◆ SpookStack

~ BUT DUPLICATE APPLICATION Cilcs..20 itt SLOT St ee tented neonate ma - ; . Premium Beers eM duty ue cece ee cece Sistee 2... os Li} zid : POUCY MACHT LE . WRITE. _— Resideat : ne eee t- ‘ i _Ageat . flat f Point of — Trip to be ‘ Rae, Ste nares la seaees be eeedeeees Departure -- 4S OAC Neh ant on: : vate Be Gr 93) m on set One-way Moe lee ae oat OF teks ~ “trip Tis . Destination? Geet Toro Mahe Ticket . 1 coll lo le Gee f+ Boas . i 2 Tim Round. ; ” % zat ee . ise — _— ; - ’ Fy Benelickary bé Insured’s ; ae unicts cheekad here? sis owner. oo 7c Name - - . Signature . foal, ne Beneficiary¥ i of Insured —. ee ee er ee eer ere. | : Nanp -- ' : . Stree Petts App ees Gl" - (é-fas5 NL” @! Ciht.-- 2. G AYO... State. RE... T33AV-M2 aes : Insured isi owner _ : te ee ne ee ee ES unless cyhecked here: [7] Beneficiary is owner. Insured’s TSignature oo... cece e eee eee Leases d¥ ere PO mmm ek oe 842M App ™ ~ Series 30TeS . : ‘ net eye, ly lee ZIN-AVESL > APPLICATION RETAINED BY MACHINE <4 ; . . - - aay wos j The Principal Sum of this policy is that amount which - TUgr Terese eepesetecaecseedrestecc eos panei ay the premium stamped on the above application will oT ons aiFeLTg purchase in accordance with the Rate Schedule on the . “Q2UIAO SF isu paveces sua po reverse side. The policy requires advance ticketing for hepyaueg O sung se QanSUj atte & designated round trip (except shuttle or in-flight SanAanDY Ait We Ad os eae aae Ps ae 30 ticketing) before leaving Point of Departure as specified - f LS vos ~2PY Sut pup mgt. .. lee in Far ” axare diz 33 ’ : apres fa - tk The Maximum Principal Sum for which this policy may eyed Ou yates uo 2 ee be issued is $75,000. In the event that the premium stamped cn the application is greater than the applicable premium specifed in the Rate Schedule for said maxi- mum Principal Sum, the excess premium will be re- turned upon demand. . This insurance is binding only if the application has ' ca) oh iy Me ee Ft, Ae ae | pony &> kesteg 0) ei : any a eA, Hy Arig Goi 7 ie Tp cee SNIHDVW ADIIOd KO C3LYNOISIA b6 been completed and personally simed by the Insured - 2015 NI G3LIsodsa b7¢ and bas been stamped by the Tels-Trip validator . 3? OL $1 GNVD SIHL | - - machine. = . NVL ' ~ SCHEDULED AIRLINE TRIP INSURANCE POLICY 7 ENVIRO AW - a . - . . - ~ - , S| DB Cooper-54/1 |