TABLE OF CASH OR LOAN VALUE, PAID-UP LIFE INSUR- The following table applies to a policy of One Thousand Dol- lars. As this contract is for Ten Thousand Dollars, the loan value, cash surrender value or paid-up insurance available in any year will be ten times the amount stated in the table for that year. No deductions from these values will be made for a surrender charge. Figures for later years will be furnished upon request. The surrender value for later years is the full reserve. REINSTATEMENT. This policy upon evidence of insurability satisfactory to the Company may be reinstated by payment of arrears of premiums with interest at not more than six per centum SUICIDE AND MILITARY OR NAVAL SERVICE.-Death resulting from suicide, whether sane or insane at the time, or death result- ing from military or naval service in time of war, during the first year under this policy, are risks not assumed by the Company, and in event of death from either of said causes, during the first year, the only liability shall be the return of the premiums actually paid thereon upon the return of this policy at the Home Office properly INCONTESTABILITY.-This policy and the application therefor constitute the entire contract between the parties and shall be in- contestable after one year from its date except for non-payment of It is free from restrictions as to residence, occupation, travel All statements made by the insured shall in the absence of fraud be deemed representations and not warranties, and no such statement shall avoid this policy unless it is contained in a written application and a copy of such application shall be endorsed upon or attached to this policy when issued. If the age of the insured has been misstated, the amount pay- able hereunder shall be such as the premium paid would have pur- OPTIONS AT MATURITY. -The insured, by written notice to the (1) By the payment of interest thereon at 32 per centum per annum, payable annually, to the payee under this policy at the end of each year during the life of the payee and by the pay- ment upon the death of the payee of the said sum and accrued interest to the executors, administrators, or assigns of the payee, unless otherwise directed in said notice. (2) By the payment of equal annual installments for a specified number of years, the first installment being payable im- OPTION 3 OPTION 3 mediately in accordance with the following table for each $1,000 of said net sum. (3) By the payment of equal annual installments payable at the beginning of each year for a fixed period of twenty years and for so many years longer as the payee shall survive in accordance with the following table for each $1,000 of said net sum. Installments payable under options (2) and (3) which shall have not been paid prior to the death of the payee shall be paid, unless otherwise directed in said notice, to the executors, administrators, or assigns of the payee. Options (2) and (3) payable monthly if desired. If the insured shall not have directed otherwise the beneficiary may after the death of the insured, by like written notice, and with the written consent of the assignee, if any, select either of the above options. Unless otherwise specified by the insured the payee may on any interest date receive the amount yet due under option (1), and may at any time receive the commuted value of payments yet to be made, computed upon the same basis as option (2) in the following table, provided that no such commutation will be made under (3) except after the death of the payee occurring within the aforesaid twenty years. TABLE OF INSTALLMENTS FOR EACH $1,000 Multiply each installment by number of thousands or fractions thereof due under the policy. Life Income for 20 Years Certain, but to Continue Thereafter During Life of OPTIONAL DISABILITY BENEFIT.-The insured at the time of making application for this policy, and upon the additional payment of twenty-five cents per annum per one thousand of insurance, may elect the benefit shown under the following clause headed "Protection in Event of Total Disability." PROTECTION IN EVENT OF TOTAL DISABILITY. -After one full annual premium shall have been paid upon this contract, and before a default of payment of any subsequent premium, and prior to attained age of 55, if the insured shall furnish satisfactory proof that he has, since such payment, become wholly disabled by bodily injury or disease, and will be permanently, continually and wholly prevented thereby for life from pursuing any and all gainful occupations, the Company by an endorsement in writing hereon will continue the insurance during such disability without payment of premiums, and the values in the Table on Page 2 shall increase in the same manner as if the premiums were paid by the insured. Or, Second: At the option of the insured and subject to the above conditions, all future premiums upon this policy shall be discontinued, and the insured shall receive upon the furnishing of said proof, one twentieth of the face of this policy in cash, and onetwentieth upon the anniversary of said payment on each year thereafter until twenty full annual payments have been made. Each such payment shall reduce to that extent the amount of insurance then in force, and the table of values set forth on Page 2 of this policy shall be correspondingly decreased. If there shall be an indebtedness