◆ SpookStack

1 058887 <= : _ | Tt : b7? | - PERSONAL ACCIDENT WITH f 6 : DOUBLE PROTECTION ON os SCHEDULED AIRLINES | : ° Amount of insurance: . $_DO 60 Capital Sum (Scheduled Ait) | city Py TL, i s $__19598 © Principat Sum (Other Ace.) < AL PREMIUM $_3:2s7— Name of Beneficiary H BAGGAGE AND PERSONAL EFFECTS | Address of Beneficia 4 $ Amount of, Insurance TE — PREMIUM gt | oes rn Effective at: - - ; pW mein ly - t ’ - r a.m. - we | _ COMBINED PREMIUM $ Hour G9 0 “Date LI 22 7V/ as Term of Coverage: —_¥4 : Month Day Year 7 4 - | pace GX DY ' Policy - - b6 oe i Number A 058888 a en I. b7C . mop PERSONAL ACCIDENT WITH an Gee eee , Amount of Insurance? $AO2 9° Principal Sum (Other Ace.) name P BAGGAGE AND PERSONAL. EFFECTS | Address of Beneficia sams Cs” $_Bd0¢% Amount of Insurance - ~ ZIP PREMIUM $.210 COMBINED PREMIUM 3.4.06 Term of Coverage: —G___ Days Atg: cone i, City See State Code Effective at: oe , - a.m. Hour 0100 f4 p.m. patel +3 Te . , Month Day Year ee ITI INOSTO a5 of Insured - 2 wt - : = ot). AGE DB}Cooper-5437 fclliterllinererenenlitll cher Dactensllilonsasemiant heechesheremestiiaetemmniadieioreneatemmmmmemnnarententes tit eraotan:samseemememmmmntemmmnamenimamammantn ratemnsaniomianion eam ammme ereeeretnias eaeark tata lad eatin eT re a Cn . AN af nN a ere me ln fs od » J whs * a fF [ t pl | | t i } Hy . wf eR iting ee tee