 00 00 00 | 00 00 00 01 00 00 00 bc |........|........|
|00002990| 16 00 00 dc 16 6c 03 6c | 00 01 00 01 00 00 00 15 |.....l.l|........|
|000029a0| 00 00 00 0c 00 00 00 03 | 00 02 00 84 00 01 00 05 |........|........|
|000029b0| 00 00 00 00 00 04 00 01 | 00 00 00 00 00 00 00 00 |........|........|
|000029c0| 00 00 00 00 00 00 00 00 | 00 00 00 03 00 00 ff ff |........|........|
|000029d0| ff ff ff ff ff ff 01 24 | 01 24 00 3c 00 30 00 00 |.......$|.$.<.0..|
|000029e0| 01 19 00 00 00 00 00 00 | 00 00 00 00 00 00 00 00 |........|........|
|000029f0| 00 00 00 00 00 00 00 02 | 16 3c 00 dc 16 6d 03 6d |........|.<...m.m|
|00002a00| 00 01 81 81 00 14 00 0a | 00 01 00 00 00 03 00 01 |........|........|
|00002a10| 00 01 00 1e 4d 6f 6e 74 | 68 6c 79 20 4c 69 66 65 |....Mont|hly Life|
|00002a20| 20 49 6e 73 75 72 61 6e | 63 65 20 50 72 65 6d 69 | Insuran|ce Premi|
|00002a30| 75 6d 00 00 00 16 00 01 | 00 00 00 00 00 0c 00 09 |um......|........|
|00002a40| 00 14 01 00 00 0a 00 00 | 00 00 00 00 00 01 00 00 |........|........|
|00002a50| 00 b4 15 78 00 dc 15 e4 | 03 6c 00 01 00 01 00 00 |...x....|.l......|
|00002a60| 00 15 00 00 00 0c 00 00 | 00 03 00 02 00 84 00 01 |........|........|
|00002a70| 00 05 00 00 00 00 00 04 | 00 01 00 00 00 00 00 00 |........|........|
|00002a80| 00 00 00 00 00 00 00 00 | 00 00 00 00 00 03 00 00 |........|........|
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|00002aa0| 00 00 01 1a 00 00 00 00 | 00 00 00 00 00 00 00 00 |........|........|
|00002ab0| 00 00 00 00 00 00 00 00 | 00 02 15 b4 00 dc 15 e5 |........|........|
|00002ac0| 03 6d 00 01 81 81 00 14 | 00 0a 00 01 00 00 00 03 |.m......|........|
|00002ad0| 00 01 00 01 00 16 4d 6f | 6e 74 68 6c 79 20 44 65 |......Mo|nthly De|
|00002ae0| 6e 74 61 6c 20 50 72 65 | 6d 69 75 6d 00 00 00 16 |ntal Pre|mium....|
|00002af0| 00 01 00 00 00 00 00 0c | 00 09 00 14 01 00 00 0a |........|........|
|00002b00| 00 00 00 00 00 00 00 01 | 00 00 00 b6 15 00 00 dc |........|........|
|00002b10| 15 6c 03 6c 00 01 00 01 | 00 00 00 15 00 00 00 0c |.l.l....|........|
|00002b20| 00 00 00 03 00 02 00 84 | 00 01 00 05 00 00 00 00 |........|........|
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|00002b60| 00 00 00 00 00 00 00 00 | 00 00 00 00 00 00 00 00 |........|........|
|00002b70| 00 00 00 02 15 3c 00 dc | 15 6d 03 6d 00 01 81 81 |.....<..|.m.m....|
|00002b80| 00 14 00 0a 00 01 00 00 | 00 03 00 01 00 01 00 17 |........|........|
|00002b90| 4d 6f 6e 74 68 6c 79 20 | 4d 65 64 69 63 61 6c 20 |Monthly |Medical |
|00002ba0| 50 72 65 6d 69 75 6d 24 | 00 00 00 16 00 01 00 00 |Premium$|........|
|00002bb0| 00 00 00 0c 00 09 00 14 | 01 00 00 0a 00 00 00 00 |........|........|
|00002bc0| 00 00 00 01 00 00 00 b4 | 15 34 05 48 15 a0 07 d8 |........|.4.H....|
|00002bd0| 00 01 00 01 00 00 00 15 | 00 00 00 0c 00 00 00 03 |........|........|
|00002be0| 00 02 00 84 00 01 00 05 | 00 01 00 00 00 03 00 01 |........|........|
|00002bf0| ff ff ff ff ff ff ff ff | 00 00 00 00 00 00 00 00 |........|........|
|00002c00| 00 00 00 03 00 00 ff ff | ff ff ff ff ff ff 01 24 |........|.......$|
|00002c10| 01 24 00 3c 00 30 00 00 | 01 1d 00 00 00 00 00 00 |.$.<.0..|........|
