Copies of over-the-counter airline travel insurance policies sold at PDX, 11/24/71
Title revised to match the document’s own text.
Original title: Copies of over-the-counter airline travel insurance policies sold at Portland International Airport 11/24/71
Document date 24 November 1971
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Id: Cooper-Part-18:114-117
Subject: Cooper Files: Cooper-Part-18:114-117 Document: Copies of over-the-counter airline travel insurance policies sold at PDX, 11/24/71 Id: Cooper-Part-18:114-117 Page: https://cooper.theunsolved.net/documents/Cooper-Part-18%3A114-117 What is wrong (title, date, type, which pages belong together, copies)? What does the scan show?
A person reads every report. Corrections are made by hand, to the data — titles, dates, names, which pages belong together — never to the scans, and they can take a while to appear.
FBI 164-81, Vault Part 18 pp. 114–117 (DB Cooper-5447–5450), Form, dated 24 Nov 1971 — cooper.theunsolved.net/documents/Cooper-Part-18%3A114-117
Policy Number A 059979 PERSONAL ACCIDENT WITH DOUBLE PROTECTION ON SCHEDULED AIRLINES Amount of Insurance: $60,000 Capital Sum (Scheduled Air) $30,000 Principal Sum (Other Acc.) PREMIUM $6.75
BAGGAGE AND PERSONAL EFFECTS $ none Amount of Insurance PREMIUM $none
COMBINED PREMIUM $________ Term of Coverage: 4 Days Countersigned by :
Licensed Resident Agent
--- Please Print --- N[REDACTED] [REDACTED]cupation Address of Insured [REDACTED] City Portland State Ore. ZIP Code Name of Beneficia[ry] [REDACTED] Address of Beneficiary City State Same ZIP Code
Effective at: Hour 9:00 [checked] p.m. Date 11-24-71 Month Day Year Place PDX
Personal Signature of Insured [REDACTED]
AGENT CO[PY]
---
Policy Number A 059981 PERSONAL ACCIDENT WITH DOUBLE PROTECTION ON SCHEDULED AIRLINES Amount of Insurance: $60,000 Capital Sum (Scheduled Air) $30,000 Principal Sum (Other Acc.) PREMIUM $6.75
BAGGAGE AND PERSONAL EFFECTS $ none Amount of Insurance PREMIUM $none
COMBINED PREMIUM $________ Term of Coverage: 4 Days Countersigned by :
--- Please Print --- [REDACTED] Address of Insured [REDACTED] City Monmouth State OR. ZIP Code Name of Beneficia[ry] [REDACTED] Address of Beneficiary City State Same ZIP Code
Effective at: Hour 10:30 [checked] p.m. Date 11-24-71 Month Day Year Place PDX
Personal Signature of Insured [REDACTED]
AGENT COPY
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b6 b7C
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DB Cooper-5447
Policy Number A 059982
PERSONAL ACCIDENT WITH DOUBLE PROTECTION ON SCHEDULED AIRLINES Amount of Insurance: $20,000 Capital Sum (Scheduled Air) $40,000 Principal Sum (Other Acc.) PREMIUM $ 1.00
BAGGAGE AND PERSONAL EFFECTS $ none Amount of Insurance PREMIUM $ none
COMBINED PREMIUM $______ Term of Coverage: 5 Days Countersigned by ___________
----- Please Print ----- [redacted] ...upation Address of Insured
City [guess: Monmouth] [guess: ate] Ore. ZIP Code Name of Beneficiary Address of Beneficiary Same City ________ State ________ ZIP Code
Effective at: Hour 1:00 [X] p.m. Date 11-24-71 Month Day Year Place PDX
Personal Signature of Insured [blank]
AGENT COPY
---
Policy Number A 33268
PERSONAL ACCIDENT AND SICKNESS $ 10,000 Amount of Insurance Insured Only Premium $ 3.20 Dependent Premium $ 1.60 TOTAL PREMIUM $ 4.80
BAGGAGE AND PERSONAL EFFECTS $ none Amount of Insurance PREMIUM $ none
COMBINED PREMIUM $______ Term of Coverage: 5 Days [guess: Countersigned by] ___________ [guess: Licensed Resident Agent] ___________
