CREDIT CARD CHARGE FORM

20524051834601
CREDIT CARD INFORMATION

CREDIT CARD COMPANY MasterCard CREDIT CARD NUMBER ************0104

CARD EXPIRY DATE **/** CARD HOLDER HERSHY BURDEOS

AUTHORIZED NUMBER 219000

CREDIT CARD STATEMENT

RESERVATION CODE 4DXY7X

TICKET NUMBER 205 24051834601

PASSENGER NAME BURDEOS/HERSHY MS

DATE OF ISSUE 20FEB17 PLACE OF ISSUE PHILIPPINES - ANA SKY WEB PH R

PAYMENT INFORMATION

CARD CHARGE USD97.59

This form cannot be reissued.

ALL NIPPON AIRWAYS CO.,LTD.

CARD HOLDER COPY