|00002c20| 00 00 00 00 00 00 00 00 | 00 00 00 00 00 00 00 02 |........|........|
|00002c30| 15 71 05 49 15 a0 07 d8 | 01 01 01 01 00 14 00 0a |.q.I....|........|
|00002c40| 00 81 00 00 00 03 00 01 | 00 01 00 16 54 6f 74 61 |........|....Tota|
|00002c50| 6c 20 20 4d 6f 6e 74 68 | 6c 79 20 50 72 65 6d 69 |l  Month|ly Premi|
|00002c60| 75 6d 00 00 00 16 00 01 | 00 00 00 00 00 0c 00 09 |um......|........|
|00002c70| 00 14 01 00 00 0a 00 00 | 00 00 00 00 00 07 00 00 |........|........|
|00002c80| 00 6c 10 a8 00 70 10 d7 | 03 44 00 01 00 01 ff ff |.l...p..|.D......|
|00002c90| ff ff ff ff ff ff 00 01 | 00 00 00 00 00 00 00 02 |........|........|
|00002ca0| 10 a8 00 70 10 d7 03 44 | 00 00 00 00 00 14 00 0c |...p...D|........|
|00002cb0| 00 01 00 00 00 01 00 01 | 00 01 00 18 44 45 50 45 |........|....DEPE|
|00002cc0| 4e 44 45 4e 54 20 4c 49 | 46 45 20 49 4e 53 55 52 |NDENT LI|FE INSUR|
|00002cd0| 41 4e 43 45 00 00 00 16 | 00 01 00 00 00 00 00 0c |ANCE....|........|
|00002ce0| 00 09 00 14 01 00 00 0c | 00 00 00 00 00 00 00 07 |........|........|
|00002cf0| 00 00 00 84 10 f4 01 18 | 11 23 04 a8 00 01 00 01 |........|.#......|
|00002d00| ff ff ff ff ff ff ff ff | 00 01 00 00 00 00 00 00 |........|........|
|00002d10| 00 02 10 f4 01 18 11 23 | 04 a8 00 00 00 00 00 14 |.......#|........|
|00002d20| 00 0c 00 00 00 00 00 01 | 00 01 00 01 00 30 50 6c |........|.....0Pl|
|00002d30| 65 61 73 65 20 63 68 65 | 63 6b 20 74 68 65 20 62 |ease che|ck the b|
|00002d40| 6f 78 20 69 66 20 74 68 | 69 73 20 63 6f 76 65 72 |ox if th|is cover|
|00002d50| 61 67 65 20 69 73 20 64 | 65 73 69 72 65 64 00 00 |age is d|esired..|
|00002d60| 00 16 00 01 00 00 00 00 | 00 0c 00 09 00 14 00 00 |........|........|
|00002d70| 00 0c 00 00 00 00 00 00 | 00 01 00 00 00 b0 10 d2 |........|........|
|00002d80| 05 34 11 28 07 74 00 01 | 00 01 00 00 00 15 00 00 |.4.(.t..|........|
|00002d90| 00 0c 00 00 00 03 00 03 | 00 01 00 01 00 04 00 00 |........|........|
|00002da0| 00 00 00 00 00 01 00 00 | 00 00 00 00 00 00 00 00 |........|........|
|00002db0| 00 00 00 00 00 00 00 01 | 00 03 00 00 ff ff ff ff |........|........|
|00002dc0| ff ff ff ff 00 d0 01 f4 | 00 34 00 34 00 00 01 1e |........|.4.4....|
|00002dd0| 00 18 00 01 00 00 00 00 | 00 00 00 00 00 00 00 00 |........|........|
|00002de0| 00 00 00 00 00 02 10 d2 | 05 80 11 29 07 75 01 00 |........|...).u..|
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|00002e00| 00 11 50 65 72 20 46 61 | 6d 69 6c 79 20 20 24 31 |..Per Fa|mily  $1|
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|00003c80| 00 00 00 00 00 0e 00 0a | 00 15 00 00 00 0c 00 00 |........|........|
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|00003e70| 00 01 00 28 00 28 00 28 | 00 28 00 00 00 00 00 00 |...(.(.(|.(......|
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|00003ec0| 00 23 50 45 52 53 4f 4e | 41 4c 20 4c 45 41 56 45 |.#PERSON|AL LEAVE|
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|00003ee0| 53 48 45 45 54 00 00 00 | 00 16 00 01 00 00 00 00 |SHEET...|........|
|00003ef0| 00 0f 00 0c 00 14 01 00 | 00 0e 00 00 00 00 00 00 |........|........|
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|00003f20| 00 00 00 02 00 b8 00 10 | 01 24 09 80 00 00 00 00 |........|.$......|
