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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 win pay the applicable benefit amount as determined from the Table of Los

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: PASSENGER TICKET 07/14/12 ORBITZ MANKATO MN $270.60 AMERICAN AIRUNES INC From: To: Carrier: Class: NEW YORK LA GUARD! DAL

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

LUE AIRWAYS CORPORATI From: To: ST THOMAS CYRIL E SAN JUAN LUIS MUNO N.Y.1 F KENNEDY I N/A N/A Ticket Number: 27970907179106 Passenger Name: DERBY/FRANCIS Document Type: PASSENGER TICKET Carrier. Class: B6 B6 YY 00 YY 00 Date of Departure: 07/19 $2,040.66 55.66 $30.00 5585.70 Continued on

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

F KENNEDY I ST THOMAS CYRIL E AA V N/A YY 00 N/A YY 00 N/A YY 00 Ticket Number 00170188252566 Date of Departure: 05/01 Passenger Name: DERBY/FRANCIS Document Type: PASSENGER TICKET 04/22/12 ORBITZ MANKATO MN AMERICAN AIRLINES INC From: To•. Carrier. Class: N.Y. IF KENNEDY I ST THOMAS O