4. This Double Indemnity Benefit is granted in consideration of an additional annual premium of $2 per thousand which is included in and is payable under the same conditions and for the same period as the premium under the Principal Contract or until the prior termination of this agreement, in which event the premium on the policy will be reduced by the amount shown above. This Double Indemnity Benefit may be cancelled and terminated by the Insured at any time by returning the policy and this agreement to the Company for proper endorsement, with written request by the Insured. Any unearned premium paid herefor will be returned to the Insured.

The extra annual premium for the Double In

demnity feature is $2.00 per $1000.

DETROIT, MICH.

October 19, 1907;

Began business October 19,

stock com

pany; issues non-participating policies only.

Extracts Annual Statement

Year Ending December 31, 1921

Disability and Double Indemnity Benefits.

When Such Benefits Take Effect: If the insured, after payment of premiums for at least one full year and before default in the payment of any subsequent premium, and before attaining the age of sixty (60) years at nearest birthday, and while. this Contract is in full force by the payment of all current premiums theretofore due, shall become. totally 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, gain gain or profit, or from following any gainful occupation, and shall furnish due proof of such disability to the Company at its Home Office within one year from the date of becoming so disabled, and that such disability has then existed continuously for not less than sixty (60) days, the Company will grant the following benefits:

Benefits-1. Waiver of Premium: The Company will, during the continuance of such disability, waive payment of each premium as it thereafter becomes due, commencing with the first premium due after receipt of said due proof of such disability.

2. Income Income to Insured: to Insured: On the anniversary of the date of issue of this policy next succeeding such due proof of disability, the Company will (with the written consent of the assignee. if any) pay to the insured, if then living and such disability shall continue, a sum equal to one per cent (1%) of the face value of the policy, and a like sum monthly thereafter without commutation, if the assured be then living and such disability still continue; in no case, however, shall any such sum be payable at or after the end of the endowment period of any policy. Interest on any indebtedness to the Company on account of said policy may be deducted from the income payments. The value of the policy shall not be decreased because of any premium waived or any income payment made, nor shall such waived. premium or income payment be deducted in any subsequent settlement of the policy, and the loan and surrender values will increase each year in the same manner as if each premium had been paid when due instead of being waived.

If the insured shall furnish proof of like disability occurring after he shall have attained the age of sixty (60) years at nearest birthday, the Company will allow all premiums falling due more than six months after receipt of such proof to accumulate without interest, as an indebtedness on this policy, and in such case the values in the table of non-forfeiture values shall increase in the same manner as if the premiums as if the premiums were being paid by the insured,

Proof of Continuance of of Disability Required; Recovery from Disability: Although the proof of total and permanent disability may have been accepted by the Company as satisfactory, the insured shall at any time thereafter, and from time to time, but not oftener than once a year, on demand, furnish to the Company due proof of the continuance of such disability, and if the insured shall fail to furnish such proof, or if it shall appear to the Company that the insured is able to perform any work or follow any occupation whatever for compensation, gain or profit, no further premiums shall be waived and no further income shall be paid.

Specific Cases of Disability: In addition to and independently of all other causes of total permanent disability, the entire and irrecoverable loss of sight of both eyes, or the severance of of both hands at or above the wrists, or of both feet at or above the ankles, or the similar loss of one hand and one foot, shall be considered as constituting total and permanent disability within the meaning of this provision.

Neither

General Provisions as to Disability: the provisions for disability benefits, nor the premium calculated and paid therefor, shall be construed as covering any of the hazards enumerated below, and the Company is specifically exempt from any liability thereunder in any of the following circumstances and conditions: (a) when the written request of the insured for cancellation of both disability and double indemnity benefits is received at the Home Office of the Company together with the policy for endorsement; (b) if the insured shall voluntarily or involuntarily engage in military or naval service in time of war; or (c) in all events when the insured shall attain the age of sixty (60) years at nearest birthday except as to waiver to waiver of premium as above pro

vided.

Double Indemnity: If, after payment of premiums hereon for at least one full year, and before default in the payment of any subsequent premium, and also before the allowance of any disability benefit under the disability provisions hereof, satisfactory proof shall be received at the Home Office of the Company at Detroit, Michigan, that the death of the insured, before attaining the

age of sixty years nearest birthday, was caused directly and independently of all other causes, from bodily injury effected solely through external, violent and accidental cause, and that such death occurred within sixty days after such accident, then and in such instance, the amount to be paid by the Company as a death benefit under this policy shall be double the amount represented by its face value.

General Provisions as to Double Indemnity: Neither the provisions for double indemnity benefit, nor the premium calculated calculated and paid therefor, shall be construed as covering any of the hazards enumerated below, and the Company is specifically exempt from any liability thereunder, in any of the following circumstances and conditions: (a) when the written request of the insured for cancellation of both disability and double indemnity benefits is received at the Home Office of the Company together with the policy for endorsement; or (b) if the insured shall voluntarily or involuntarily engage in military or naval service in time. of war or in work as a civilian in any capacity whatever in connection with actual warfare, including the manufacture or handling of munitions or explosives; or (c) if death should result from submarine or aeronautic operations or ascensions; or (d) in all events when the insured shall attain the age of sixty (60) years at nearest birthday; or if death shall occur from suicide, suicide, or any form of mental infirmity, or from any physical infirmity, or directly or indirectly from illness or disease of any kind.

ST. LOUIS, MO.

Began business January 22, 1913; stock company issues non-participating insurance only.

Extracts Annual Statement

Year Ending December 31, 1921

The company has four forms of "riders" providing for: waiver of premium only; waiver of premium and and income; double indemnity and a rider (see below) embracing all of such benefits. Double Insurance, Disability and Income Benefits

In consideration of the representations, warranties and agreements made in the application for said policy above referred to, which is hereby made a part of this supplemental contract, and in consideration of the payment, on or before the delivery of this supplemental contract, of the premium of $.... and of the payment

thereafter of a like amount with each. annual premium required by the terms of said policy above referred to, or until the anniversary nearest the sixtieth birthday of the insured, the company upon receipt of due proof of the death of the insured, agrees to pay to the beneficiary under said policy

Double the Face of Said Policy,

making the total amount payable. dollars, provided the death of the insured is caused by and as a direct result of bodily injury or injuries 4 effected solely and solely and independently of all other causes through external, violent and accidental means (suicide or self-destruction while sane or insane, or death due directly or indirectly to disease, not included), and provided such death shall have occurred during the premium paying period of said policy above referred to and within ninety (90) days after such injury or injuries were sustained.

Total Disability Benefit-Waiver of Premium

Income Payments

If after one year's premium year's premium shall have been paid on said policy and before default in the payment of any subsequent premium the insured shall furnish to the Company due proof that before attaining the age of sixty (60) years he has become totally disabled by bodily injury or disease, so that he is and thereby will be permanently and continuously unable to engage in any