|00003f30| 00 15 00 0c 00 00 00 00 | 00 03 00 03 00 01 00 4e |........|.......N|
|00003f40| 50 4c 45 41 53 45 20 55 | 53 45 20 54 48 45 20 54 |PLEASE U|SE THE T|
|00003f50| 41 42 20 4b 45 59 20 54 | 4f 20 4d 4f 56 45 20 46 |AB KEY T|O MOVE F|
|00003f60| 52 4f 4d 20 20 46 49 45 | 4c 44 20 54 4f 20 46 49 |ROM  FIE|LD TO FI|
|00003f70| 45 4c 44 20 57 48 45 4e | 20 46 49 4c 4c 49 4e 47 |ELD WHEN| FILLING|
|00003f80| 20 4f 55 54 20 54 48 49 | 53 20 46 4f 52 4d 00 00 | OUT THI|S FORM..|
|00003f90| 00 16 00 01 00 00 00 00 | 00 0e 00 0a 00 15 00 00 |........|........|
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|00003fc0| ff ff 00 01 00 00 00 00 | 00 00 00 02 01 90 00 9c |........|........|
|00003fd0| 0b 38 07 dc 00 00 00 00 | 00 14 00 0c 00 00 00 00 |.8......|........|
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|00004000| 4c 65 61 76 65 20 6f 66 | 20 41 62 73 65 6e 63 65 |Leave of| Absence|
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|00004070| 78 63 65 65 64 69 6e 67 | 20 33 30 20 64 61 79 73 |xceeding| 30 days|
|00004080| 2e 20 20 41 70 70 6c 65 | 20 77 69 6c 6c 20 67 65 |.  Apple| will ge|
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|000040b0| 09 09 09 09 09 09 09 09 | 09 09 09 09 09 09 09 09 |........|........|
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|00004120| 09 09 09 09 09 09 09 09 | 09 09 09 09 09 09 09 09 |........|........|
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|00004190| 09 09 09 09 09 09 09 09 | 09 09 09 09 09 09 09 09 |........|........|
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|000041f0| 09 09 09 09 09 09 09 09 | 09 09 09 09 09 09 09 09 |........|........|
|00004200| 09 50 65 72 73 6f 6e 61 | 6c 20 6c 65 61 76 65 73 |.Persona|l leaves|
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|00004260| 09 09 09 09 09 09 09 09 | 09 09 09 09 28 36 29 20 |........|....(6) |
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|000042c0| 09 09 09 09 09 09 09 09 | 09 09 09 09 09 09 09 09 |........|........|
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|000042f0| 09 09 09 09 09 09 09 09 | 09 09 09 09 09 09 09 09 |........|........|
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|00004360| 09 09 09 09 09 09 09 09 | 09 09 09 09 09 09 09 09 |........|........|
|00004370| 09 09 09 73 74 61 74 65 | 64 20 69 6e 74 65 6e 74 |...state|d intent|
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|000043c0| 20 09 09 09 09 09 09 09 | 09 09 09 09 09 09 09 09 | .......|........|
|000043d0| 09 09 09 09 09 09 09 09 | 09 09 09 09 09 09 09 09 |........|........|
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|000043f0| 6c 6f 79 6d 65 6e 74 20 | 76 6f 6c 75 6e 74 61 72 |loyment |voluntar|
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|00004460| 09 09 09 09 09 09 09 09 | 09 09 09 09 09 09 09 09 |........|........|
|00004470| 09 09 09 09 09 09 63 6f | 6e 74 69 6e 75 65 20 6d |......co|ntinue m|
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|00004490| 66 69 74 73 20 69 6e 20 | 74 68 65 20 70 6c 61 6e |fits in |the plan|
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|000044d0| 09 09 09 09 09 09 09 09 | 09 09 09 09 09 09 09 09 |........|........|
