Insured Name: George Doe
Coverage Status: Death
Claim #: C123456
Disability Date: 12MAR2012
Claim Status: Closed
Benefit Expiry Date: 12MAR2012
Original Benefit Amount: $50000.00
Travel & Accomodation Expense: $10000.00
Remaining benefit Amount: $40000.00
Lump Sum Amount: $40000.00
Benefit Paid Out: $40000.00
Repatriation Expense: $10000.00