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such policy. 3d. That inasmuch as only the officers at the Head Office of the Company in the City of Chicago have authority to determine the terms and conditions upon which a policy shall issue on any application, no statements, promises or information made or given by, or to, the person soliciting or taking this application for a policy, or by or to any other person, shall be binding on the TOTAL Company or in any manner affect its rights, unless such statements, promises or information be reduced to writing, and presented to the officers of the Company, at the Head Office, in this application. 4th. That the Company shall incur no liability under this application until the first premium has actually been paid to, and accepted by the Company or its authorized agent, and this application has been received, approved, the policy issued thereon by the Company at the Head Office, and said policy actually delivered to and accepted by the Insured, all during my lifetime and sound health. 5th. That any policy that may be issued in pursuance of this application shall be in consideration of the statements, answers and agreement by on me made in this application. 6th. That the whole or any part d of the risk herein proposed may be reinsured. 7th. That my rebesiding or traveling outside of the Temperate Zone, or engaging in re any of the following occupations or employments, within two years from the date of the policy issued under this application, without first obtaining the Company's written permission and the payment the of the extra premium_required therefor, will render such policy all absolutely void, viz.: Blasting; Mining; Sub-Marine Labor; Aeroeffe nautic Ascensions; the manufacture, handling or transportation_of office inflammable or explosive substances; handling electric wires or dyshau namos; service on railroad trains (excepting as passenger or sleeping car or parlor car conductor; or, on dining cars or as baggageman, express agent, or railway postal clerk); switching or coupling cars; service on any steamboat or other vessel or boat, excepting as by officer on river steamboat; service as bartender; or dealing in indem toxicating liquors. 8th. I hereby expressly waive all provisions of of law forbidding any physician or surgeon from disclosing any information acquired while attending me in a professional capacity, per and I hereby direct and authorize any said physician to make any ensa and all disclosures of information desired by said Company upon its application therefor.

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20 PREMIUMS LIFE NONPARTICIPATING GUARANTEED GRADED PREMIUM REDUCTION POLICY WITH DISABILITY BENEFITS.

By this Policy of Insurance Agrees to pay Ten thousand dollars, at its Home Office in St. Louis, Missouri, as follows:

The Benefi

ciary.

To Mary Doe, wife of the Insured, upon receipt of due || proofs of the death of the Insured, during the continuance of this policy.

The Insured John Doe of St. Louis, County of.

Missouri.

State of

This Policy is absolutely free from Conditions as to Residence, Occupation, Travel or Place of Death. No permit or extra premium will be required for Military or Naval Service in time of war or in time of peace.

STATE OF MISSOURI.

INSURANCE DEPARTMENT.

This policy is registered and secured by a pledge of bonds or deeds of trust on real estate deposited with this department.

GUARANTEED PREMIUM REDUCTIONS.

This policy is issued on the Guaranteed Graded Premium Reduction, Triple Option, Non-Participating plan, and in the use of the coupons, the Insured may select one of the three following options:

Option 1. The Insured may use the amount designated in the coupons hereto attached for the reduction of his premium payments from year to year.

Option 2. The Insured may elect to pay all premiums without reduction, in which case the Company guarantees that, after paying premiums in full for fifteen years and surrendering this policy and all attached coupons to the Company, a policy paid-up for life for the face amount hereof will be issued to the Insured.

Option 3. The Insured may elect to pay all premiums without reduction, in which case the Company guarantees that this policy shall mature as an Endowment paying the premiums in full

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for twenty-four years; and, on the surrender of this policy and all attached coupons on the first anniversary of this policy after such payments are completed, the face amount hereof will be paid in cash to the Insured.

In case the Insured shall pay all premiums in full, without coupon reductions, the unused due coupons shall be placed to the credit of the policy and shall be payable at any time, together with compound interest at the rate of three and one-half per centum (32%) per annum for each full year after due dates thereof; or, in the event of the death of the Insured, said amount shall be payable to the beneficiary in addition to the face amount of the policy. OPTIONS OF SETTLEMENT AT END OF TWENTY YEARS.

If all premiums on this policy shall have been paid in full, without coupon reductions, to the end of twenty years, and there be no indebtedness to the Company, the Insured may then have the choice of one of the three following options, on surrender to the Company of this policy and all coupons attached thereto :

Option 2. Receive a policy of paid-up life insurance for $10,000.00 and $2,150.90 cash; or, receive a policy of paid-up life insurance for $13,710.00; or,

Option 3. Receive a paid-up Endowment insurance policy for the face amount hereof, maturing in thirty-one years from the date of this policy.

AUTOMATIC PREMIUM LOAN.

If a request for the Automatic Premium Loan privilege, signed by the Insured, is received at the Company's Home Office with the application for this policy, or before default in the payment of any premium, without further action by the Insured, the Company will lend the amount of any premium not paid when due or within the days of grace, until a written revocation of said request has been received by the Company, provided the loan value is sufficient to pay the premium then due, all outstanding indebtedness and interest in advance for one year at a rate not exceeding six per cent. per annum. Such loan shall be a first lien on this policy in any settlement hereunder.

GUARANTEED BENEFITS OF THIS POLICY.

AUTOMATIC EXTENDED INSURANCE.-If any premium shall not be paid on or before the date when due, and if there be no indebtedness to the Company, the full amount of insurance hereunder will automatically continue from said due date as Term Insurance it during the term, including the period of grace, specified in Column three (3) of the accompanying table.

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PAID-UP INSURANCE.-If any premium after the third shall not be paid on or before the date when due, and if there be no indebtedness to the Company, upon written request therefor made by the Insured within six months from default in payment and on surrender of this policy, the Company will issue a policy paid-up for life for the amount specified in Column two (2) of the accomli panying table for the year to the end of which premiums in full f have been paid.

SURRENDER FOR CASH. If any premium after the third shall not be paid on or before the date when due, and if there be no indebtedness to the Company, upon written request therefor within six months from such default in payment and on surrender of this policy, the Company will pay in cash the net value of either the paid-up or extended insurance hereunder, which is the amount specified in Column one (1) of the accompanying table for the year to the end of which premiums in full have been paid.

CASH LOANS.-On or after the beginning of any policy year after two years from date hereof, and on demand in writing to the Home Office of the Company, the Insured may borrow on the sole security of this policy an amount not to exceed that specified in Column one (1) of the accompanying table for the year in which the loan is made.

This policy shall be assigned to the Company as security, according to the terms of the Company's loan agreement, and the premium on this policy and interest on the loan at a rate of interest not exceeding six per cent per annum shall be paid or deducted from the loan in full to the anniversary of the insurance next succeeding the date when the loan shall be made. Interest, if not paid when due, shall be added to the principal and bear the same rate of interest. The amount available at any time includes any previous loans then unpaid.

Unless the total indebtedness hereon shall equal or exceed the cash value of this policy, and then not until one month after notice shall have been mailed by the Company to the last known address of the Insured and Assignee, if any, failure to pay any loan or interest thereon shall not void this policy, but, in the event of such default, when the premium becomes due and is not paid, an amount of insurance equal to the face amount of this policy, less the indebtedness, shall automatically continue from the date of default as Term Insurance for the term, including the period of grace which the excess of the cash value over the indebtedness will purchase at the then age of the Insured according to the American Experience Table of Mortality and interest at the rate of three and one-half per centum (32%) per annum; or, in lieu of such Term Insurance, the Company will (upon written request of the Insured and surrender of this policy within one month from date of default) either pay said excess in cash or issue a paid-up policy for the amount which said excess will purchase at the then age of the Insured according to the said Table of Mortality and rate of interest. The Term Insurance specified in this policy shall not be subject to cash loans.

ANNUITY OPTIONS.-At the end of twenty years, if this policy be in full force and there be no indebtedness to the Company, upon its surrender, an Annuity Bond will be issued guaranteeing an annual income of $440.00 to the Insured during his natural life, the first payment to be made on the 14th day of December, 1933.

If all premiums on this policy shall have been paid in full, without coupon reductions, to the end of twenty years, and, if there be no indebtedness to the Company, upon surrender of this policy and all coupons attached hereto to the Company, an Annuity Bond will be issued guaranteeing an annual income of $610.00 to the Insured during his natural life, the first payment to be made on the 14th day of December, 1933.

RESERVE BASIS. This policy is issued on the basis of the American Experience Table of Mortality and interest at the rate of three and one-half per centum (32%) per annum, The values

used for cash surrender, loans, extended term and paid-up insurance, shown in the accompanying table are calculated upon the reserves indicated by said Table of Mortality and Interest, less a surrender charge which in no case exceeds two and one-half per centum (2%) of the amount insured under this policy.

Loan and cash values after the twentieth policy year will be the full reserve of this policy on the basis stated herein, the figures for which will be furnished on request to the Home Office of the Company.

If default occur after a fractional part of the current year's premium has been paid, the above values will be proportionately adjusted.

$94.50. On or at any time after Dec. 14, 1932, International Life Insurance Co., St. Louis, Mo., will pay to the order of the insured under policy No. sample, (or to the order of the assignee if said policy is assigned), Ninety-four 50/100 Dollars subject to conditions of said policy, provided all premiums due on said policy up to and including said date, have been paid. Payable at its Home Office.

No. 19.

MASSEY WILSON, President.
I

$93.50.

On or at any time after Dec. 14, 1931, International Life Insurance Co., St. Louis, Mo., will pay to the order of the insured under policy No. sample (or to the order of the assignee if said policy is assigned), Ninety-Three 50/100 Dollars subject to conditions of said policy, provided all premiums due on said policy up to and including said date, have been paid. Payable at its Home Office. MASSEY WILSON, President.

No. 18.

$92.50.

On or at any time after Dec. 14, 1950, International Life Insurance Co., St. Louis, Mo., will pay to the order of the insured under policy No. sample, (or to the order of the assignee if said policy is assigned), Ninety-Two 50/100 Dollars subject to conditions of said policy, provided all premiums due on said policy up to and including said date, have been paid. Payable at its Home Office. MASSEY WILSON, President.

No. 17

I

$91.50.

On or at any time after Dec. 14, 1929, International Life Insurance Co., St. Louis, Mo., will pay to the order of the insured under