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|00004500| 62 65 6e 65 66 69 74 73 | 20 61 73 20 6e 6f 74 65 |benefits| as note|
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|00004530| 20 09 09 09 09 09 09 09 | 09 09 09 09 09 09 09 09 | .......|........|
|00004540| 09 09 09 09 09 09 09 09 | 09 09 09 09 09 09 09 09 |........|........|
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|00004570| 69 63 61 6c 20 63 6f 76 | 65 72 61 67 65 20 69 6e |ical cov|erage in|
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|00004590| 75 72 20 6c 65 61 76 65 | 2e 20 20 54 6f 20 09 09 |ur leave|.  To ..|
|000045a0| 09 09 09 09 09 09 09 09 | 09 09 09 09 09 09 09 09 |........|........|
|000045b0| 09 09 09 09 09 09 09 09 | 09 09 09 09 09 09 63 6f |........|......co|
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|00004610| 09 09 09 09 09 09 09 09 | 09 09 09 09 09 09 09 09 |........|........|
|00004620| 09 09 09 09 09 09 09 09 | 09 09 73 68 61 72 65 2e |........|..share.|
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|00004670| 09 09 09 09 09 09 09 09 | 09 09 09 09 09 09 09 09 |........|........|
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|000046a0| 66 69 72 73 74 20 6f 66 | 20 65 61 63 68 20 6d 6f |first of| each mo|
|000046b0| 6e 74 68 2e 20 20 49 66 | 20 79 6f 75 20 67 6f 20 |nth.  If| you go |
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|000046d0| 65 6e 20 74 68 65 20 09 | 09 09 09 09 09 09 09 09 |en the .|........|
|000046e0| 09 09 09 09 09 09 09 09 | 09 09 09 09 09 09 09 09 |........|........|
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|00004750| 09 09 09 09 09 09 09 09 | 09 09 09 09 09 09 09 09 |........|........|
|00004760| 73 74 61 72 74 73 20 62 | 65 74 77 65 65 6e 20 74 |starts b|etween t|
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|000047b0| 09 09 09 09 09 09 09 09 | 09 09 09 09 09 09 09 09 |........|........|
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|000047f0| 20 54 68 65 72 65 20 69 | 73 20 61 20 33 30 2d 64 | There i|s a 30-d|
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|00004810| 65 61 63 68 20 6d 6f 6e | 74 68 2e 0d 0d 57 48 45 |each mon|th...WHE|
|00004820| 4e 20 59 4f 55 52 20 42 | 45 4e 45 46 49 54 53 20 |N YOUR B|ENEFITS |
|00004830| 54 45 52 4d 49 4e 41 54 | 45 3a 20 20 59 6f 75 72 |TERMINAT|E:  Your|
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|00004870| 09 09 09 09 09 09 09 09 | 09 09 09 09 09 09 09 09 |........|........|
|00004880| 09 09 09 09 09 09 09 09 | 09 09 09 09 66 6f 6c 6c |........|....foll|
|00004890| 6f 77 69 6e 67 20 72 65 | 61 73 6f 6e 73 3a 20 20 |owing re|asons:  |
|000048a0| 20 a5 20 20 20 42 79 20 | 79 6f 75 72 20 72 65 71 | .   By |your req|
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|000048d0| 73 20 63 61 6e 6e 6f 74 | 20 62 65 20 09 09 09 09 |s cannot| be ....|
|000048e0| 09 09 09 09 09 09 09 09 | 09 09 09 09 09 09 09 09 |........|........|
|000048f0| 09 09 09 09 09 09 09 09 | 09 09 09 09 09 09 09 09 |........|........|
|00004900| 09 09 09 09 09 09 09 09 | 09 09 09 09 09 09 09 09 |........|........|
|00004910| 09 09 09 09 09 09 09 09 | 09 09 09 09 09 09 09 09 |........|........|
