existing assignment of this Policy, may while the Policy is in force, designate a new beneficiary with or without reserving right of revocation by filing written notice thereof at the Home Office of the Company accompanied by the Policy for suitable endorsement thereon. Such change shall take effect when endorsed on the Policy by the Company and not before. If any beneficiary shall die before the insured, the interest of such beneficiary shall pass equally to the survivor or survivors, unless otherwise provided in the Policy. If no beneficiary shall survive the insured, then payment shall be made to the executors, administrators or assigns of the insured.

REINSTATEMENT.-At any time within five years after default in payment of any premium, or thereafter by special arrangement, if this Policy has not been surrendered to the Company, it may be reinstated upon presentation at the Home Office of evidence of the insurability of the insured satisfactory to and approved by the Company, and the payment of all premium arrears with interest thereon at the rate of six per cent per annum and payment or reinstatement of any indebtedness which existed at the time of such default with interest at the rate of six per cent per annum.

PAID UP OR MATURED BY DIVIDENDS.-By giving the Company written notice at its Home Office, the Insured may elect to have this Policy endorsed as a FULL PAID PARTICIPATING LIFE POLICY for its face amount, when the reserve value of this Policy together with the reserve value of any paid-up additions, and the accumu lated value of any dividends left at interest to the credit of the Policy, (said additions and dividend credits being thereby cancelled) equal the net single life premium at the attained age of the insured according to the American Experience Table of Mortality with interest at three and one-half per cent per annum, for the face amount of the policy, any indebtedness to the Company on accoun of the Policy to remain as a lien in accordance with the terms o the Policy and with interest payable as provided; or, this policy will be MATURED AS AN ENDOWMENT for its face amoun when the reserve values and accumulated dividends above referred to equal said amount of insurance, any indebtedness to the Com pany on account of the Policy being deducted in such settlement a herein provided.

OPTION TO CHANGE FORM OF POLICY.-At any time while n premium is in default, this Policy, if properly surrendered to th Company, may be exchanged, without re-examination, for any form of Policy issued by the Company at the date hereof and of equa amount requiring a higher rate of premium, upon payment of th differences between the premiums paid hereunder and the premium. for the new Policy (based on the age of the insured at the dat hereof) with six per cent interest per annum on such difference and with adjustment for the difference in annual dividends.

NON-FORFEITURE PROVISIONS.

In event of default in premium payments after premiums shal have been paid for three full years, the insured shall have th following options:

Insurance.-Withou

EXTENDED INSURANCE. -(A)-Extended any action on the part of the insured, the insurance will be auto matically extended from date of default in premium payments without participation in surplus, for a sum equal to the face amoun of the Policy and existing dividend additions, less any indebtednes to the Company hereon. The term of extended insurance will b such as the cash surrender value hereinafter provided for will pur chase at net single premium rates, according to the attained age o the insured. (See Table of Guarantees below.)

PAID-UP VALUE.-(B)-Paid-up Insurance.-Upon the writte request of the insured and assigns, if any, prior to the expiration of the thirty-one days' grace and the surrender of this Policy to th Company, it will issue a Paid-up Participating Policy, payable a

herein provided. The amount of the Paid-up Policy will be such as the cash surrender value, hereinafter provided for, will purchase at net single premium rates, according to the attained age of the insured. (See Table of Guarantees below.)

The Extended Insurance or the Paid-up Policy will be entitled to cash. surrender values according to the reserve thereon at the time of surrender, computed upon the basis hereinafter mentioned, less any indebtedness to the Company.

CASH SURRENDER VALUE SURRENDER CHARGE, (C)-Cash Value. Within one month from date of default in premium payment, to surrender this Policy to the Company at its Home Office for its cash surrender value, which shall be equal to the entire net reserve on this Policy, and dividend additions thereto, according to the American Experience Table of Mortality, with interest at three and one-half per cent per annum, less any indebtedness on the Policy and a surrender charge as follows: During the third, fourth and fifth policy years, one per cent of the amount of insurance, and decreasing one-tenth of one per cent annually thereafter until the end of the fourteenth year, after which no surrender charge is made. The payment of such cash value may be deferred for not exceeding six months after the application therefor is made, should the Company deem such action necessary. (See Table of Guarantees below.)

