◆ SpookStack

~ DOUBLE PROTECTION ONS _ SCHEDULED AIRLINES :. be AS 90 Amount of Insurance?. Capital Sum eRe Ain Cty Principal’ Sum (Other, Acc.) - PREMIUM - $: 7 Big AGE AND. PERSONAL’ EFFECTS ‘ _Amount-6f I PREMIUM iL (oe -]| COMBINED PREMIUM $_——_-] — 7, 9¢/ -Hf 4 . {Term of Coverage:- sf __ Days . Month Day Year . 4 Personal Signature of Insured Policy b6 Number b7c a PERSONAL ACCIDENT WITH Address patty nite SCHEDULED AIRLINES i - Amount © nsurance: PREMIUM gn Ope om) ‘ame of Béhefi : | x BAGGAGE AND PERSONAL EFFECTS | Address of Beneficiary SSS Fare So $C) = Amount of Insurance i 4 < PREMIUM $ ac723 | | f- Effective ati - : COMBINED PREMIUM s 550 Hour 8" j fo \< : ie Term of Coverage: i LQ____ Days in . Month Day Year _ I ponewene i ~ . : * SAL. t — ) : es Personal Signatur be tye 4 of Insured ~ gy ; fe “ ~ DB Cooper-5445