ÆäÀÌÁö À̹ÌÁö
PDF
ePub
[merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][ocr errors][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][ocr errors][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][ocr errors][merged small][merged small][merged small][merged small][merged small][ocr errors][merged small][merged small][merged small][merged small][ocr errors][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][ocr errors][merged small][merged small][merged small][ocr errors][merged small]

Any dividend additions shall operate to increase the benefits in the above schedule of values.

The values in the above table are based upon the British Offices Life Tables, 1893, OM (5), with interest at three per cent less an amount not exceeding two and one-half per cent of the sum assured. The cash value in any year is equal to the value of the extended insurance calculated on the basis of the above mentioned table of mortality and rate of interest. After the twentieth year the minimum basis for values shall be the above mentioned table of mortality and rate of interest, less an amount not exceeding one per cent upon the sum assured.

THE CANADA LIFE ASSURANCE COMPANY.

To be attached to Policy No. 99999 on the life of John Smith and to be read as part thereof.

TOTAL DISABILITY BENEFIT.— (a) After this policy shall have been in force one full year, if the assured before attaining the age of sixty years shall furnish during continuance of this contract proof satisfactory to the Company that he has become wholly and permanently disabled by bodily injury or disease, so that he shall and will be permanently, continuously and wholly prevented thereby from performing any work for compensation or profit, or from following any gainful occupation, and if premiums have been duly paid to the end of the policy year, in which such proof is approved, the Company will waive payment of the premiums thereafter falling due while such disability remains total and permanent and not otherwise, and will make endorsement hereon to that effect, which premium so waived will not be an indebtedness hereon and this policy will continue in full force.

(b) In addition to waiving premiums as aforesaid the Company, after proof of such disability as provided in (a), will pay, one year after such proof, one-tenth of the sum assured under the policy and a like amount yearly thereafter upon the anniversary of the first payment until ten such payments in all have been made. Should the death of the assured occur before the total of the payments so made is equal to the sum assured, the difference between the total payments made and the sum assured shall be paid in one sum to the beneficiary or other person entitled. Each such pay

ment shall reduce to that extent the amount of assurance in force, and the Loan and Surrender Values shall be based upon the reduced amount. If at any time, when any such payment is due, there exists an indebtedness on the policy in excess of the Cash Surrender

Value of the reduced amount of assurance, the Company will apply such part of the payment as may be necessary to reduce the indebtedness to the amount secured by such Cash Surrender Value.

PROVIDED ALWAYS that notwithstanding proof of disability may have been accepted by the Company, the assured shall, as often as required by the Company, but not oftener than once a year, furnish satisfactory proof of the continuance of such disability. If the assured shall fail to furnish such proof or if he shall so far recover as to be able to engage in any gainful occupation, then no further premiums shall be waived and no further payments under (b) shall be made by the Company. In such an event, if the amount of the assurance shall have been reduced by the amount of the payments made under (b), such reduced amount of assurance shall thereafter be deemed the sum assured hereunder and the premiums thereafter falling due, as well as all benefits under the policy, shall be reduced proportionately.

Without prejudice to any other cause 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.

This benefit is granted in consideration of an extra annual premium of Seven and no/100 Dollars, and this extra premium is included in the amount of the premiums stated on the first page of this policy. This benefit and the extra premium therefor may be cancelled by the written request of the assured at any premium anniversary upon endorsement of such cancellation upon the policy by the Company.

If this benefit be continued in force until the assured has attained his sixtieth birthday any premiums which may fall due thereafter on this policy shall be reduced by the amount of the extra premium above stated for this benefit.

Toronto, Canada, June 1, 1917.

Should the assured engage in military or naval service in time of war, this benefit shall thereupon become null and void and the extra premium mentioned above shall thereafter cease to be pay

able.

C. R. ACRES,

Secretary.

APPLICATION.

H. C. Cox,
President.

I hereby declare and agree that to the best of my knowledge and belief I am at present in good health, not being afflicted with any disease or disorder, external or internal, and that the answers to the above questions are, and that those to be given to the Company's Medical Examiner shall be, full, complete and true; that I will accept and pay the first premium on the policy hereby applied for when issued by the Canada Life Assurance Company, subject to the privileges and conditions contained in said policy; and further that the said policy shall not take effect until the same shall be issued and delivered by the said Company and the first premium paid thereon in full, and Head Office receipt therefor be received by me, while my health is in the same condition as described in this application and in my answers to the Company's Medical Examiner; and further that the principles and methods now or hereafter followed by the Company in determining and allotting the surplus in connection with participating policies shall be accepted by all parties; and further that the Company shall not be liable on the said policy in the event of my death by self-destruction (whether I be sane or insane) during the first policy year.