LOANS. After three full years' premiums have been paid, the Company, at any time while this Policy is in force, except as Extended Insurance, on proper assignment of this Policy and on the sole security thereof, will advance at the rate of six per cent interest per annum, a sum equal to, or at the option of the owner of the Policy less than, the cash surrender value at the end of the then current policy year as shown in column four of the "Table of Guarantees" below, deducting therefrom all indebtedness hereon to the Company and any unpaid balance of premium for the current policy year and interest in advance to the end of such year on the amount of the loan. Such loan, unless made to pay premiums on this policy, may be deferred for not exceeding six months after the application therefor is made. Failure to repay any such advance or interest shall not void this Policy, unless the total indebtedness hereon to the Company shall equal or exceed such loan value at the time of such failure nor until one month after notice shall have been mailed by the Company to the last known address of the insured, and of the assignee, if any, on record at the Home Office of the Company,

PREMIUM LOANS.-At any time while this policy is not assigned, and while there is no premium in default, the insured may direct by written notice to the Company at its Home Office, that after premiums have been paid for three years, any subsequent premium not paid prior to the expiration of the grace period shall be charged against the policy as a loan at six per cent interest per annum, subject to the provisions above in regard to loans, except that the assignment of the policy shall not be required and the interest shall be added to the loan each year unless paid to the Company. Such premium loan may be repaid at any time, and the insured may, at any time, by written notice to the Company, revoke the direction for such loan as to premiums thereafter payable.

POLICY CLAIMS. Upon maturity of this Policy its legal surrender will be required, and any indebtedness of the insured to the Company under this Policy will be deducted in any settlement thereunder. All proofs of death must be furnished upon blanks supplied by the Company.

Showing minimum "Non-forfeiture" values at the end of years stated for which premiums shall have been paid in full and in case there be no indebtedness on this Policy. Loans may also be ob tained during the Policy year as set forth in Loan clause above..

The above named guarantees beyond the twentieth year, if this Policy be continued in force, will be based upon the full reserve without any deduction for a surrender charge.

If the sum insured is increased by surplus accumulations, the above guarantees will be increased, but any indebtedness placed upon this Policy will operate to reduce said guarantees.

AGREEMENT FOR DISABILITY BENEFIT.

To be attached to and form a part of the Policy No. 99999, dated February 21st, 1916, of the Bankers Life Company, Des Moines, Iowa, on the life of John Doe.

The premium set out in the Policy No. 99999 includes an additional premium of Five and 50/100 Dollars per annum, as the consideration for the following additional benefits:

DISABILITY BENEFIT. After the premiums have been paid for at least one full year and provided no premium is in default, if the insured, before attaining the age of sixty years, becomes totally, permanently and incurably disabled as a result of accident or disease (not due to any cause or condition existing at the time of application for this agreement) and is thereby prevented permanently, continuously and wholly from performing any work or following any occupation for compensation or profit, the Company will waive payment of premiums thereafter becoming due under said policy which shall be continued in force for the same amount and with the same cash surrender and loan values (except as hereinafter provided) as if such premiums had been paid, and beginning one year after receipt of due proof of such disability, if the policy is in full force, the Company will pay the policy to the insured at a monthly income for ten years, dividing the face of the policy into 120 equal monthly installments; the policy to be returned to the Company for endorsement thereon of each payment. The amount of the policy shall be reduced by the amount of each monthly installment paid, and any balance of the policy remaining upon the insured's death, or at maturity, shall be paid in accordance with the policy provisions. The cash surrender and loan values shall decrease in the same proportion as the amount of the policy.

INSTALLMENTS LEFT AT INTEREST.-The monthly income payments above provided for may be left with the Company to accumulate at a rate of interest to be determined by the Company, but not less than three and one-half per cent per annum; such accumulated fund to be withdrawable on any anniversary date of this agreement.

The granting of these benefits shall be subject to the conditions and full compliance with the requirements herein set forth.

WHEN BENEFITS BEGIN. This agreement shall become operative upon receipt by the Company, at its Home Office, of due proof of such disability of the insured, such proof to be furnished upon the Company's forms and while no premium is in default.

EVIDENCE OF DISABILITY.-Before approval of the proof of disability or at any time thereafter, any medical examiner or other accredited representative of the Company, shall be permitted to make such physical examination of the insured relative to his disability as the Company may desire.

RECOVERY FROM DISABILITY.-If, at any time, it is found that the insured has recovered from his disability, or has become able to perform any work or follow any occupation for compensation or profit, no further premiums shall be waived and no further monthly installments shall be paid to the insured by the Company, but the policy may then be continued in force for the net amount of insurance, after deducting any monthly installments paid from the original amount of the policy; the premiums subsequently payable, to be adjusted accordingly. The non-forfeiture values of the policy shall be reduced in the same proportion as the amount of insurance.