----- Please Print ----- [redacted] Address of Insured
City Vancouver State Wash ZIP Code Name of Beneficiary Address of Beneficiary City Vancouver State Wash ZIP Code
Effective at: Hour 11:10 [X] a.m. Date 11-24-71 Month Day Year Place PDX
Personal Signature of Insured [blank]
AGENT COPY
---
DB Cooper-5448
---
b6 b7C
Policy Number A 058912
PERSONAL ACCIDENT WITH DOUBLE PROTECTION ON SCHEDULED AIRLINES Amount of Insurance: $ 40,000 Capital Sum (Scheduled Air) $ 25,000 Principal Sum (Other Acc.) PREMIUM $ 9.50
BAGGAGE AND PERSONAL EFFECTS $ [guess: 500] Amount of Insurance PREMIUM $ [illegible]
COMBINED PREMIUM $______ Term of Coverage: 10 Days
Counte[r] _______________
Licens[e] _______________
--- Right side ---
Please Print Name of Insured [redacted] Address of Insured [redacted] City Tillamoo[k] State Ore ZIP Code ___ Name of Beneficiary _______________ Address of Beneficiary _______________ City Bothell State Wash ZIP Code ___ Effective at: Hour 11:30 [X] a.m. Date 11 - 24 - 71 Month Day Year Place PDX Personal Signature of Insured X [signature present]
AGENT COPY
---
Policy Number A 058916
PERSONAL ACCIDENT WITH DOUBLE PROTECTION ON SCHEDULED AIRLINES Amount of Insurance: $ 20,000 Capital Sum (Scheduled Air) $ 10,000 Principal Sum (Other Acc.) PREMIUM $ [guess: 5.00]
BAGGAGE AND PERSONAL EFFECTS $ [guess: 1,000] Amount of Insurance PREMIUM $ [illegible]
COMBINED PREMIUM $______ Term of Coverage: 14 Days
Cou[nter] _______________
Lic[ense] _______________
--- Right side ---
Please Print Name of Insured [redacted] Address of Insured [redacted] City Kalama State Wash ZIP Code ___ Name of Beneficiary _______________ Address of Beneficiary _______________ City Kalama State Wash ZIP Code ___ Effective at: Hour 1:00 [X] p.m. Date 11 - 24 - 71 Month Day Year Place PDX Personal Signature of Insured [signature present]
AGENT COPY
---
b6 b7C
DB Cooper-5449
Policy Number A 059984
PERSONAL ACCIDENT WITH DOUBLE PROTECTION ON SCHEDULED AIRLINES Amount of Insurance: $60,000 Capital Sum (Scheduled Air) $30,000 Principal Sum (Other Acc.) PREMIUM $ 6.75
BAGGAGE AND PERSONAL EFFECTS $ None Amount of Insurance PREMIUM $ None
- COMBINED PREMIUM $________ Term of Coverage: 4 Days Countersigned by ________
--- Please Print --- Name of [REDACTED b6/b7C] Occupation [REDACTED b6/b7C] Address of Insured [REDACTED b6/b7C] City Portland State Ore ZIP Code [REDACTED] Name of Beneficiary [REDACTED b6/b7C] Address of Beneficiary [REDACTED b6/b7C] City Fullerton State Calif. Code [REDACTED] Effective at: Hour 1:00 [X] p.m. Date 11-24-71 Place PDX Personal Signature of Insured [REDACTED]
AGENT COPY
---
Policy Number A 059986
PERSONAL ACCIDENT WITH DOUBLE PROTECTION ON SCHEDULED AIRLINES Amount of Insurance: $60,000 Capital Sum (Scheduled Air) $30,000 Principal Sum (Other Acc.) PREMIUM $ 9.75
BAGGAGE AND PERSONAL EFFECTS $ None Amount of Insurance PREMIUM $ None
- COMBINED PREMIUM $________ Term of Coverage: 6 Days Countersigned by ________
--- Please Print --- Name of [REDACTED b6/b7C] Occupation [REDACTED b6/b7C] Address of Insured [REDACTED b6/b7C] City Portland State Or. ZIP Code [guess: 927] Name of Beneficiary [REDACTED b6/b7C] Address of Beneficiary [guess: Same] City [REDACTED] State [REDACTED] ZIP Code [REDACTED] Effective at: Hour 2:15 [X] p.m. Date 11-24-71 Place PDX Personal Signature of Insured [REDACTED]
AGENT COPY
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DB Cooper-5450
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b6 b7C
Serials: A 059979, A 059981, A 059982, A 059984, A 059986, A 33268