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Y $15.15 DesalptIon GROCERIES/SUND 07/14/12 ORBITZ MANKATO MN $409.20 UNITED AIRLINES From: To: Carrier. Class: ST THOMAS CYRIL E N.Y. NEWARK INTL A UA N/A YY 00 N/A YY 00 N/A YY 00 Ticket Number: 01670903543131 Date of Departure:07/21 Passenger Name:DERBY/FRANCIS Document Type: PASS

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

5.15 212-737-2850 Description GROCERIES/SONO ORBITZ MANKATO MN $409.20 UNITED AIRLINES From: To: Carrier. Class: ST THOMAS CYRIL E N.Y. NEWARK INTL A UA U N/A YY 00 N/A YY 00 N/A YY 00 Ticket Number: 01 7 1 1 Date of Departure:07/21 Passenger Name: Document Type: PASSENGER TICKET O

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

ing Date 05/25/12 p 13/16 Account Ending 8-42008 Detail Continued Amount 05/22/12 UNITED AIRLINES NEWARK NJ UNITED AIRLINES Front To: N.Y. NEWARK INTL A PARG CHARLES DEG N/A N/A N/A Ticket Number:01629283379356 Passenger Name: /FIRST CLASS PL Document Type: SPECIAL SERVICE TICKET Carrier. Cl

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

67.80 05/03/12 ST THOMAS JET CENTERST THOMAS VI 340-777-9177 $1,77336 05/04/12 UNITED AIRLINES HOUSTON TX UNIT ED AIRLINES From: To: N.Y. NEWARK INTL A PALM BEACH INTERNA N/A N/A N/A Ticket Number: Passenger Name: VISOSKIAARRYPMR Document Type: SPECIAL SERVICE TICKET Carrier: Claw UA 00 Y

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

te of Departure. 05/24 05/21/12 AMERICAN EXPRESS TVLPHOENIX AZ $3,835.30 UNITED AIRLINES From: To: Carrier. Class: TEL AVIV BEN GURIO N.Y. NEWARK INTL A WA WA WA Ticket Number: 01670624950875 Passenger Name: EPSTEIWJEFFREY E Document Type: PASSENGER TICKET UA YY 00 VY 00 YY 00 Date of De

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