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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

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: Document Ty

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

DIRECT INC INDIAN HARBOR FL 3217773000 Carrier. WN YY YY YY Date of Depanure:05/15 $102.07 05/14/12 SW AIR DALLAS TX SOUTHWEST NRUNES (MASTE From: To: FT LAUDERDALE/HOLL JACKSONVILLE INTER WA N/A WA Ticket Number: Passenger Name: EARLY/TODD Document Type: PASSENGER TICKET Claw

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

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: WN Y