OCCUPATION AND TRAVEL. This Contract is entirely free from all restrictions as to Residence, Occupation and Travel except Military or Naval Service in time of war. PREMIUM.-This Contract is issued in consideration of the written and printed application, a copy of which is attached hereto and made a part of this Contract, and of the payment of Three Hundred Seventy-Three and 00/100 Dollars in advance, before this Contract shall take effect, as the premium for an insurance terminating one year from the date hereof, and will be renewed and extended thereafter as a Limited Payment Life Contract upon the further payment of a like amount due one year from the date hereof and on the same anniversary day in every year thereafter and payable on said date annually or within the grace period as above provided until a total of twenty annual premiums shall have been paid on this Contract. INCONTESTABLE.-This Contract shall be incontestable after one year from its date, except for nonpayment of premium and for violation of the provision relating to Military and Naval Service, provided, however, that if the age of the Insured is misstated the amount payable under this Contract shall be the insurance which the actual premium paid would have purchased at the true age of the Insured. SUICIDE. Should the Insured, die by his own act (whether sane or insane) within one year after the date of this Contract, the Company's liability shall not exceed the premium paid on account of this Contract. CHANGE OF BENEFICIARY.—If this Contract has not been assigned, the Insured may change the Beneficiary at any time by filing at the Home Office written request for such change on the Company's form, and by forwarding this Contract for endorsement of change. If the Beneficiary does not survive the Insured, the proceeds hereof shall be paid to the Executors, Administrators or Assigns of the Insured. AUTOMATIC NONFORFEITURE PROVISION.-Upon the nonpayment of any premium after the second, the Company will advance such premium, also subsequent unpaid premiums, with interest at 6 per cent per annum due annually in advance, as a premium loan secured by this Contract, so long as such loan together with all other indebtedness and with interest at 6 per cent per annum does not exceed the Cash Value of this Contract, plus any dividends on deposit, or the Cash Value of any additional paid-up insurance, at the end of the period to which any such premium or interest applies. Extra premiums for Military or Naval Service shall be advanced only upon compliance with the requirements of the Military or Naval Service clause of this Contract. All indebtedness thus created shall be a first charge against the Contract ranking in priority to the claim of any Beneficiary or Assignee. At any time while this Contract is continued as aforesaid, payment of premiums may be resumed without any medical re-examination of the Insured. If the available Cash Value be insufficient to pay a full annual premium, the Company will continue the insurance under the Extended Term Insurance Provision set forth herein for such time as the balance of value will permit. If extra premiums for Military or Naval Service have been advanced hereunder, a pro rata extra premium shall be included in calculating the period for which the insurance is to be extended. Should the total liens charged against this Contract at any time exceed the Cash Value thereof, as herein provided, or should the balance of such value be applied to purchase Extended Term Insurance, the insurance under this Contract shall in no event terminate until one month after notice shall have been mailed to the last known address of the Insured and Assignee, if any. PAID-UP INSURANCE.-After premiums for two full years have been paid, on the nonpayment of any succeeding premium, this Contract shall, after endorsement by the Company upon request of the Insured within ninety days (including days of grace) after said nonpayment, take effect for the amount of Paid-up Participating Insurance stated in the table of Surrender Values herein as determined by the number of years the Contract has been force by payment of premiums. CASH VALUE OR EXTENDED TERM INSURANCE.-After premiums for two full years have been paid, on the nonpayment of any subsequent premium, the Insured, on satisfactory release and surrender of this Contract within ninety days thereafter (including days of grace), shall be entitled to the Cash Surrender Value as stated in the table of Surrender Values, or in lieu thereof the Insured shall be entitled to Participating Extended Term Insurance as stated in said table, which value shall be increased by the value of any additional paid-up insurance then to the credit of the Contract. The aforesaid values shall be determined by the number of full annual premiums paid on this Contract, and the acceptance of either one of these values shall be in lieu of all other values herein provided. Such values are based upon the reserve by the American Experience Table of Mortality with 3% per cent interest. of the Cash Value may be deferred ninety days. Payment LOAN VALUE.