This Agreement shall become null and void if the Insured shall engage in military service out of the United States during war, or military service involving aeronautics or naval service whether in or out of the United States during war; provided that, upon presentation after the termination of such service of evidence of insurability satisfactory to the Company and payment of the additional premium aforesaid, this Agreement shall again become operative.

Dated at Hartford, Connecticut, this First day of June, A. D. 1917.

THE CONNECTICUT MUTUAL LIFE INSURANCE COMPANY, WILLIAM H. DEMING, Secretary.

TOTAL AND PERMANENT DISABILITY AGREEMENT WAIVER OF PREMIUM WITH LIFE INCOME.

THE CONNECTICUT MUTUAL LIFE INSURANCE COMPANY

OF HARTFORD, CONNECTICUT.

In Consideration of the Application herefor, which is the basis of and a part of this Agreement, by John Doe, the Insured under Policy No. 99999, issued June 1, 1917, by said Company, and of the payment to said Company of the additional annual premium of Six and 20/100 Dollars on the First day of June, 1917, and of a like additional annual premium on or before the anniversary of the same date in every year during the continuance of such Policy until twenty additional annual premiums shall have been paid, hereby agrees that, if there shall have been no failure to pay premiums as provided in said Policy, upon receipt at the Home Office of the Company of due proof that the Insured, prior to his attaining the age of sixty years, shall have become totally disabled by bodily injury or by disease so that he then is and will be thereby permanently and continuously prevented from engaging in any occupation whatsoever for remuneration or profit, and that such disability has existed continuously for not less than sixty days.

(A) payment of each subsequent full annual premium on said Policy and on this Agreement shall be waived as it becomes due during the said disability of the Insured, and any premium so waived shall not be deducted in any settlement under said Policy, and any values and benefits provided for in said Policy shall be the same as if said premium had been duly paid to the Company, except that any dividends apportioned to said Policy during said disability shall be payable in cash; and

(B) in addition that, if after one year from the date of receipt of proof as aforesaid due proof of the continuance of such total and permanent disability be furnished, upon satisfactory release and surrender by all parties in interest of said Policy (subject to restoration as hereinafter provided, and reserving the rights to any paid-up additions to the payees thereof), the Company will issue either

(1) a Contract whereby the Company will agree (a) to pay to said Insured each month, while living, one per centum of the amount insured by said Policy (exclusive of any paid-up additions) less any then existing indebtedness to the Company secured thereby until 100 such payments shall have been made (the first of such monthly payments to be made one month after issue of such Contract) and, in the event of the death of the Insured before 100 such payments shall have been made, then to pay an amount equal to the remainder of such 100 payments to such persons as, except for such surrender, would have been the payees of said Policy at its maturity, and (b) in the event that said Insured shall be living at the expiration of 100 months from the date of issue of such Contract, to pay thereafter to him a life annuity, the amount of each annual payment to be five times the amount of a monthly payment as aforesaid (the first of such annual payments to be made one year after the expiration of said 100 months, and such annual payments to terminate with the last payment due prior to the decease of the Insured); such Contract not to participate in any division of the Company's surplus;

or at the option of said Insured,

3

--(2) a Contract whereby the Company will agree to retain the
amount insured by said Policy (exclusive of any paid-up
Tadditions) less any then existing indebtedness to the Com-
>pany secured thereby, and to pay to the Insured such in-
terest thereon from the date of issue of such Contract as
shall, from time to time, be determined and thereto appor-
tioned by the Company, but at a rate not less than three
per centum per annum, payable annually or, at the option
of the Insured, semi-annually. quarterly or monthly, and
upon the death of the Insured, or upon the date when said
Policy would have matured as an endowment if prior to,
such death, to pay the amount so retained, together with
any accrued interest, to such persons as, except for such
surrender, would have been the payees of said Policy at
its maturity.

Notwithstanding that proofs of such disability shall have been accepted, the Company may thereafter, at its pleasure, but not oftener than once a year, demand of the Insured due proof of the 'failure to furnish suchcontinuance of such disability; and upon f proof, or if it appears to the Company that the Insured has become able to engage in any occupation whatsoever for remuneration or profit, no further premiums will be waived, and no further payments under either of said options will be made; and any Contract Issued as provided shall be canceled, and said Policy shall be restored reduced in amount by the sum of any and all payments made under such Contract, but subject to any

indebtedness to the Company on said Policy existing at the time of issue of such Contract, which indebtedness shall be reinstated.

Without prejudice to any other cause of disability, the total and irrecoverable loss of sight of both eyes, loss of both hands at or above the wrist, loss of both feet at or above the ankle, or similar loss of one hand and one foot, shall be considered to constitute total and permanent disability within the meaning of this Agreement.

The additional annual premium hereon, with an addition of two per centum thereof if paid in semi-annual instalments or three per centum thereof, if paid in quarterly instalments, may, on written request, be paid in such instalments beginning with the due date of the additional annual premium.

The payment of the additional premiums as herein provided is the consideration for the additional risk incurred under the provisions hereof, and does not entitle the Insured or any Beneficiary under said Policy to any additional participation in any division of the Company's surplus, or to any additional cash, loan or paid-up value thereunder; and failure to pay any additional premium hereon when due as herein provided or within thirtyone days thereafter, or to pay any premium or instalment thereof as provided in said Policy, will forthwith terminate all liability of the Company hereunder or on account of any payments made hereon; provided, however, that this Agreement may be reinstated at any time upon receipt of evidence of insurability satisfactory to the Company and payment of all arrears of premiums on said Policy and on this Agreement with interest at a rate to be determined by the Company not exceeding six per centum per

annum.

