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mber: 00671241016084 Date of Departure:08/21 Passenger Name Document Type: PASSENGER TICKET 55.897.64 08/09/12 AMERICAN EXPRESS TVLPHOENIX AZ SOUTHWEST AIRLINES (MASTE From: To: Carrier. Class: OAKLAND INTERNATlO ALBUQUERQUE WN N/A YY 00 N/A N/A Ticket Number: 5262460657560 Passenger Name: Docu

ll pay the applicable benefit amount as determined from the Table of Losses for the benefits listed below if a Covered Person suffers a loss from an Injury while coverage is in force under the Policy. For Dismemberment the Company win pay the applicable benefit amount as determined from the Table of Los

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ll pay the applicable benefit amount as determined from the Table of Losses for the benefits listed below if a Covered Person suffers a loss from an Injury while coverage is in force under the Policy. For Dismemberment the Company will pay the applicable benefit amount as determined from the Table of Lo

R WA N/A WA Ticket Number: Passenger Name: EARLY/TODD Document Type: PASSENGER TICKET Claw 00 00 00 $199.80 05/14/12 SW AIR DALLAS TX SOUTHWEST AIRLINES (MASTE From: To: FT LAUDERDALE/HOLL JACKSONVILLE INTER WA WA WA Ticket Number: Passenger Name: VISOSKKAWRENCE Document Type: PASSENGER TICK

ll pay the applicable benefit amount as determined from the Table of Losses for the benefits listed below if a Covered Person suffers a loss from an Injury white coverage is in force under the Policy. For Dismemberment the Company will pay the applicable benefit amount as determined from the Table of Lo

ent Type: PASSENGER TICKET Cartier: Class: DL DL YY 00 YY 00 Date of Departure: 08/21 $5,897.64 ogrogn 2 AMERICAN EXPRESS TVLPHOENIX AZ SOUTHWEST AIRLINES (MASTE From: To: OAKLAND INTERNATIO ALBUQUERQUE N/A N/A N/A Ticket Number Passenger Name: Document Type: PASSENGER TICKET Carrier: Class:

ll pay the applicable benefit amount as determined from the Table of Losses for the benefits listed below if a Covered Person suffers a loss from an Injury while coverage is in force under the Policy. For Dismemberment the Company will pay the applicable benefit amount as determined from the Table of Lo