15 $18 14 $67 79 110 45 160 02 18 85 70 37 114 60 165 97 19 58 73 05 118 92 172 13 20 34 75 84 123 41 178 52 21 12 78 74 128 08 185 15 20 21 94 81 75 132 94 192 04 22 79 84 91 138 00 199 17 23 68 88 20 143 26 206 59 24 61 91 64 148 74 214 27 25 59 95 21 154 44 222 25 26 61 98 94 160 36 230 50 27 68 102 83 166 50 239 05 27 28 79 106 88 172 90 247 88 28 29 95 111 11 179 54 256 99 31 17 115 51 186 44 266 38

23 24

25

26

30

33

34

35

36

37

38

39

40

$45 71 173 16 285 55 419 88 107 25 408 38 676 46 930 27 46 55 176 29 290 67 427 36 107 25 408 33 676 39 930 24 47 42 179 51 295 94 435 04 107 25 408 28 676 31 930 21 48 31 182 83 301 36 442 95 107 25 408 22 676 23 930 18 49 22 186 24 306 94 451 07 107 23 408 16 676 15 930 14 50 15 189 76 312 68 459 42 107 22 408 10 676 06 930 10 51 12 193 38 318 58 468 00 107 20 408 03 675 97 930 06 52 12 197 11 324 65 476 80 107 19 407 97 675 87 930 02 53 15 200 95 330 89 485 83 107 19 407 91 675 77 929 97 54 22 204 89 337 29 495 10 107 19 407 85 675 66 929 92 55 31 208 95 343 86 504 59 107 19 407 79 675 54 929 87 56 44 213 12 350 59 514 30 107 19 407 73 675 42 929 81 56 70 217 40 357 49 524 23 107 19 407 67 675 29 929 74 58 79 221 80 364 56 534 37 107 20 407 62 €75 15 929 67 60 02 226 31 371 80 544 70 107 21 407 56 675 00 929 59 30 230 94 379 19 555 22 107 24 407 51 674 85 929 51 60 235 67 386 75 565 89 107 27 407 47 674 70 929 41 63 93 240 52 394 45 576 71 107 30 407 44 674 53 929 30 65 32 245 49 402 30 587 67 107 35 407 41 674 36 929 19 66 74 250 58 410 27 598 74 107 41 407 42 674 19 929 05 68 20 255 78 418 33 609 92 107 50 407 45 674 00 928 91 69 69 261 10,426 48 621 18 07 58 407 51 673 78 928 74 71 23 266 51 434 69 632 51 107 70 407 59 673 54 928 56 72 81 272 01 442 94 643 89 107 82 407 70 673 27 928 35 74 44 277 60,451 23 655 30 107 99 407 84 672 96 928 12

61

32 45 120 10 193 61 276 02 31 33 78 124 87 201 04 285 90 62 32 35 17 129 83 208 72 296 00 36 63 135 01 216 66 306 33 38 16 140 40 224 86 316 86 39 76 146 01 233 28 327 58 41 42 151 83 241 92 338 48 43 16 157 86 250 76 349 53 44 96 164 11 259 79 360 72 46 87 170 57 269 02 372 04 48 85 177 20 278 40 383 47 76 11 283 23 459 51 666 72 108 19 407 98 672 61 927 86 41 50 94 184 01 287 94 394 98 77 85 288 90 467 78 678 13 108 44 408 14 672 21 927 57 42 53 11 190 96 297 61 406 55 79 62 294 58 475 99 689 50 108 72 408 28 671 74 927 24 55 37 198 06 307 40 418 14 81 44 300 26 484 15 700 83 109 04 408 41 671 20 926 86 57 70 205 28 317 29 429 75 83 29 305 91 492 20 712 08 109 38 408 53 670 58 926 45 60 12 212 62 327 27 441 35 85 17 311 52 500 15 723 24 109 78 408 62 669 88 925 98 62 60 220 06 337 30 452 90 87 07 317 06 507 94 734 27 110 19 408 68 669 08 925 45 65 13 227 59 347 39 464 37 88 97 322 53 515 55 745 16 110 61 408 70 668 17 924 86 48 67 70 235 21 357 49 475 73 90 86 327 91 522 96 755 88 111 04 408 69 667 15 924 20 49 70 30 242 91 367 62 486 96 92 73333 19 530 15 766 41 111 48 408 66 666 01 923 46 72 96 250 69 377 76 498 04 94 61 338 37 537 10 776 73 111 94 408 61 664 75 922 64 75 68 258 55 387 88 508 93 96 49 343 43 543 77 786 82 112 45 408 55 663 36 921 72 78 45 266 47 397 96 519 63 98 37 348 37 550 14 796 67 113 00 408 49 661 83 920 79 81 28 274 44 407 97 530 19 100 27 353 18 556 18 806 28 113 59 408 43 660 17 919 58 84 15 282 46 417 87 540 68 102 16 357 85 561 84 815 69 114 22 408 37 658 33 918 33

43

44

45

46 47

50

87 08 290 50 427 64 551 19 104 06 362 37 567 10 824 93 114 92 408 33 656 29 916 95 56 90 06 298 53 437 25 561 83

93 09/306 54 446 70 572 69

58 96 15 314 50 456 02 583 83

99 24 322 36 465 32 595 28

60 102 35 330 10 474 71 607 12 61 105 48 337 69 484 30 619 17

62 108 64 345 13 494 25 631 56 63 111 79 352 49 504 62 644 45 64 114 90 359 87 515 47 658 19

65 117 96 367 43 526 88 673 03

Extended Insurance (Participating) on $1,000 Participating Policies

20 PAYMENT LIFE ANNUAL DIVIDEND POLICY WITH TOTAL AND PERMANENT DISABILITY BENEFITS -DOUBLE INDEMNITY FOR FATAL ACCIDENT.