This Agreement shall become null and void if the Insured shall engage in military service out of the United States during war, or military service involving aeronautics or naval service whether in or out of the United States during war; provided that, upon presentation after the termination of such service of evidence of insurability satisfactory to the Company and payment of the additional premium aforesaid, this Agreement shall again become operative.

Dated at Hartford, Connecticut, this First day of June, A. D. 1917.

6

THE CONNECTICUT MUTUAL LIFE INSURANCE COMPANY, By WILLIAM H. DEMING, net Secretary.

1

20 PAYMENT LIFE ANNUAL DIVIDEND POLICY WITH DISABILITY BENEFITS.

No. 99999.

AMOUNT $10,000.

AGE 35.

ANNUAL PREMIUM $368.50.

CONTINENTAL LIFE INSURANCE COMPANY,
SALT LAKE CITY, UTAH.

Hereby insures the life of John Doe (hereinafter called the Insured) and promises to pay at its Home Office at Salt Lake City, Utah, Ten Thousand Dollars immediately upon receipt of due proof of the death of the Insured, to Mary Jane Doe, Wife of the Insured (hereinafter called the Beneficiary of the Insured), if living; otherwise, to the executors, administrators or assigns of the Insured, provided this policy is then in force, and is then surrendered, properly released.

The Consideration for this insurance is the application therefor, a copy of which is hereto attached or endorsed hereon; the payment of Three Hundred Sixty-Eight and 50/100 Dollars, for insurance for the term ending on the first day of June, 1918, and the further payment of a like amount on or before the corresponding day in each year thereafter until twenty full annual premiums, including the first, shall have been paid, or until the prior death of the Insured.

ANNUAL DIVIDENDS.

Upon the payment of the premium or premiums for the second policy-year, and at the end of the second and of each subsequent policy-year, this policy, while in force, will receive annually such dividends as may be apportioned to it by the Company.

Dividends thus apportioned shall, at the option of the Insured, be either

OPTION No. 1.

OPTION No. 2.

or premiums; or,

OPTION No. 3.

to the policy; or,

Paid in cash; or,

Applied toward the payment of any premium

Applied to the purchase of paid-up additions

OPTION NO. 4. Left to accumulate to the credit of the policy, with interest at the rate of three and one-half per cent per annum, payable in case of death of the Insured, and withdrawable at the option of the Insured.

Unless the Insured shall elect otherwise within one month after the mailing to the Insured by the Company of a written notice requiring the election of one of the four above options, the dividends will be applied to the purchase of paid-up additions to the Policy as provided in Option No. 3.

PRIVILEGES AND PROVISIONS.

1. PAYMENT OF PREMIUMS.-All premiums are payable in advance at the Home Office of the Company on or before the date specified in this Policy, or, at the pleasure of the Company, to the designated agent or collector; but in any case, only in exchange

for the Company's receipt signed by the President, Vice-President, Secretary or Assistant Secretary, and countersigned by such agent or collector. No notice of the non-payment of a premium, and no acceptance of a premium or premiums after maturity elsewhere than at its Home Office is to be construed as a waiver by this Company of any provision of this Policy, no matter how often repeated. This Policy is issued upon the payment of premiums annually but premiums may be paid at other times as follows:

Annually $368.50, or semi-annually $191.70, or quarterly $97.70, and the Insured may change from one to another of such methods of payment upon the written approval of the Company.

If any premium shall not be paid when due, or if any note or part thereof, or interest thereon, or any bill of exchange or writing of any kind whatsoever given by the Insured, or Beneficiary in this Policy named, or by any other party in payment or in part payment of a first or any subsequent annual or other premium due or to become due under this Policy, and whether given to said Continental Life Insurance Company or one or more of its agents, or to any other person or persons as payee therein, is not paid when due, this Policy shall thereupon ipso facto become null and void, except as otherwise provided in this Policy for automatic premium loans and days of grace. In the event of the death of the Insured while this Policy is in force, all sums, if any, due by the Insured to the Company shall be deducted from the amount of the death claim hereunder, including any unpaid portion of the premium for the then current policy year.

、,

2. GRACE. A grace of one month (not less than thirty days), subject to an interest charge at the rate of not to exceed six per cent per annum, will be granted for the payment of any premium after the first, during which period the insurance hereunder shall continue in force. If death occurs within the days of grace, the premium for the then current policy year, or any unpaid instalment thereof, will be deducted from the amount payable hereunder. cept as herein expressly provided, the payment of any premium or instalment thereof shall not maintain this Policy in force beyond the date when the succeeding premium or instalment thereof becomes payable.

Ex

3. LOANS. After two full annual premiums have been paid hereon, the Insured, upon a proper assignment of this Policy to the Company and the deposit of the Policy with the Company as security, may borrow at any time from the Company, a sum not greater than the cash surrender value hereof less any indebtedness to the Company hereon. Any unpaid balance of the premium for the then current policy year will be deducted and interest at not to exceed six per cent per annum will be charged in advance to the next anniversary of the Policy and annually in advance on that date and thereafter. Failure to repay any such loan or to pay interest shall not void this policy unless the total indebtedness hereon to the Company shall equal its Cash Surrender Value, nor until one month after notice of such fact shall have been mailed by the Company to the last known address of the Insured and of the Assignee of record at the Home Office of the Company, if any.

4. TABLE OF CASH SURRENDER OR LOAN VALUES, PAID-UP AND CONTINUED INSURANCE. The figures contained in the following table are for completed policy years and will be increased by the value of any dividend due and not paid or otherwise redeemed by the Company and by the value of paid-up additions bought with such dividends, but in case the Insured elects Option No. 4 of the dividend clause then by the amount credited to the Insured as provided under said Option. They will be reduced to the extent of any indebtedness hereon, The loan obtainable at the end of any given year may be secured during that year if the premium for the entire year has been paid.

* I Jud ;763 9H05 TO 9b4

"