DIVIDEND CREDITS APPLIED.-Upon approval of proof of disability, the full legal reserve value of any paid up additions and the accumulated value of any dividends left at interest to the credit of the policy shall be applied on any indebtedness to the Company on the policy, or if there be no indebtedness shall be paid to the insured in cash, and such paid up additions or dividend credits shall thereby be cancelled.

INDEBTEDNESS, HOW CANCELLED.Any indebtedness against the policy remaining unpaid after this agreement becomes operative, shall be paid to the Company with accrued interest, in full, or in installments so as to reduce the indebtedness in the same proportion that the policy is reduced by the monthly payments to the insured, and any such installment due and unpaid on the indebtedness, with accrued interest, shall be deducted from any monthly income payment due the insured.

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SPECIFIC CAUSES.-Without prejudice to any other cause of disability the entire and irrevocable loss of the sight of both eyes or the severance of both hands above the wrist or of both feet above the ankles or of one entire hand and one entire foot shall be considered as total and permanent disability within the meaning of this agreement.

DISABILITY AFTER AGE SIXTY. If the insured becomes totally disabled, as herein defined, after the age of sixty, and the requirements for furnishing due proof of such disability are complied with, the Company will waive cash payment of all premiums thereafter becoming due, while the cash value of the policy is sufficient, charging such waived premiums with interest at three and one-half per cent per annum against said policy as indebtedness to be deducted in any settlement as provided in the policy. When the cash value at the end of any policy year is not sufficient to cover all indebtedness then existing with due or accrued interest, and the annual premium for the succeeding year, payment shall be waived on the terms above provided of only such part of the interest and premiums as will keep the total indebtedness, including the payments so waived, within the cash value of the policy, the balance of such interest and premium to be paid in cash to continue the policy in force.

PREMIUM TO AGE SIXTY. The additional premium for the Disa bility Benefit shall not be payable after the insured is sixty years of age.

To CANCEL AGREEMENT This agreement may be cancelled by the insured, at any time before it becomes, operative by proof of disability, by giving the Company written notice at its Home Office, and after receipt by the Company of such notice, together with the policy for endorsement, no further additional premiums shall be payable, the policy to be continued on the same terms as though this agreement had not been issued.

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Dated, Des Moines, Iowa, February 21st, 1916.

BANKERS LIFE COMPANY.
BY G. S. NOLLEN, Secretary,

SPECIAL SETTLEMENT OPTIONS. 2.

Policy is payable in one sum (as provided in face of policy) unless Company is given written notice as indicated below.

WRITTEN NOTICE OF ELECTION REQUIRED, The insured may elect, by written notice delivered to the Company at its Home Office at any time while this Policy is not assigned, that out of the proceeds payable in a single sum as provided in the face of the Policy upon the Insured's death, any specified amount, instead of being paid in one sum, shall be applied under any one or divided between two or more of the options set out below, except that any amount less than $1000.00 becoming payable to one beneficiary under any one option shall be paid in a single sum. The insured may revoke such election at any time by written notice delivered to the Company at its Home Office, indicating the manner in which payment shall be made.

201 INSTALLMENTS AND SINGLE SUM.-OPTION 1. The specified amount applied under this option shall be paid (beginning immediately) in twenty annual payments each equal to one-twentieth of said amount and at the end of the twenty year period, a further payment equal to one-half of said amount, Instead of the annual payments, the Company will make monthly payments, each equal to one-twelfth of the annual payment upon request of the insured or the beneficiary hereunder.

EVE LEFT ON DEPOSIT AT INTEREST. OPTION 2. The specified amount applied under this option shall be left with the Company on deposit at three and one-half per cent interest per annum payable at the end of each year, or such interest will then be divided into twelve equal installments payable monthly if request therefor has been made by the insured or the beneficiary hereunder, and unless otherwise directed in the above required notice of election, said specified amount with any accrued interest shall be paid upon the death of the beneficiary hereunder to the executors or administrators of said beneficiary.

10 MONTHLY INCOME FOR FIXED PERIOD. OPTION 3. The specified amount applied under this option shall be paid as a monthly income (beginning immediately) for the fixed period stated in the above required notice of election; the monthly payments to be at the rate designated in the following table for each $1000.00 applied hereunder.

The

LIFE INCOME WITH MINIMUM FIXED PERIOD.-OPTION, 4. specified amount applied under this option shall be paid as a monthly income (beginning immediately) for the minimum fixed period of ten, fifteen, twenty or twenty-five years stated in the above required notice of election, and as long thereafter as the beneficiary hereunder is living; the monthly payments to be at the rate designated in the following table for each $1000.00 applied hereunder corresponding with the age of the beneficiary at the time the first monthly payment hereunder is due.