OVE CASH LOANS.

At any time after three full annual premiums shall have been paid hereon, within thirty-one days of application therefor, the Company will loan, upon proper assignment of this Policy to the Company upon its prescribed form and on the sole security hereof, with interest at the rate of six per cent per annum, payable in advance, a sum not exceeding the Loan Value of this Policy at the end of the then current policy year, as provided in the Table of Values herein contained, plus the reserve on any dividend addition, less any indebtedness to the Company hereon or secured hereby, and any unpaid portion of premium for the balance of said policy year. If interest is not paid when due, it shall be added to the principal and bear interest at the same rate. Failure to repay such loan or interest thereon, shall not avoid this Policy, unless and until the total indebtedness hereon or secured hereby shall equal the Loan Value, nor until thirty-one days after notice shall have been mailed to the last known address of the Insured, and any Assignee of record at the Home Office; but failure to repay such loan after the total indebtedness, as aforesaid, shall equal said Loan Value and after giving such notice, shall render this Policy void.

BENEFICIARY-CHANGE OF

Provided the Insured has reserved the right to change the beneficiary in the application herefor, the Insured may at any time while this Policy is in force, by written notice to the Company at its Home Office, change the beneficiary, such change to take effect only upon endorsement of the same on the Policy by the Company, whereupon, all rights of the former beneficiary shall cease; provided that no such change of beneficiary shall be valid if the Policy or any interest therein be assigned at the time of such change. If any beneficiary shall die before the Insured, the interest of such beneficiary shall vest in the Insured.

11 POLICY MAY BE REINSTATED.

In event of default of premium payments, unless the cash surrender value has been paid, it is agreed that this Policy may be reinstated upon presentation at the Home Office of evidence of insurability satisfactory to the Company and payment of arrears of premium and the payment or reinstatement of any indebtedness to the Company hereon or secured hereby, with interest at a rate of not exceeding six per cent per annum.

ANNUAL DIVIDENDS.

After the first policy year, upon payment of the premium for the second policy year, and annually thereafter upon payment of the premium for each policy year, this Policy will be credited with a dividend as apportioned by the Company Dividends will be credited annually to this Policy after it shall have become fully paid-up by the payment of all premiums required by the terms hereof to be paid.

OPTIONS. Dividends may be: (a) Taken in cash; or, (b) Applied toward the payment of any premium; or,

(c)

Applied to the purchase of participating paid-up additions to the Policy; or

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(d) Left to accumulate to the credit of the Policy at a rate of interest not less than three and one-half per cent per annum, and payable at the maturity of the Policy, but withdrawable on any anniversary of the Policy.

Unless the Insured shall elect otherwise within three months after mailing by the Company of a written notice requiring the election of one of the four above options, the dividends will be applied as provided in option (a). Paid-up additions may be surrendered at any time for cash, and the cash value thereof shall not be less than the original dividend. O 1990 eig

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NON-FORFEITURE PROVISIONS.

After premiums shall have been paid hereon for three full years, in case of default in the payment of any premium or instalment thereof on the date when due, the owner shall, within sixty days from such due date, have the choice of one of the following:

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OPTIONS.

(1) PAID-UP INSURANCE.-Upon written application therefor and legal surrender of this Policy to the Company at its Home Office, the Company will issue a non-participating paid-up policy, payable at the same time and on the same conditions as this Policy, for such an amount as the cash surrender value of this Policy at date of default will purchase, as hereinafter provided; or, (2) EXTENDED INSURANCE. To have the insurance hereunder automatically extended in force from such due date as terminsurance, without participation and without the right to loans, for its. face amount, for the number of years and days which the cash surrender value at date of default will purchase, as hereinafter provided; or,

(3) CASH SURRENDER VALUE. To receive the cash surrender value at date of default, within thirty-one days of application therefor, upon legal surrender of this Policy to the Company at its Home Office. Said cash surrender value at date of default will be the full reserve on this Policy and any existing dividend additions, which is computed upon the American Experience Table of Mortality, with interest at the rate of three and one-half per cent per annum, less a sum having a maximum at the end of the third policy year, not in excess of seven-tenths of one per cent of the face amount of this Policy, and thereafter decreasing, and less any indebtedness hereon or secured hereby. After the ninth policy year, said cash surrender value will be the full reserve, less any indebtedness as aforesaid. X

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DISABILITY AND LIFE CONSERVATION CLAUSE.
Supplementary to and forming a part of Policy No. 99999.