-The Company will make loans to the Insured upon the sole security of this Contract at any time after premiums for two full years have been paid, and while this Contract is in full force. The amount of such loans shall not exceed the Cash Surrender Value at the end of the year for which premiums in full (excluding premiums paid in advance) have been paid, and shall include any previous loans or liens then unpaid. Interest shall be paid annually in advance at the rate of 6% per annum, but should the Insured fail to pay interest on said loan or any premium due on this Contract, the Company shall advance said interest and premium on the security of this Contract as an additional lien, bearing interest as above, in accordance with the terms of the Automatic Non-Forfeiture Provision of this Contract. Upon endorsement on the Contract by the Company as to the existence of any loan, the Contract will be returned to the Insured. Payment of Loans, unless for premiums due the Company, may be deferred ninety days. INDEBTEDNESS-Any indebtedness to the Company on account of this Contract, including any unpaid premium or portion thereof, will be deducted in any cash settlement of this Contract, or will be deducted from the reserve used in the calculation of any benefit provided herein. PREMIUMS-WHERE AND HOW PAYABLE.-All premiums are payable annually in advance at the Home Office, Richmond, Virginia, but may be paid to an authorized Agent of the Company in exchange for a receipt signed by the President, Secretary or Treasurer. REINSTATEMENT.-This Contract, should it have lapsed, may be reinstated at any time upon evidence of insurability satisfactory to the Company, and the payment of all past due premiums, with interest at 6% per annum, and the payment or reinstatement of any indebtedness or cash payment made on account of this Contract with interest at the same rate. ASSIGNMENT.-Any assignment of this Contract must be made in duplicate, and one copy filed at the Home Office. The Company assumes no responsibility for the validity of any assignment. THE CONTRACT.This Contract shall constitute the entire agreement between the parties. All statements made by the Insured shall in the absence of fraud, be deemed representations and not warranties, and no such statement shall avoid the Contract unless it is contained in the written and printed application (Part I and II), photographic copy of which is attached to the aforesaid Contract. This Contract cannot be modified except by endorsement signed by an Executive Officer of the Company, and no Agent is authorized to extend the time for payment of any premium, waive provisions, modify or discharge Contracts. This Contract is not to take effect until the first premium shall have been paid during the life and good health of the Insured, but after said event shall be considered as having been in force from the date hereof. MILITARY OR NAVAL SERVICE. SO If within five years from the date of this Contract the Insured shall engage in Military or Naval Service in time of war, the liability of the Company in event of the death of the Insured while so engaged, or within six months thereafter, shall be limited to the return of the premiums paid hereon, exclusive of any extra premium paid for Military or Naval Service, less any indebtedness to the Company hereon; unless before engaging in such service or within one month (of not less than thirty days), or at the time of paying the first premium due hereon, if the Insured shall be then engaged, the Insured shall, in addition to the premium stated on the first page hereof, pay to the Company at its Home Office in Richmond, Virginia, such extra premiums as may be required by the Company, and in like manner shall pay annually thereafter on each anniversary of this Contract or within one month (of not less than thirty days), while the Insured shall continue to be so engaged, such extra premiums as may be required by the Company. If said notice shall have been given and the first extra premium shall have been paid, the premiums that may thereafter be advanced in accordance with the Automatic Nonforfeiture Provision shall include any extra premiums that may be due on account of Military or Naval Service. Within one year after the termination of the war the Company will return such portion of the extra premiums as in its judgment will not be required to cover the extra hazard. TABLE OF SURRENDER VALUES.-The amounts stated in columns (1) and (2) are for a Contract of One Thousand Dollars. As this Contract is for Ten Thousand Dollars, these amounts should be multiplied by ten in order to obtain the proper Cash, Loan or Paidup Insurance Value. If there be any indebtedness against this Contract, the amount of same will be deducted from any Cash or Loan Value paid. If Paid-up or Extended Insurance be selected in accordance with the foregoing options, any indebtedness will reduce such Paid-up or extended insurance by the proportion which such indebtedness bears to the reserve value of the benefit selected. In Witness Whereof, The ATLANTIC LIFE INSURANCE COMPANY has caused this Contract to be signed by its President or one of its Vice-Presidents, and its Secretary or Assistant Secretary, Treasurer or Assistant Treasurer, at Richmond, Va., and dated the First day of April, 1978. ROY M. JONES, E. STRUDWICK. Secretary. President. INSTALMENT AND TRUST FUND OPTIONS The Insured may change the mode of payment of the proceeds of this Contract, if not then assigned, from payment in one sum, as provided on the first page, to payment by instalments as stated below. The Insured may at any time revoke or change the manner in which the proceeds of this Contract shall be paid at his death and after the death of the Insured any amount payable to the Beneficiary named herein may, at the option of said Beneficiary, be paid in accordance with the provisions of these options. The following tables are based upon a Contract of $1,000, and will apply pro rata to the amount payable under this Contract, provided the amount is not less than $1,000; if the amount is less than $1,000, these Instalment Options shall not apply, but the proceeds of this Contract will be payable in one sum only. Equal Annual Instalments to continue during entire lifetime of Beneficiary, but Twenty Annual Instalments at least to be paid. Attained age of 15 16 17 7 18 19 26 39 40 30 31 32 33 34 35 36 37 38 39 ༄།༅༎ $44 $44 $44 $45 $45 $45 $45 $46 $46 $46 $46 $47 $47 $47 $48 $48 $48 $49 $49 $50 $50 $51 $51 $52 $52 $53 Beneficiary at ma- 41 42 43 turity of Contract Amount of each $53 $54 $55 $55 $56 $57 $57 $58 $59 $59 $60 $61 $61 $62 $53 $63 $64 $64 $65 $65 $66 $66 $66 $67 $67 1 EXAMPLE:-If the attained age of the Beneficiary at the death of the Insured is 45, the Continuous Instalment will be $56. The payment of the first Instalment shall be made immediately on the maturity of the Contract, and subsequent Instalments shall be paid annually thereafter. The Beneficiary can neither assign or commute unpaid Instalments, unless such right is given to the Beneficiary by the Insured in writing, and is endorsed on this Contract by the Company at its Home Office, during the lifetime of the Insured. The Insured may also provide that the proceeds of this Contract shall be held by the Company as a trust fund for such period as the Insured may direct, the Beneficiary to receive semi-annually interest at a rate of not less than three and one-half per cent, per annum, but said trust shall only be created upon terms and conditions acceptable to the Company and take effect when made in writIng subscribed by the Insured and the Company at its Home Office and endorsed on this Contract. When a trust is revoked and a new one is not created and no other provision is made for the payment of the proceeds of this insurance the payment shall be made in cash as provided in the Contract. Should any one of the foregoing options be selected by the Insured or Beneficiary, there shall be paid (but only so long as said instalments are being paid or said trust continues) on each anniversary of the first instalment an interest dividend of such amount as shall be determined by the Company. ATLANTIC LIFE INSURANCE COMPANY TOTAL DISABILITY BENEFIT-WAIVER OF PREMIUMS AND Supplemental agreement made a part of, issued and taking effect concurrently with Contract No. 99,999, dated April 1st, 1918, on the life of John Doe. IN CONSIDERATION of the payment of the premium mentioned on the first page of said Contract, and subject to all the terms and conditions thereof: DISABILITY DEFINED.-ATLANTIC LIFE INSURANCE COMPANY hereby agrees that if, prior to attaining the rated age of sixty years, while this Contract is in full force by the payment of premiums, the Insured shall furnish proof satisfactory to the Company that, from causes originating after delivery of this Contract, and entirely beyond the control of the Insured, he has become totally and permanently disabled, and will by such disablement be prevented for life from engaging in any gainful occupation, the Company shall by endorsement hereon agree to 1. PREMIUM WAIVED.-Waive the payment of premium thereafter falling due during the continuance of such disability, during which period of waiver the right of the Insured to dividends (payable only in cash), surrender values, and all other benefits under said Contract shall continue with the same force and effect as if premiums were duly paid by the Insured; and in addition thereto, 2. INCOME DURING DISABILITY.-Pay to the Insured, with the written consent of the assignee, if any, one-tenth of the face amount of said Contract and one-tenth of the said face amount annually thereafter during the life of the Insured and the continuation of such disability. SPECIFIC CAUSES OF DISABILITY.—In addition to other causes of disability, the Company will consider the entire and irrevocable loss by accident or disease of the sight of both eyes, or the total and permanent loss by accident or disease of the use of both hands or both feet, or of one hand and one foot, as total and permanent disability within the meaning of this provision. MILITARY OR NAVAL SERVICE.-Should the Insured in time of war engage in military or naval service or should he, while a civilian, in time of war engage in any occupation involving an association with military or naval maneuvers or the manufacture of explosives, the benefits herein provided shall cease without action on the part of the Company or notice to or from the Insured, and thereafter no payment of premium for the benefit hereunder by the Insured or acceptance thereof by the Company shall continue or restore the benefit herein provided. In the event the benefits herein provided shall be so determined, the Insured shall be entitled to a reduction of the premium mentioned on the first page of this Contract by the amount charged for this benefit, and to the return of the unearned portion of any premiums paid therefor, and such reduction shall be made and such refund paid to the Insured immediately upon notice from said Insured. PROOF OF DISABILITY.-After the granting of the disability benefits herein provided, the Insured shall keep the Company informed at all times of his residence and address and shall give immediate notice to the Company should such total disability not prove to be permanent, and shall on demand of the Company at any time and from time to time furnish additional proof of the continuance of such disability and permit the Company to examine him. Should disability not prove total and permanent, or should the Insured fail or refuse to permit the examination herein referred |