◆ SpookStack

pik?" F "PERSONAL ACCIDENT WITH.” 35°F = 3 : aaa _ DOUBLE PROTECTION ON 445, 2:3", “4 “a SP, _. SCHEDULED AIRLINES 2%" - ama c. . bal mat Ess ~~ ay - Amount of Insurances. - A Da 2 fe. ‘re |$Ze Capital Sum (Schedaled Air) | City 9° //4 42°O/ d r 7 Principal Sum (Othér Acs.) of - st $ “ . we of t . . Tee,“ . -. 4. | wy . 4 oh: “ iP: * af Lo a “ a , ; . 3 ~- , _ PREMIUM * $2 _ pay. Pha /, =]. f \ ; ’ itn Ree a. : oe ee ee 2 . -M. my ete < -3] COMBINED PREMIM $225 == 3b gcse) 307A pm ™ Bite _ Term of Coverage: ZO Days oe - _ t-Place " Personal Signature _ - to, of Insured =. ' a : ae AGENTCOPY- = CCC : 1 Fe, big e an rs — = : _ SO OO TT ~~ — Please pant oso ee —— “ bE : Nomber A 058916 ~ ji - +" p7¢ . PERSONAL ACCIDENT WITH te eke he DOUBLE PROTECTION ON SCHEDULED AIRLINES ‘>. Amount of Insurance: | Capital Sum (Scheduled Air} | City Principal Sum (Other Ace.) a PREMIUM $-2aScl- } | | } * pei $8 — Amount of See — | “pide. - # - 2 ! 7 } - C PREMIUM Effective at: - COMBINED a ype Hour OO pat. _ . | Term of Coverage: Days 7 . Month Day = Year Place PX : Personal Signature i - yo of Insured - yore “DB Cooper-5449