Face

Beneficiary Agrees to Pay to Mary, wife of the Insured, Beneficiary, (with the right on the part of the Insured to change the Beneficiary in the manner provided in Section 6) Ten Thousand Dollars (the face of this Policy) upon receipt of due proof of the death of John Doe, the Insured; or Double the Face of This Policy upon receipt of due proof that the death of the Insured resulted 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 sustaining such injury.

Amount
Insured
Double.
Indemnity

Permanent
Disability

Premium

This Double Indemnity Benefit will not apply if the Insured's death resulted from self-destruction, whether sane or insane; from any violation of law by the Insured; from military or naval service in time of war; from a state of war or insurrection; from engaging in submarine or aeronautic operations; from physical or mental infirmity; or directly or indirectly from illness or disease of any kind. The Company shall have the right and opportunity to examine the body, and to make an autopsy unless prohibited by law.

And the Company Agrees to Pay to the Insured One-tenth the face of this Policy per annum, during the lifetime of the Insured, if the Insured becomes wholly and permanently disabled before age 60, subject to all terms and conditions contained in Section 1 hereof.

This contract is made in consideration of the payment in advance of the sum of $411.80, the receipt of which is hereby acknowledged, constituting the first premium and maintaining this Policy to the First day of April, Nineteen Hundred and Twenty, and of a like sum on said date and every twelve calendar months thereafter during the life of the Insured, until premiums for Twenty full years in all shall have been paid from the date on which this Policy takes effect.

This Policy takes effect as of the 1st day of April, Nineteen Hundred and Nineteen, which day is the anniversary of

the Policy. If the Insured becomes wholly and permanently disabled before age 60, the payment of premiums will be waived under the terms and conditions contained in Section 1. SECTION 1.-TOTAL AND PERMANENT DISABILITY

BENEFITS.

Whenever the Company receives due proof, before default in the payment of premium, that the Insured, before the anniversary of the Policy on which the Insured's age at nearest birthday is 60 years and subsequent to the.delivery hereof, has become wholly disabled by bodily injury or disease so that he is and will be presumably, thereby permanently and continuously prevented from engaging in any occupation whatsoever for remuneration or profit, and that such disability has then existed for not less than sixty days-the permanent loss of the sight of both eyes, or the severance of both hands or of both feet, or of one entire hand and one entire foot, to be considered a total and permanent disability without prejudice to other causes of disability-then

1. WAIVER OF PREMIUM.-Commencing with the anniversary of the Policy next succeeding the receipt of such proof, the Company will on each anniversary waive payment of the premium for the ensuing insurance year, and, in any settlement of the Policy, the Company will not deduct the premiums so waived. The loan and surrender values provided for under Sections 3 and 4 shall be calculated on the basis employed in said sections, the same as if the waived premiums had been paid as they became due.

2. LIFE INCOME TO INSURED.-One year after the anniversary of the Policy next succeeding the receipt of such proof, the Company will pay the Insured a sum equal to one-tenth of the face of the Policy and a like sum on each anniversary thereafter during the lifetime and continued disability of the Insured. Such income payments shall not reduce the sum payable in any settlement of the Policy. The Policy must be returned to the Company for indorsement thereon of each income payment. If there be any indebtedness on the Policy, the interest thereon may be deducted from each income payment.

3. RECOVERY FROM DISABILITY.-The Company may at any time and from time to time, but not oftener than once a year, demand due proof of such continued disability, and upon failure to furnish such proof, or if it appears that the Insured is no longer wholly disabled as aforesaid, no further premiums shall be waived nor income payments made.

The

annual premium for the Total and Permanent Disability Benefits is $15.60, and is included in the premium stated on the first page of this Policy. Any premium due on or after the anniversary of the Policy on which the age of the Insured at nearest birthday is 60, shall be reduced by the amount of premium charged for the Disability Benefits.

SECTION 2.-PARTCIPATION IN SURPLUS-DIVIDENDS.

The proportion of divisible surplus accruing upon this Policy shall be ascertained annually. Beginning at the end of the second insurance year, and on each anniversary thereafter, such surplus as shall have been apportioned by the Company to this Policy shall at the option of the Insured be either

(a) Paid in cash; or

(b) Applied toward payment of premiums; or

(c)

Applied to purchase a Participating Paid-up Addition to the sum insured; or

(d) Left to accumulate at such rate of interest as the Company may declare on funds so held, but at a rate never less than three per cent compounded and credited annually, and withdrawable in cash on any anniversary, or payable at the maturity of the Policy to the person entitled to its proceeds.

If the Insured fails to notify the Company in writing, within three months after the Company shall have mailed to him a written notice of the amount of said dividend and the options avail