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n 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 of Master Policies: (varies per state) AX0950, 0916, AX0124 or Policy Form Number TM
00 0.00 05/31/05 444.10 BVV1A INTL AIRWAYS LTD MIAMI FL. AIRLINES -INTL Routing Details Not Available Ticket Number: 10621023707870 06/07/05 SEPHORA 8336-67TH STNEW YORK NY DUTY FREE STORE 56.36 06/08/05 DELTA AIR LINES ATLANTA GA From: To: Carrier: Class: WEST PALM BEACH FL LAGUARDIA
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 of Master Policies: (varies per state) AX0950, AX0916, AX0124 or Policy Form Number T
rrcARD 447.42 " 01/22/07 PARFUEMERIE DOUGLAS, MUENCHEN FEDERAL REPUBLIC OF GERMANY GOODS/SERVICES 220) "Eircpwin Unto Euo 29.13* 01/26/07 SEPHORA 159 CHAMP ELYSEES, PARIS FRANCE VOUS REMERCIE DE VOTRE VISITE I0600 - Etreptan 144.74 Unto aro 01/27/07 CANTALOUP LTD 0030 NEW YORK NY WOM
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 of Master Policies: (varies per state) AX0950, X0916, AX0124 or Policy Form Number TM
Claim Oss. )0000000CM 07/12/06 Page 3 of 8 Transactions Continued A71104mt 06/23/06 EQUINOX COLUMBUS C 212-881.0425 NY HEALTH SPA 06/29/06 SEPHORA #336 -67TH STNEW YORK NY 150.00 COSMETIC STORE 87.24 06/30/06 BLISS SPA 857 NEW YORK NY SPA EXPERIENCE 06/30/06 5 NINTH NEW YORK NY NY RE
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