I hereby request that the Company's automatic premium loan privilege shall become operative should that privilege be available under the policy hereby applied for. hom

MEDICAL EXAMINER'S FORM.

3

The foregoing answers are full, complete and true, and are a continuation of and form part of my application for Assurance to and in the Canada Life Assurance Company. moje odd to (2)

20 PAYMENT LIFE GUARANTEED GRADED COUPON OPTIONS POLICY WITH DISABILITY BENEFITS.

No. 99,999.
AMOUNT, $10,000.00.

AGE, 35.

PREMIUM, $381.40.

THE CAPITOL LIFE INSURANCE COMPANY

OF COLORADO.

HOME OFFICE DENVER, COLO.

By this Policy of Insurance agrees to pay the sum of ($10,000.00) Ten Thousand Dollars, at its Home Office in the City of Denver, IMMEDIATELY upon the receipt of due proof of the death of John Doe, of Denver, County of Denver, State of Colorado, (the Insured under this Policy), to Mary Doe, Wife, with the right of revocation, subject to all the requirements, priviliges and provisions stated on this and the following pages, which are conditions precedent, and are a material part of this contract as fully as if they were recited at length over the signatures hereto affixed.

THIS CONTRACT is made in consideration of the written application of the above named Insured, which is made a part hereof, a copy of which is hereto attached, and the payment in advance to said Company, on the delivery of this policy, of Three Hundred Eighty-one and 40-100 Dollars, being the premium for term insurance ending on the Fourth day of February, 1916, and the further payment of a like sum annually upon the Fourth day of the month of February in every year during the life of the said Insured, until the premiums for twenty full years shall have been duly paid to the said Company.

In Witness Whereof, the Company has caused this Policy to be executed this Fourth day of February, 1915.

THOS. F. DALY,
President.

PREMIUM WAIVER AND DISABILITY BENEFIT.

SECTION 1.-After one full year's premium has been paid hereon and before default in the payment of any subsequent premium, if the Insured prior to attaining age sixty (60) shall furnish satisfactory proof that he has since such payment become totally and 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 endorsement in writing hereon will continue the insurance in force during such disability without payment of premiums, and the values in Table 1" shall remain the same as if the premiums were paid by the Insured.

Upon the written request of the Insured, the beneficiary and any assignee, after proof as aforesaid, the Company will pay in any policy year during such total and permanent disability, if there shall be no indebtedness against the policy, not more than one twentieth (1-20) of the amount originally insured as stated on the first page

!

hereof, or if there shall be an indebtedness not more than one twentieth (1-20) of the difference between such indebtedness and the amount originally insured, each of such payments shall reduce to that extent the amount of insurance then in force, and in the proportion of such payments to the amount originally insured shall reduce the values set forth in "Table 1," and, if when the payments so made shall, together with any indebtedness to the Company, equal the amount originally insured, the Company's obligation under this policy shall be fully satisfied and discharged.

The Insured shall furnish satisfactory evidence of continued, total and permanent disability whenever so requested by the Company. Without prejudice to any other cause of disability the following will be considered as total and permanent disability within the meaning of this provision:

(a) The entire and irrecoverable loss of sight of both eyes; or (b) the severance of both hands at or above the wrists; or (c) the severance of both feet at or above the ankles; or (d) the severance of one entire hand and one entire foot.

Should this policy be surrendered for paid-up insurance under part (b), or for extended insurance under part (c), of Section V of the "Options on Surrender," the provisions of this section, (Section I), shall not apply.

GUARANTEED COUPON OPTIONS.

SECTION II.-(a) At the maturity of any coupon attached hereto, the amount thereof may, upon the surrender of the said coupon to the Company, be applied to the annual premium then due on this policy; or, upon the payment of the said premium in full, the amount of the said coupon, upon its surrender to the Company, may be withdrawn in cash, or, within thirty (30) days thereafter, applied to the purchase of a reversionary addition.

(b) If, however, after the first policy year, the premium, when due hereon, be paid in full, and the amount of the coupon then due the insured be left with the Company, the said amount shall accumulate at interest; and, at any time thereafter, within twenty (20) years from the date hereof, the said amount, together with interest thereon compounded at three and one-half (32%) per cent per annum for each full year, will be paid upon the presentation of the said coupon; provided always that, if, at any time, this policy be continued in force through the operation of the "automatically nonforfeitable" condition thereof, then, as provided in the said condition, the amount of any and all matured unpaid, and maturing, coupons, with any interest thereon, together with the reserve value of any and all reversionary additions, shall be applied to further continue this policy in force.

