◆ SpookStack

tir 1 1 me ae WON tote at vere Ta r Eugh. : woo ' ne erie te ng ery Polic . A 058901 | Name of Insured : , PERSONAL ACCIDENT WITH ‘ DOUBLE PROTECTION ON i we SCHEDULED AIRLINES - Codf - b6 Amount of Insurance: $0 COO Capital Sum (Scheduled Aid | ity /. Pancipal Sum (Other, Ace b7C Amount of Jrfsfrance PD) —ae PREMIUM COMBINED PREMIUM § in? a. 44.0 an ry Term of Coverage; _ £0 oe y ° Month Day = Year - Personal Signature ? of Insured ip. “< D PERSONAL ACCIDENT WITH -l Ad eee Oe ce DOUBLE PROTECTION ON ats Re SCHEDULED AIRLINES . bIC Amount of insurance: ; : Capital Sum (Scheduled Air) Principal Sum (Other PREMIUM $ “on “eT ‘nt we Effective at: ° COMBINED PREMIUM $ Hour. Beas | Term of Coverage: _ © ! . oo a , Month Day = Year _ wat onsianee ‘Cooper -5432 Personal Signature go * of Insured “eof,