◆ SpookStack

z Policy " Name of In mm. A 059966 PERSONAL ACCIDENT WITH Address : DOUBLE PROTECTION ON of Insured SCHEDULED AIRLINES Amount of Insurance: Capital Sum (Scheduled Afr) Principal Sum {Other Acs.) PREMIUM $ Name of Beneficiz *IBAGGAGE. AND PERSONAL EFFECTS Address of Benefici $— (Psd Amount of. Insurance PREMIUM | Effective at: os Hour tow ise Datel - | Personal Signature of Insured Number __A 059967. PERSONAL ACCIDENT WITH DOUBLE PROTECTION ON SCHEDULED AIRLINES Amount of Insurance: Capital Sum (Scheduled ain Principal Sum (Other Acc. PREMIUM $ BAGGAGE AND PERSONAL EFFECTS $i Amount of Insurance PREMIUM $Q1dhtncn .. ‘ ~ . v4 ' “ ’ . ' on A \ sn oat oy - , ' ve: . los 1 re ' * Meo, oa, - . . *. ' - ‘ ite . j \ ’ Ce ey TR i RE ERR TT tn +e ae ' : , . a s ; , Address of Beneficia — Effective at: : J . @.Mr it. te Hour aa p.m. vil Mont - Year ee ep ree COMBINED PREMIUM’ $— Term of Coverage: