CASH VALUE IN INSTALLMENTS.

The cash surrender value of this policy, and of any outstanding paid-up additions, together with any dividend accumulations, may, if aggregating $1,000 or more, be paid according to any one of the above Options.

CASH VALUES-PAID-UP INSURANCE,

(AMERICAN 3 PER CENT. NET RESERVES.)

If this policy becomes paid-up by payment of all premiums, or by operation of law, or otherwise, the cash value per $1,000 of paid-up insurance, provided there is no indebtedness against the policy, will be as shown in the table below opposite the age attained.

e. g.-If the policy is paid-up for $2,000 and the age of the insured is 55, the cash value is 2X $609.92 or $1,219.84.

NOTICE: The insured is hereby notified that by virtue of this Policy he is a member of the MASSACHUSETTS MUTUAL LIFE INSURANCE COMPANY, and is entitled to vote either in person or by proxy at any and all meetings of said Company. The annual meeting is held at its Home Office on the third Wednesday of January in each year, at 2 o'clock P. M.

PROVISION FOR WAIVER OF PREMIUM.

IN THE EVENT OF PERMANENT TOTAL DISABILITY.

If the insured, after the payment of premiums for the first policy year, and before default in the payment of any subsequent

year's premium, and before attaining the age of sixty years, an while this policy is in full force, shall furnish due proof to th Company at its Home Office that he has become wholly and per manently disabled by bodily injury or disease so that he is an will be permanently, continuously, and wholly prevented thereb from performing any work for compensation or profit, or from fol lowing any gainful occupation, and that such disability has existe continuously for not less than sixty days, the Company, by indorse ment hereon, will waive the payment of all premiums becoming du under this policy after the expiration of the then current polic year. The premiums so waived shall not be deducted from the sun payable under this policy, and the values provided for under "Non Forfeiture Provisions" shall be the same as if such premiums ha been paid in cash. Provided that, notwithstanding proof of dis ability may have been accepted by the Company as satisfactory, th insured shall at any time, on demand from the Company, furnis due proof of the continuance of such disability, and if the insure shall fail to furnish such proof, or if the insured is able to per form any work or to follow any occupation whatsoever for com pensation, gain, or profit, all premiums thereafter falling due mus be paid in conformity with the conditions of this policy.

It is further agreed that the entire and irrecoverable loss of th sight of both eyes, or the severance of both hands at or above th wrists, or of both feet at or above the ankles, or of one entire han and one entire foot, will be considered as total and permanent dis ability within the meaning of this provision, and that the Company upon due proof of such loss or severance, will waive the premium becoming due under this policy after the expiration of the the current policy year.

This provision is granted in consideration of the payment c an additional premium of $1.90 with each annual premium payable and this amount is included in the whole premium charged for thi policy. This provision may be discontinued by the insured on an anniversary of this policy by written request to the Company, suc discontinuance to take effect upon indorsement thereof on thi policy by the Company at its Home Office. When the insured ha passed the age of sixty years, the additional premium charged fo this provision will be discontinued without the request of the ir sured. Non-payment of said additional premium will void this pro vision and the benefits secured thereby.

THE POLICYHOLDER IS REQUESTED TO READ THI POLICY, THAT HE MAY BE INFORMED OF ITS PROVISIONS

APPLICATION.

This application, made to the MASSACHUSETTS MUTUAL LIF INSURANCE COMPANY, of Springfield, Massachusetts, is the basi and a part of the proposed contract for insurance.

13. Do you reserve the right to change and to successivel change the beneficiary without the consent of the beneficiary Answer yes or no.

[If this right is reserved, the policy may possibly becom part of the estate in case of bankruptcy].

I agree that the insurance hereby applied for shall not be i force until the approval of this application by the Company at it Home Office, the delivery of the policy to me or my agent and th payment of the first premium as required therein during my pres ent condition of health (except as these conditions may have bee modified, if I have paid the said first premium, by the terms of th Company's conditional receipt given in exchange for said premium) and that thereupon said policy shall be considered as having be come effective upon the date stipulated in the policy as the dat on which the insurance begins.

I also agree that military and naval service in time of war are risks not assumed by said Company during the first policy year, unless a written permit therefor, at a rate of extra premium to be fixed by the Company, shall be granted; and that if without such permit I shall engage in any such service during the first policy year, said policy shall thereupon become void, and no claim shall exist thereunder except for the net reserve held against it, reckoned according to the legal standard of Massachusetts; it being a condition of the foregoing that I may serve at any time, without a permit, in the militia of any State.

