Part 18, page 103

Open in FBI Vault (Part 18, page 103 of the PDF)

FBI 164-81, Vault Part 18 p. 103 (DB Cooper-5436), Form — cooper.theunsolved.net/parts/Cooper-Part-18/pages/103

Transcript

The scan is the source; the transcript is machine-generated from it.

Policy Number A 059964

PERSONAL ACCIDENT WITH DOUBLE PROTECTION ON SCHEDULED AIRLINES Amount of Insurance: $ 60,000 Capital Sum (Scheduled Air) $ 30,000 Principal Sum (Other Acc.) PREMIUM $ 2.00

BAGGAGE AND PERSONAL EFFECTS $ none Amount of Insurance PREMIUM $ none

COMBINED PREMIUM $________ Term of Coverage: ______ Days

Countersigned by _______________ Li___________________________

--- Right Side --- —Please Print— Name of Insured [REDACTED b6/b7C] Address of Insured [REDACTED b6/b7C] City Salem State Ore ZIP Code [REDACTED] Name of Beneficiary [REDACTED b6/b7C] Address of Beneficiary SAME City ________ State ________ ZIP Code ________

Effective at: Hour 3:45 ☐ a.m. ☒ p.m. Date 11/23/71 Month Day Year Place PDX

Personal Signature of Insured [REDACTED b6/b7C]

AGENT COPY

---

Policy Number A 058923

PERSONAL ACCIDENT WITH DOUBLE PROTECTION ON SCHEDULED AIRLINES Amount of Insurance: $ [guess: 106,000] Capital Sum (Scheduled Air) $ [guess: 59,000] Principal Sum (Other Acc.) PREMIUM $ [guess: 11.25]

BAGGAGE AND PERSONAL EFFECTS $ none Amount of Insurance PREMIUM $ None

COMBINED PREMIUM $________ Term of Coverage: ______ Days

Countersigned by _______________

--- Right Side --- —Please Print— Na[me of Insured] [REDACTED b6/b7C] Occupation [REDACTED b6/b7C] Address of Insured [REDACTED b6/b7C] City Longview State Ore ZIP Code [REDACTED] Name of Beneficiary [REDACTED b6/b7C] Address of Beneficiary Same City ________ State ________ ZIP Code ________

Effective at: Hour [guess: 4:36] ☐ a.m. ☒ p.m. Date [guess: 11]/23/71

Pl[ace] _______________

Personal Signature of Insured _______________

AGENT COPY DB Cooper-5436

AI notes

Commentary by the AI model that transcribed this page. It may bring in context the page itself does not state. The scan is the source; the transcript is machine-generated from it.

Flight insurance policy (Agent Copy), Policy Number A 059964. Personal accident coverage of $60,000 capital sum for scheduled air travel and $30,000 principal sum for other accidents, with a $2.00 premium. No baggage/personal effects coverage. Effective at 3:45 p.m. on 11/23/71 at PDX (Portland International Airport). Insured person resides in Salem, Oregon. Beneficiary address listed as SAME. All personal identifying information redacted under FOIA exemptions b6 and b7C. Flight insurance policy (Agent Copy), Policy Number A 058923. Personal accident coverage with capital sum of approximately $106,000 for scheduled air and approximately $59,000 principal sum for other accidents, with an estimated premium of $11.25. No baggage/personal effects coverage. Effective at approximately 4:36 p.m. on 11/23/71. Insured person resides in Longview, Oregon. Beneficiary address listed as Same. Personal identifying information redacted under FOIA exemptions b6 and b7C. FBI case identifier DB Cooper-5436 stamped at bottom right.

Scanned photocopy of two flight insurance policy agent copies
Personal information redacted under FOIA exemptions b6 and b7C
Dollar amounts on the bottom form are difficult to read precisely due to scan quality
Dark spots and artifacts along left and right edges of the scan

Part 18, page 103

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