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poo: — oo 4 b6 _ - Trt b7C joe En? "_ PERSONAL ‘ACCIDENT: WITH * 7:57 = * oe - DOUBLE PROTECTION ON 5s oF 7 - +. SCHEDULED AIRLINES <7“: fet : - Ns “Amount of Insurance: onal ~} Ll btee 986 Se enancedh SH MS fhe Cie ye “he COMBINED PREMIUM $— Term of Coverage:. Month Pog Year : Policy Number PERSONAL ACCIDENT AND SICKNESS g19,O°89 _ amount of Insurance Insured Only Premium §& Dependent Premium $ 6 © TOTAL PREMIUM § 44. '6© b6 _b7c | Name of Beneficiary of Beneficia ZIP eo Veancouser sasuaashs Para Address of Beneficia BAGGAGE AND PERSONAL EFFECTS > ay gf Amount of Insurance ZIP PREMIUM $ AQAA | City Vancouver state LOOSIKN ef Effective at: “ow Sale COMBINED PREMIUM § Hour Leto om p.m. Date__#f ~ RUFF yc . Term of Coverage: . Month Day = Year ¥ * i - Personal Signature of Insured DB Cooper-5448 *