(c) In the event of the death of the insured while this policy is in force, the amount of any and all matured unpaid coupons shall, upon the surrender to the Company of this policy and all coupons then thereon, be paid in addition to the amount of the policy, less any indebtedness to the Company.

(d) If the twenty annual premiums required on the first page hereof be paid in full, and if, as each coupon attached hereto matures, the amount thereof shall have been left with the Company to accumulate at interest until the end of twenty years from the date hereof, then, upon the surrender to the Company of this policy and all the said original coupons, the insured shall have the option of one of the following modes of settlement:

1. Receive the sum of Seven Thousand Six Hundred and Ninety Dollars ($7,690.00) in cash; or,

2 Receive an annuity of Six Hundred and Twenty Dollars, ($620.00) payable at the end of the first year, and annually thereafter during the lifetime of the said insured; or,

3 Receive a paid-up life policy for Ten Thousand Dollars, ($10,000.00) and the sum of Two Thousand and Thirty Dollars, ($2,030.00) in cash.

(e) If the annual premium required on the first page hereof be paid in full for fifteen (15) years, and if, as each coupon matures, the amount thereof shall have been left with the Company to accumulate at interest until the end of fifteen (15) years from the date hereof, then, upon the surrender to the Company of all the coupons originally attached hereto, the Company will endorse this policy paid-up for Ten Thousand Dollars.

(f) If the annual premium required on the first page hereof be paid in full for twenty (20) years, then, irrespective of the manner in which the insured may have applied the amounts of the matured coupons, the said insured shall, at the end of the said twenty (20) years from the date hereof, have the option of one of the following modes of settlement:

1 Surrender to the Company this policy with any reversionary additions and any unpaid coupons then thereon, and receive the sum of Five Thousand Six Hundred and Sixty Dollars, ($5,660.00) in cash, together with the cash value of such reversionary additions and coupons; or,

Fy $2.
Surrender to the Company any unpaid coupons then on this
policy, for their cash value, and receive a paid-up policy for Ten
Thousand Dollars ($10,000) and any reversionary additions; or,

3. Surrender to the Company this policy with any reversionary. additions and any unpaid coupons then thereon, and receive an annuity of Four Hundred and Fifty Dollars ($50.00) increased by whatever amount the cash value of such reversionary additions and coupons will purchase; payable at the end of the first year, and annually thereafter during the lifetime of the said insured.

[ocr errors][merged small][merged small]

SECTION III. If the owner shall not, within one month from default, surrender this Policy to the Company at its Home Office, in accordance with one of the Options on Surrender, and if any premium due hereon be not paid in accordance with the provisions of this contract, the amount of the premium, without any action on the part of the Insured, shall be charged against the Policy as a loan; provided the loan value on the premium due date, as stated er Page 3 hereof, after deducting therefrom all existing loans and other indebtedness with accrued interest, be sufficient to permit of the advance of the premium and interest to the end of the policy year in which the loan is made. Interest on such loan shall be charged in advance at a rate not exceeding six per cent per annum, and unless paid in advance shall be added to and form part of the principal of the loan, so long as the loan value of the policy will so permit. If the loan value or the balance thereof shall not be sufficient to permit of the advance of the premium and interest to the end of the policy year in which the loan is made, then it shall be used to continue this Policy in force for such shorter period (even if it be but one day) as the said loan value or balance thereof shall permit. Such loan and interest accumulations, if not paid in cash, shall constitute a first lien against the Policy until repaid, in priority to the claim of any beneficiary or assignee; and at any time while this policy is thus maintained in force, payment of premiums may be resumed without any medical re-examination.

It is further understood and agreed that, upon the exhaustion of the loan value referred to above, the amount of any and all matured unpaid, and maturing, coupons, with any interest thereon, together with the reserve value of any and all reversionary additions, shall be applied to further continue this policy in force, in the same manner and upon the same conditions as the said loan value.

The termination of this policy from any cause, or the surrender for any benefit thereunder, voids all unmatured coupons then thereon, and the said coupons, on demand, shall be returned to the Company.

[ocr errors][ocr errors][ocr errors][merged small]
« ÀÌÀü°è¼Ó »