Part 18, page 113

Transcript

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

Policy Number A 058911

PERSONAL ACCIDENT WITH DOUBLE PROTECTION ON SCHEDULED AIRLINES Amount of Insurance: $60,000 Capital Sum (Scheduled Air) $20,000 Principal Sum (Other Acc.) PREMIUM $ 8.25

BAGGAGE AND PERSONAL EFFECTS $ [guess: 10M] Amount of Insurance PREMIUM $ [partially illegible]

COMBINED PREMIUM $ ______ Term of Coverage: ______ Days

Co[untersigned by] _______________ Li[censed Resident Agent] _______________

--- Please Print --- Name of [REDACTED b6, b7C] Address of Insured [REDACTED b6, b7C] City Portland State Ore ZIP Code ___ Name of Beneficiary [REDACTED b6, b7C] Address of Beneficiary [REDACTED b6, b7C] City [guess: Same] State ___ ZIP Code ___ Effective at: Hour 8:45 PM Date 11 - 24 - 71 Month Day Year Place PDX Personal S[tatement] of Insured ___ AGE[NT] ___

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Policy Number A 33267

PERSONAL ACCIDENT AND SICKNESS $ 25,000 Amount of Insurance Insured Only Premium $ 8.15 Dependent Premium $ 2.15 TOTAL PREMIUM $ 10.30

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

COMBINED PREMIUM $ ______ Term of Coverage: 7 Days

Countersigned by _______________ Licensed Resident Agent _______________

--- Please Print --- Name of [REDACTED b6, b7C] Occupation [REDACTED b6, b7C] Address of Insured [REDACTED b6, b7C] City Vancouver State Wash ZIP Code ___ Name of Beneficiary [REDACTED b6, b7C] Address of Beneficiary [guess: Same] City ___ State ___ ZIP Code ___ Effective at: Hour 9:00 PM Date 11 - 24 - 71 Month Day Year Place PDX Personal S[tatement] of Insured ___ AGE ___

DB Cooper-5446