◆ SpookStack

aPitier. 2} b7C PERSONAL. ACCIDENT WiTH és = be. -. DOUBLE PROTECTION ON: #82! of Insuird a = - SCHEDULED: AIRLINES (Hire! oe y v« Amount of Insurances "S74. : f- : —Cépital Sami (Scheduled . ain ais” Apa Coming - State hy, Code] TY - ‘Principal Sum £Other_Ace: ) PREMIUM $ } Name of Beneficiary | BAGGAGE AND PERSONAL: ‘EFFECTS. aE Address of Beneficia oe, ent of Insurance: Re AWE PREMIUM * : = - Effective ats “conn PREY $s —|* " Hour rie Term of Coverage: - |e Number - A 059969 _ _ PERSONAL ACCIDENT WITH - DOUBLE PROTECTION ON - - SCHEDULED AIRLINES 7 Amount 0 nsurance! slLQ000 Capital Sum (Scheduled Air) , ra Principal Sum Sek Acs.) PREMIUM $ ; Addre ss Yee AF KEL Pisin Ze we Name of Beneficiary - BES Ry $_MAW 2. Amount of Insurance - - PREMIUM $ rene. | _ COMBINED PREMIUM’$ <a Term of Coverage: 52 ____ Days - ¥ = i . DB fooper5499