ISSUED BY THE

CENTRAL STATES LIFE INSURANCE COMPANY OF ST. Louis, Mo. on the life of Will B. Thrifty.

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The Company will agree, by endorsement hereon, to pay for the Insured the premiums thereafter becoming due, if the Insured, before attaining the age of sixty years, after paying at least one full annual premium and before default in the payment of any subsequent premium, shall furnish satisfactory proof to the Company at its Home Office that he has become wholly and permanently disabled by bodily injury or disease, so that he is and will be permanently, continuously and wholly prevented thereby from performing any work for compensation or profit, or from following any gainful occupation.

IN THE EVENT OF TOTAL AND PERMANENT DISABILITY as aforesaid, the Insured shall, in submitting proofs, select in writing either to continue the policy in full force according to its terms under the foregoing provisions without reduction or modification of the "NonForfeiture Provisions," by reason of his premium being paid by the Company; or, in lieu of all other benefits, to receive immediately in cash one-twentieth of the face of this policy, or of the commuted value of any instalments in which it may be payable, and to receive on each anniversary of such proof a like amount during the remainder of his disabled life. If the payment of twentieths is selected by the Insured as last aforesaid, then in the event of recovery as hereinafter provided, the Insured shall resume the pay

ment of premiums without obligation to restore those paid by the Company; but the sum of the twentieths received by him shall be deducted from any settlement or benefit thereunder. In the event of the Insured's death without recovery and before twenty annual payments have been made, then the Company shall continue making annual payments of like amount to the beneficiary, or the person lawfully entitled to receive the same, until twenty payments in all shall have been made.

PROVIDED: That notwithstanding proof of disability may have been accepted by the Company as satisfactory, the Insured shall at any time, on demand, furnish the Company satisfactory proof of the continuance of such disability; and if the Insured shall fail to furnish proof, or if it shall appear to the Company that the Insured is able to perform any work or to follow any occupation whatsoever for compensation, gain or profit, the Company's obligation to pay such premiums and twentieths shall cease and all premiums thereafter falling due must be paid by the Insured in conformity with the policy and this contract.

THE IRRECOVERABLE LOSS of the entire sight of both eyes, or the severance of both hands above the wrists, or of both feet above the ankles, or of one entire hand and one entire foot, will be considered as total and permanent disability within the meaning of this provision.

THE LOSS OF ANY ONE MEMBER as aforesaid or the undergoing of a major surgical operation, not resulting in such loss, shall permit the Insured without prejudice to his rights under the policy itself, to surrender this Disability and Life Conservation Clause and in lieu thereof upon furnishing proofs satisfactory to the Company of such dismemberment or operation, to receive in cash the sum set forth in the following schedule:

Nature of Permanent
Partial Disablement

Amount payable in respect to each $1,000 of Insurance

Loss of right arm above the elbow.
Loss of right arm below the elbow.
Loss of left arm above the elbow,
Loss of left arm below the elbow.
Loss of either limb above the knee.
Loss of either limb below the knee.

Loss of the sight of either eye.

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$250.00

150.00

150.00

100.00

250.00

125.00

100.00

MAJOR SURGICAL OPERATION subject to the following conditions not to exceed $100.

The

THIS SURGICAL BENEFIT shall not apply to operations performed before the payment of the second annual premium and shall not vary with the amount of the policy nor shall a larger sum be paid on any one life regardless of the number of policies in force. amount claimed by the Insured hereunder shall not exceed the actual cost of surgeon's and hospital fees which, if less than one hundred dollars, will leave the balance of that sum available to apply to future operations. The Insured will not be required to surrender this Disability and Life Conservation Clause to secure surgical benefits aggregating less than one hundred dollars. This surgical benefit cannot be claimed in addition to any other benefi provided herein, and any amount paid therefor will be deducted from any settlement under said policy only if death occurs withir ninety days from the date of the operation. Satisfactory proof of said operations must be submitted within sixty days from the date thereof. Any operation not performed in a hospital in the United States or Canada, and not requiring complete anesthesia, shal not be regarded as within the meaning of this benefit.