I further agree that if I shall die by my own hand or act during the first policy year, whether I be at the time sane or insane, the Company shall be liable only for the net reserve held against said policy, reckoned according to the legal standard of Massachusetts.

I understand and agree: (1) That the policy, if issued, cannot be modified or altered except upon my written request, and that of other parties in interest, if any, and the approval, on behalf of the Company, of its President, or a Vice-President, or the Secretary, or an Assistant Secretary, and that any modification or alteration shall comply with the legal requirements of the state in which the policy is delivered. (2) That no agent of the Company has any authority to make or modify contracts on behalf of the Company, or to alter or waive any of the conditions or requirements herein contained.

I hereby declare, on behalf of myself and of any person who shall have or claim any interest in any policy issued upon this application, that, to the best of my knowledge and belief, each of the foregoing answers in Parts I and II of this application is full, complete, and true, and that I am in sound physical condition, and a proper subject for life insurance.

20 PREMIUMS LIFE POLICY WITH DISABILITY
BENEFITS.

No. 99,999.
AMOUNT, $10,000.

AGE 35. PREMIUM, $373.80.

MERIDIAN LIFE INSURANCE COMPANY.

Hereby Insures the life of John Doe of Indianapolis, County of Marion, State of Indiana, (hereinafter called the Insured), in the sum of Ten Thousand Dollars, which amount the Company agrees to pay at its Home Office at Indianapolis, to Mary Doe, His Wife, (or to such other beneficiary as may be designated by the insured as hereinafter provided), if living, otherwise to the insured's executors, administrators, or assigns, upɔn receipt of due proofs of the death of the insured, this Policy being then in force, subject to all of the Benefits, Privileges and Conditions stated on this and the following pages hereof, all of which are hereby made a part of this contract as fully as if recited at length over the signatures hereto affixed.

Annual Dividends.-This policy shall participate in the surplus of the Company as apportioned by the Board of Directors. At the end of the second year and annually thereafter, the surplus so apportioned to this policy will be credited as a dividend and the insured may then select any one of the following options:

First. Receive in cash the dividends so apportioned; or,

Second. Apply the dividend to the reduction of the premium then due; or,

Third. If neither of the foregoing options is selected the dividend shall be held to the credit of the policy and be payable in cash at maturity of the policy or be withdrawable in cash at any anniversary of its date.

If the dividends are left to accumulate in accordance with the third option, interest on the amount thereof at the rate of three per cent per annum shall be added thereto at the end of each policy year, and whenever such accumulations together with the reserve under this policy shall equal the net single premium for the benefits hereunder at the attained age of the insured computed upon the same basis as the reserve under this policy, the Company will, upon receipt of a proper request, endorse this policy as fully paid-up.

STATE OF INDIANA-INSURANCE DEPARTMENT.
INDIANAPOLIS, INDIANA.

I hereby certify that the Meridian Life Insurance Company is incorporated and conducts its business under the Indiana Legal Reserve Compulsory Deposit Law of 1899, and in accordance therewith is required to maintain, and does maintain, on deposit with this Department, securities equal to the amount of the net cash value of all its policies as ascertained by valuations made by this Department each year. WILLIAM H. O'BRIEN, Auditor of State.

In Witness Whereof, The MERIDIAN LIFE INSURANCE COMPANY has caused this Policy to be signed by its President and Secretary, at its office in the City of Indianapolis, this 10th day of December, One Thousand Nine Hundred and Nine. THOS. J. OWENS, ARTHUR JORDAN,

Secretary.

President.

BENEFITS, PRIVILEGES AND CONDITIONS. THIS POLICY IS ISSUED in consideration of the application therefor, which is hereby made a part hereof and a copy of which is attached hereto, and of the payment on or before the delivery hereof of Three Hundred Seventy-three and 80/100 Dollars, and the further payment of a like amount on or before the 10th day of December in every year thereafter until Twenty premiums have been paid to the Company at its Home Office in Indianapolis, Inάiana. TABLE OF OPTIONS HEREINAFTER REFERRED TO.

Any unpaid note and other existing indebtedness to the Company on account of or secured by this policy reduces the values above specified in the proportion that such indebtedness bears to the net value of the Extended Insurance, the Extended Insurance being reduced in amount, not in the term of extension.

The reserve under this policy shall be computed upon the basis of the American Experience Table of Mortality and three and onehalf per cent. interest. The first year's insurance under this policy is term insurance, purchased by the whole or part of the premium to be received during the first policy year and the policy shall be valued according to its terms and the laws of the State of Indiana, CASH LOANS.-After three full years' premiums have been paid, the Company will loan upon the sole security of this policy, while in force, within six months from date of written application for such loan, any sum not in excess of the amount stated in the Table