|00004920| 09 72 65 69 6e 73 74 61 | 74 65 64 20 75 6e 74 69 |.reinsta|ted unti|
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|00004940| 77 6f 72 6b 29 2e 0d 09 | 09 09 09 09 09 09 09 09 |work)...|........|
|00004950| 09 09 09 09 09 09 09 09 | 09 09 09 09 09 09 09 09 |........|........|
|00004960| 09 09 09 09 09 09 09 09 | 09 09 09 09 09 09 09 09 |........|........|
|00004970| 09 09 09 09 09 09 09 09 | 09 09 09 09 09 09 09 09 |........|........|
|00004980| 09 09 a5 20 20 09 54 65 | 72 6d 69 6e 61 74 69 6f |...  .Te|rminatio|
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|000049a0| 77 69 74 68 20 41 70 70 | 6c 65 2c 20 6f 72 20 6e |with App|le, or n|
|000049b0| 6f 6e 2d 20 09 09 09 09 | 09 09 09 09 09 09 09 09 |on- ....|........|
|000049c0| 09 09 09 09 09 09 09 09 | 09 09 09 09 09 09 09 09 |........|........|
|000049d0| 09 09 09 09 09 09 09 09 | 09 09 09 09 09 09 09 09 |........|........|
|000049e0| 09 09 09 09 09 09 09 09 | 09 09 09 09 09 09 09 09 |........|........|
|000049f0| 09 09 09 09 09 09 09 09 | 09 09 09 09 09 09 09 09 |........|........|
|00004a00| 09 70 61 79 6d 65 6e 74 | 20 20 6f 66 20 70 72 65 |.payment|  of pre|
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|00004a20| 09 09 09 09 09 09 09 09 | 09 09 09 09 09 09 09 09 |........|........|
|00004a30| 09 09 09 09 09 09 09 09 | 09 09 09 09 09 09 09 09 |........|........|
|00004a40| 09 09 09 09 09 09 09 09 | 09 09 09 09 09 09 09 09 |........|........|
|00004a50| 09 a5 20 20 20 09 49 6e | 20 6f 72 64 65 72 20 74 |..   .In| order t|
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|00004a70| 68 65 61 6c 74 68 20 63 | 61 72 65 20 63 6f 76 65 |health c|are cove|
|00004a80| 72 61 67 65 20 61 66 74 | 65 72 20 09 09 09 09 09 |rage aft|er .....|
|00004a90| 09 09 09 09 09 09 09 09 | 09 09 09 09 09 09 09 09 |........|........|
|00004aa0| 09 09 09 09 09 09 09 09 | 09 09 09 09 09 09 09 09 |........|........|
|00004ab0| 09 09 09 09 09 09 09 09 | 09 09 09 09 09 09 09 09 |........|........|
|00004ac0| 09 09 09 09 09 09 09 09 | 09 09 09 09 09 09 09 09 |........|........|
|00004ad0| 09 09 74 65 72 6d 69 6e | 61 74 69 6f 6e 2c 20 79 |..termin|ation, y|
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|00004af0| 42 52 41 20 63 6f 6e 74 | 69 6e 75 61 74 69 6f 6e |BRA cont|inuation|
|00004b00| 20 09 09 09 09 09 09 09 | 09 09 09 09 09 09 09 09 | .......|........|
|00004b10| 09 09 09 09 09 09 09 09 | 09 09 09 09 09 09 09 09 |........|........|
|00004b20| 09 09 09 09 09 09 09 09 | 09 09 09 09 09 09 09 09 |........|........|
|00004b30| 09 09 09 09 09 09 09 09 | 09 09 09 09 09 09 09 09 |........|........|
|00004b40| 09 09 09 09 09 09 09 09 | 09 09 09 63 6f 76 65 72 |........|...cover|
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|00004b60| 79 73 20 6f 66 20 74 68 | 65 20 64 61 74 65 20 6f |ys of th|e date o|
|00004b70| 66 20 79 6f 75 72 20 09 | 09 09 09 09 09 09 09 09 |f your .|........|
|00004b80| 09 09 09 09 09 09 09 09 | 09 09 09 09 09 09 09 09 |........|........|
|00004b90| 09 09 09 09 09 09 09 09 | 09 09 09 09 09 09 09 09 |........|........|
|00004ba0| 09 09 09 09 09 09 09 09 | 09 09 09 09 09 09 09 09 |........|........|
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