Flitcraft ... Life Insurance Manual ...

Age Attained by Payee when Proceeds are Payable...

22 25 28 31 33 35 37 39 and to to and and and and and 41 and 44 under 24 27 30 32 34 36 38 40 43

57 59 61 64 69

to to

when Proceeds are and 47 and 50 and 53 and 56 and and to
Payable....
55

Amount of Each Annual

58 60 63 68 80

Installment per $1,000 $53 $54 355 $56 $57 $58 859 $60 $61 $62 $63 864 865

TOTAL AND PERMANENT DISABILITY.-After one full annual premium shall have been paid upon this policy and before a default in the payment of any subsequent premium, if the Insured prior to attaining the age of sixty years shall furnish satisfactory proof that he has since such payment become wholly disabled by bodily injuries or disease, and will be permanently, continuously and wholly prevented thereby for life from pursuing any and all gainful occupations, the Company by an endorsement on this policy, will continue the insurance in force during such disability without the payment of premiums, and the values in this policy shall increase in the same manner as if the premiums were paid by the Insured.

If the Insured shall furnish satisfactory evidence of like total and permanent disability, occurring after he shall have attained the age of sixty years, the Company will, without further action on the part of the Insured, allow the subsequent premiums to accumulate without interest as an indebtedness on this policy.

In any such case the cash loans and the values of this policy shall increase in the same manner as if the premiums were being paid by the Insured.

Provided, however, that as often as required by the Company, the Insured shall furnish satisfactory proof of the continuance of the disability; that should the Insured so far recover as to be able to engage in any gainful occupation, he shall then resume payment of subsequent premiums as originally provided in this policy.

In addition to or independently of all other causes of total and permanent disability, the Company will consider the entire and irrecoverable loss of the sight of both eyes, or the severance of both hands at or above the wrists, or of both feet at or above the ankles, or of one entire hand and one entire foot, as total and permanent disability within the meaning of this provision.

On any anniversary of this policy this provision may be cancelled by the Insured, in which event the subsequent annual premiums will be reduced twenty-five cents for each one thousand dollars of insurance and such reduction shall be endorsed on this policy.

APPLICATION.

This application, which I make to The Ohio State Life Insurance Company of Columbus, Ohio, is the basis and part of the proposed contract of insurance.

I hereby declare and agree on behalf of myself and of any person having, or claiming, any interest in any policy issued under this application, as follows:

1. That the policy shall not be binding upon the Company, unless it has been delivered to me during my good health and the amount of the first premium payment thereon has been made to the Company or its duly authorized agent.

2. That all provisions of law, preventing or excusing any physician or other person from disclosing any and all information which he has acquired in serving me, are hereby expressly waived.

3. That death within one year from the date of the policy by my own hand or act, whether sane or insane, shall render the policy null and void.

4. That blank proofs of death may be furnished to my beneficiary or representative without incurring any liability or waiving any rights on the part of the Company.

5. That all statements and answers written in this application, as well as those to be made to the Medical Examiner in continuation hereof, are declared to be true and complete, that no material facts have beeen suppressed; and that the same are offered to the Company as a consideration for the issuance of the policy.

MEDICAL EXAMINER'S FORM

I hereby declare that, to the best of my knowledge and belief, I am in sound physical condition and a proper subject for life insurance.

Largest Amount of Insurance Issued on one life *$25,000. each $1,000 Insurance (Nonparticipating).

Adopted 1909.

Premiums for