THIS SUPPLEMENTAL CONTRACT shall terminate upon the termination, forfeiture, cancellation or exchange of the policy first herein above described, and the Company shall not be obligated to issue any similar contract in connection with any substituted policy which may thereafter be issued in exchange thereof.

In Witness Whereof, the CENTRAL STATES LIFE INSURANCE COMPANY has caused this contract to be signed by its President and Secretary at St. Louis, Missouri, this 1st day of January, 1917.

W. H. MCBRIDE,
Secretary

TABLE OF VALUES.

F. P. CRUNDEN,
President.

The values in the following table are for full paid policy years, subject to any indebtedness and will be adjusted proportionately for additional instalments of premiums beyond the full paid policy years. Said values will be increased by the value of any dividend additions standing to the credit of this Policy.

NOTE. A statement of the values for succeeding years will be furnished upon application to the Company.

*Loan values are the same as cash values, and subject to the provisions of the "Cash Loans" clause, are available at any time after three full years' premiums have been paid,

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The amount of paid-up insurance or the term for which the insurance will be extended will be such as the Cash Surrender value at time of default will purchase applied as a net single premium at the attained age of the Insured, according to the American Experience Table of Mortality with interest at the rate of three and one-half per cent, per annum.

(1) Any assignment of this Policy must be made in duplicate and both copies sent to the Home Office, one to be retained by the Company for a record and the other to be returned. The Company assumes no responsibility for the validity or sufficiency of any assignment and the claim of any assignee shall be subject to proof of interest and extent thereof. (2) This Policy and the application herefor taken together constitute the entire contract. All statements made by the Insured shall, in the absence of fraud, be deemed representations and not warranties, and no such statement shall avoid this Policy unless it is contained in a written application and a copy of such application is endorsed upon or attached to the Policy when issued, (3) This Policy is payable at the Home Office of the Company in St. Louis, Missouri, and proof

of interest of any claim will be required; any indebtedness to the Company hereon, or secured hereby, will be deducted in any settlement of this Policy or of any benefit hereunder. Any unpaid balance of the current year's premium will be deducted in any settlement of this Policy as a death claim. (4) Only the President, a Vice-President or Secretary has power, on behalf of the Company, to make or modify this or any contract of insurance, or to extend the time for paying any premiums, or to waive any forfeiture, and the Company shall not be bound by any promise or representation heretofore or hereafter made, unless made in writing by one of the said Officers. (5) In case of suicide of the Insured, whether sane or insane, within one year from the date of this Policy, the liability of the Company shall be limited to the amount of the premium paid hereon. (6) This Policy shall not take effect until the first premium hereon shall have been actually paid and the Policy actually delivered to the Insured during the lifetime and good health of the Insured. (7) In any apportionment or distribution of profit or surplus, the principles and methods which may be adopted by the Company for said apportionment or distribution, and its determination of the amount equitably belonging to this Policy, shall be conclusive upon the Insured and upon all parties having or claiming any interest under this Policy. (8) If the age of the Insured was misstated, the amount payable hereunder shall be such the premium paid would have purchased at the correct age.

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This insurance is granted in consideration of the application herefor, a copy of which is hereto attached and made a part of this contract and of the payment in advance of Three Hundred Fifty-one and 70/100 Dollars, being the premium for term insurance for the first policy year ending on the First day of January, 1918.

This contract will be continued as a Limited Payment Life Policy upon the payment of the annual renewal premium of Three Hundred Fifty-one and 70/100 Dollars, on or before the First day of January, 1918, and of the payment thereafter of a like sum on or before the First day of January, in every year during the continuance of this Policy, until premiums for Twenty Years from the date hereof shall have been paid, or until the prior death of the Insured.

After delivery of this Policy to the Insured, it takes effect as of the following date.

In Witness Whereof, the CENTRAL STATES LIFE INSURANCE COMPANY has caused this policy to be signed this First day of January, 1917. W. H. MCBRIDE,

Secretary.

F. P. CRUNDEN,
President.

INSTALMENT BENEFITS. In the event of this Policy becoming a claim upon the Company by death, the Beneficiary, or prior thereto the Insured, may elect the payment of the proceeds of this policy in either monthly or annual instalments for which figures and terms will be provided upon request. Instalments elected either by the Beneficiary or the Insured, will be the mathematical equivalent of the amount payable in a single sum. The Insured may in his election, if he desires, deprive the Beneficiary of the right to commute the instalments so provided,