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ype ADDITIONAL COLLECTION 08/07/12 JETBLUE AIRWAYS 90101ETBLUE NY 5509.80 JETBLUE AIRWAYS From: To: Carder. Class: SAN FRANCIXO INTL N.Y.1 F KENNEDY I 86 H WA YY 00 WA YY 00 WA YY 00 root Hunter. 27921801959594 Date of Depanure:08/07 Passenger Name = Document Type: PASSENGER TICKET
SHING NY 718-5141203 $6.60 07/26/12 PARADIES JFK 9212 ()JAMAICA NY 4043447905 $84.19 AMEX00035
erage section is removed and replaced with the following: For Accidental Death the Company will 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 C
Class: 86 YY 00 YY 00 YY 00 Date of Departure:07/21 07/16/12 AMERICAN EXPRESS TVLPHOENIX AZ JETBLUE AIRWAYS CORPORATI From: To: N.Y.! F KENNEDY I PALM BEACH INTERNA WA WA WA Ticket Number. 27970763674313 Passenger Name: Document Type: SUPPORTED REFUND $439.80 Carrier: Class: 66 YY
erage section is removed and replaced with the following: For Accidental Death the Company will 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 C
1,818.32 07/10/12 PC RICHARD & SON ISNEW YORK NY -$734.87 07116/12 AMERICAN EXPRESS TVLPHOENIX AZ JETBLUE AIRWAYS CORPORAll From: To: N.Y.1 F KENNEDY I PALM BEACH INTERNA N/A N/A N/A Ticket Number: 27970763674302 Passenger Name: Document Type: SUPPORTED REFUND AMERICAN EXPRESS TVLPHOENIX A
verage section is removed and replaced with the following. For Accidental Death the Company will 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 C
of Departure: 09/27 $475.70 09/26/12 AA AIR TICKET SALE 4DALLAS TX AMERICAN AIRLINES From: Tcc ST THOMAS CYRIL E MIAMI INTERNATIONA N.Y. IF KENNEDY I N/A N/A Ticket Number Passenger Name: VlSOSKVLARRY Document Type PASSENGER TICKET Carrier. AA AA YY YY Date of Departure:09/27 Class:
erage section is removed and replaced with the following: For Accidental Death the Company will 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 C
Description 35P47F 1.900.65 EurapeM Euro $2.43473 05/24/12 MINTZ MANKATO MN JETBLUE AIRWAYS CORPORATI From: To: PALM BEACH INTERNA N.Y.1 F KENNEDY I N/A N/A N/A Ticket Number Passage. Name: Document Type PASSENGER TICKET Carrier: Class: B6 8 TY 00 TY 00 TY 00 Date of Departure:
verage section is removed and replaced with the following. For Accidental Death the Company will 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 C
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