FORM NO RECORD NO INVOICE NO DATE OF PURCHASPOLICY NO REFERENCE NO

IDATA(8581) HI-66334 HI-OvQ-Jmn_6N.A. P-359243545468574 JX2R9IBON9VN0Y

IDATA(8581) HI-66335 HI-OvQ-Jmn_6N.A. P-548470194438187 KXLKE640V2N4DT
IDATA(8581)
IDATA(8581)
IDATA(8581)
IDATA(8581)
IDATA(8581)
IDATA(8581)
AGENT NAMEAGENT CODEPLAN NAMEPLAN CODESUM OF INSURE
Standard Insur PH3ISSY9 PLAND D 16235007 2500
Sentry InsurHNY7BH79 PLAN B 5774434 1500
PERIOD OF INSURANCE POLICY HOLDER NAME
N.A. AMANDA LITTLEPAGE
N.A.
POLICY HOLDER ADDRESS POLICY HOLDER CITPOLICY HOLDER STAT
117 Avenue of The Americas New York NY
POLICY HOLDER ZIP POLICY HOLDER PHONE POLICY HOLDER E MAIL
10016-6445 (212)757-0717 N.A.
POLICY HOLDER DOB NOMINEE NAMENOMINEE ADDRESNOMINEE CITY
5/24/2004 Michael D.Griffith 1177 Avenue of The Ame
New York
NOMINEE STATENOMINEE ZIP RELATIONCHEST HEIGHT WEIGHT BLOOD GROUP
NY 10016-6445 N.A. 85 170 142 A-
PAYMENT OPTION PREMIUMDISCOUNT TOTAL PAYMENT CARD TYPE CARD NO EXPIRY DATE
Credit Card 225 35 190 Master Card C-5194589N.A.
CARD HOLDER NAMTRANSACTION ID REMARK
AMANDA LITTLEPAG d78vb7kncni9c1sd DATE OF PURCHASE AND RELATION WITH NOMINEE NOT GIVEN
INEE NOT GIVEN
FORM NO RECORD NO INVOICE NUMBER DATE OF PURCHASE POLICY NUMBER
IDATA(8581) AMI-OvQ-Jmn_66 P-341078399116109 N.A. 38JQD18TZBLY7U5M
REFERENCE NUMBER AGENT NAME AGENT CODE PLAN NAME PLAN CODE SOI POI
GEICO P2RQWZD3 Collision Isurea CI29987575 3500 1 Year Maureen
OWNER NAME OWNER ADDRESS OWNER CITY OWNER STATE OWNER ZIP OWNER PHONE
T Mueller 2705 weat 7th st PALMDALE MS 72871 (305)248-4510
OWNER EMAIL TYPE OF VEHICLE MODEL NO COLOR ENGINE NO CHASSIS NO DOP OF VEHICLE
N.A. 4 Wheeler XJS White 76DI9MQ3D1JSXN5R9NPFH 7/30/2010
PAYMENT OPTION PREMIUM DISCOUNT TOTAL PAYMENT CARD TYPE CARD NO EXPIRY DATE
Credit Card 350 45 305 Diners Club C-3020815N.A.
CARD HOLDER NAME TRANSACTION ID REMARK
Maureen T Mueller z6d4xsvdh0ki5poa DATE OF PURCHASE NOT GIVEN
FORM NO RECORD NO INVOICE NUMBER DATE OF PURCHASE POLICY NUMBER
IDATA(8581) MI-66332 MI-OvQ-Jmn_66332 N.A. P-838822136501175
IDATA(8581) MI-66336 MI-OvQ-Jmn_66333 N.A. P-873806677758388
IDATA(8581) MI-OvQ-Jmn_66334
IDATA(8581) MI-OvQ-Jmn_66335
IDATA(8581) MI-OvQ-Jmn_66336
IDATA(8581) MI-OvQ-Jmn_66337
IDATA(8581) MI-OvQ-Jmn_66338
IDATA(8581) MI-OvQ-Jmn_66339
REFERENCE NUMBER AGENT NAME AGENT CODE PLAN NAME PLAN CODE SOI
VI0ABKQ3WRZDLJXY Mercury Insurance MO85947592 336 2 Year Bettencourt Joe
56SMK0PAJ6FDRUZD New Jersey Manufac2C68X6HP GoCare MO39698375
POI NAME ADDRESS CITY STATE
1223 Harrowgate Rd Chugiak WA
ZIP PHONE NUMBER EMAIL MODEL NUMBER COLOR IME NO MAC NO
22663 805-343-7907 N.A. LG Optimus F7 Black 66-62-03-0N.A.
