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DUPLICATE COPY Preparof For CI:meg Doe G MAXWELL 03/09/05 Page 7 of 10 Notice of Changes to You
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en more than 150 mile radius from Your Permanent Residence for up to 45* days whether driving, flying on a Scheduled Airline or taking the Amtrak. Travel Medical Protection is underwritten bqkfixAEX Assurance Company, Administrative office, De Pere, Wisconsin. Coverage is subject to the terms, conditions, and exclusions
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YC. 212-823-9500. www.porterhousenewyork.com. AJ Maxwell's Steakhouse - Classics in a sophisticated Rockef
en more than 150 mile radius from Your Permanent Residence for up to 45* days whether driving, flying on a Scheduled Airline or taking the Amtrak. Travel Medical Protection is underwritten AMEX Assurance Company, Administrative %yr office, De Pere, Wisconsin. Coverage is su • ct to the terms, conditions, and exclusions
YC. 212-823-9500. www.porterhousenewyork.com. AJ Maxwell's Steakhouse - Classics in a sophisticated Rockef
ile radius from Your Permanent Residence for up to 45* days whether driving, on a cruise ship, flying on a Scheduled Airline or taking the Amtrak. Travel Medical Protection is underwritten by AMEX Assurance Company, Administrative Office, De Pere, Wisconsin. Coverage is subject to the terms, conditions, and exclusions o
8045066P 6.99 Total of Due in Full Activity for G MAXWELL 8,295.06 Total Due in Full Activity 4,751.46
ile radius from Your Permanent Residence for up to 45* days whether driving, on a cruise ship, flying on a Scheduled Airline or taking the Amtrak. Travel Medical Protection is undenviitten by AMEX Assurance Company, Administrative Office, De Pere, Wisconsin. Coverage is subject to the terms, conditions, and exclusions o
5.99 100.00 157.50 Total of New Activity for G MAXWELL New Charges Payments/Credits 37,506.53 -2,009
more than 150 mile radius from Your Petmanent . Residence for up to 45* days whether driving, flying on e Scheduled Airline or taking the Amtrak. Travel Medical Protection is underwritten by AMEX Assurance Company, Administrative office, De Pere, Wisconsin. Coverage is subject to the terms, conditions, and exclusions o
DUPLICATE COPY rupe,,d Te, G MAXWELL Page 4(110 Due in Full continued " Fate Como/
ile radius from Your Permanent Residence for up to 45* days whether driving, on a cruise ship, flying on a Scheduled Airline or taking the Amtrak. Travel Medical Protection is underwritten by AMEX Assurance Company, Administrative Office, De Pere, Wisconsin. Coverage is subject to the terms, conditions, and exclusions o
YC. 212-823-9500. www.porterhousenewyork.com. AJ Maxwell's Steakhouse - Classics in a sophisticated Rockef
en more than 150 mile radius from Your Permanent Residence for up to 45* days whether driving, flying on a Scheduled Airline or taking the Amtrak. Travel Medical Protection is underwritten AMEX Assurance Company, Administrative by AMEX office, De Pere, Wisconsin. Coverage is subject to the terms, conditions, and exclus
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