PAYMENT OPTION PREMIUM DISCOUNT TOTAL PAYMENT
Credit Card 15 1 14
CARD TYPE CARD NO EXPIRY DATE CARD HOLDER NAME TRANSACTION ID
Master Card C-541070742943319N.A. Bettencourt Joe 7v4rpgdc8i4zwafe
REMARK
DATE OF PURCHASE AND MAC NO NOT GIVEN
FORM NO RECORD NO INVOICE NUMBER DATE OF PURCHASE POLICY NUMBER
IDATA(8581) CLI-66334 CLI-OvQ-Jmn_66334 N.A. P-243967494900140
IDATA(8581) CLI-66335 CLI-OvQ-Jmn_66335 N.A. P-522068947187427
IDATA(8581) CLI-66336 CLI-OvQ-Jmn_66336 N.A. P-972983828405281
IDATA(8581) CLI-66337 CLI-OvQ-Jmn_66337 N.A. P-007411257437319
REFERENCE NUMBER AGENT NAME AGENT CODE PLAN NAME PLAN CODE SOI POI
ARVKRYDEUVAR1M21 American InsurancUKRFHA3 Protection Plan LI2542168 400 2 Year
QKY2SCW6FKZP1DXG Bankers Life and CKQ9J2KN Protection Plan LI2542168 450 2 Year
5RTRCIURZ4JQ4FBL ACE Limited HP65ZWMS Protection Plan LI2542168 480 2 Year
7ECV39HOXQHSUD7M Affirmative Insura 97VAD7AQ Protection Plan LI2542168 480 2 Year
 NAME ADDRESS CITY STATE ZIP PHONE NUMBER MAC NUMBER MODEL NUMBER
JOHN M T 26852 RBEINGLEWOOMD 80524 (305)556-3030 PL4VN4DEYSWJ Chromebook 11-312
MICHAEL Rt.1 Box 4 EDISON CA 83098 (323)294-3472 K0LEJ2ZD4FYC Aspire V3-572PG-7
Andrew K NE 101 RABentonvill WA 20436 (225)273-2650 QZPBD538KK1F TMP645-MG-5409
Carol Mitte5684 W. Mu
MILWAUKIFL 43137 (757)671-7194 KAMU2YNQT3S2 Inspiron 14 3000
SERIAL NUMBER PAYMENT OPTION PREMIUM DISCOUNT TOTAL PAYMENT
R2AL0TK Credit Card 20 4 16
D0XNY81 Credit Card 20 1 119
4X3421Y Credit Card 25 5 20
L7EV04R Credit Card 25 5 20
CARD TYPE CARD NO EXPIRY DATE CARD HOLDER NAME
JCB C-3112247984382958 N.A. JOHN M TILGHMAN
MasterCard C-5198563330406826 N.A. MICHAEL O HARA
Diners Club C-30109757428498 N.A. Andrew K Warford
JCB C-3088969814300740 N.A. Carol Mittelstadt
TRANSACTION ID REMARK
280j3nu6t0pkn9c DATE OF PURCHASE NOT GIVEN
bg509tdc89mdinjw DATE OF PURCHASE NOT GIVEN
gd85b6l6a9hdmujx DATE OF PURCHASE NOT GIVEN
ciqmw8fsa16wp1lg DATE OF PURCHASE NOT GIVEN
FORM NO RECORD NO INVOICE NUMBER DATE OF PURCHASE POLICY NUMBER REFERENCE NUMBER AGENT NAME
IDATA(8581) HOI-OvQ-Jmn_663P-576456237151612 N.A. D6ZPCOY9MBSW1XD
AGENT CODE PLAN NAME PLAN CODE SOI POI OWNER NAME OWNER ADDRESS OWNER CITY OWNER STATE
OWNER ZIP OWNER PHONE PROPERTY TX NO OCCUPATION PAYMENT OPTION PREMIUM DISCOUNT TOTAL PAYMENT
CARD TYPE CARD NO EXPIRY DACARD HOLDER TRANSACTION ID REMARK