upon this policy at the time of such total disability one-twentieth of the difference between such indebtedness and the face of the policy shall be paid each year as specified above. In event of the death of the insured after payment of one or more installments, the remaining portion of the policy shall be paid to the beneficiary after deducting all indebtedness together with the amount paid by installments. In addition to or independently of all other causes of total and permanent disability the Company will consider the entire and irrevocable 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 one entire hand one entire foot as total and permanent disability in the meaning of the above provision. Upon any anniversary of this contract the above provisions of "Protection In Event of Total Disability" may be canceled by the insured in which event the subsequent annual premiums will be reduced twenty-five cents for each One Thousand of insurance hereunder, and such reduction shall be endorsed hereon. APPLICATION. I hereby agree that this application and the policy hereby applied for, taken together, shall constitute the entire contract between the parties hereto. I hereby represent that all the answers made to the above questions and those that shall be made to the medical examiner, are true, and form the basis of the contract, and that this contract shall not take effect until the application, together with the medical examination, has been approved at the Home Office of the Company, and the first premium has been paid during my continued good health. I also agree to have the required examination made at once by a physician acceptable to the Society. Supplement to Application For Insurance. 9. I hereby agree that any policy the Company may issue on my application may, if the rules of the Company so require, contain a provision for extra premium if I travel on the high seas, engage in Military, Naval, Red Cross or other Relief Service, in experiments with or ascensions in balloons, aeroplanes or other devices for aerial locomotion; and that if the policy contains provisions for Double Indemnity and Disability Benefits, such provisions shall immediately terminate should I engage in any of the above work or service. I hereby agree that the above answers and agreement shall form a part of my application for insurance dated the........day of...... 19..... 20 PAYMENT LIFE ANNUAL DIVIDEND POLICY WITH DISABILITY AND LIFE CONSERVATION CLAUSE. No. 99,999. AGE 35. ANNUAL PREMIUM, $351.70. CENTRAL STATES LIFE INSURANCE COMPANY ST. LOUIS, MISSOURI. Promises to pay Ten Thousand Dollars, upon receipt, at its Home Office in St. Louis, Missouri, of due proof of the death, during the continuance of this Policy, of Will B. Thrifty, the Insured hereunder, to Prudence Thrifty, Wife of the Insured. 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. BY JEFFERSON CITY, Mo,,. Deputy Superintendent 1917 Superintendent This Policy is absolutely free of conditions as to residence, occupation or travel. No permit or extra premium will be required for military or naval service. a CONVENIENCE IN THE PAYMENT OF PREMIUMS. Premiums after the first may be paid annually in advance, or in suitable instalments thereof in advance, with deferred payments represented by proper form of note. The Company will allow change from one to another of such modes of payment upon written request therefor by the Insured on the Company's form. All premiums are payable either at the Home Office of the Company or to an authorized agent, upon delivery of a receipt signed by the President, Vice-President or Secretary and countersigned by the agent designated. If any premium or instalment therof is not paid on the date when due, this Policy shall become void and all payments previously made shall remain the property of the Company, except as herein otherwise provided. GRACE IN PAYMENT OF PREMIUMS. A grace of thirty-one days, without interest charge, will be allowed for the payment of any premium after the first, during which time the insurance shall continue in force. If the Insured die within said period, the unpaid premium shall be deducted from the amount payable under this policy. INCONTESTABILITY. This Policy shall be incontestable after one year from its date of issue except for non-payment of premium. INSTALMENT PRIVILEGES. Payment of the proceeds of this Policy as a death claim may be changed from payment in one sum to payment by instalments, as provided on the fourth page hereof. CASH LOANS. At any time after three full annual premiums shall have been paid hereon, within thirty-one days of application therefor, the Company will loan, upon proper assignment of this Policy to the Company upon its prescribed form and on the sole security hereof, with interest at the rate of six per cent per annum, payable in advance, a sum not exceeding the Loan Value of this Policy at the end of the then current policy year, as provided in the Table of Values herein contained, plus the reserve on any dividend addition, less any indebtedness to the Company hereon or secured hereby, and any unpaid portion of premium for the balance of said policy year. If interest is not paid when due, it shall be added to the principal and bear interest at the same rate. Failure to repay such loan or interest thereon, shall not avoid this Policy, unless and until the total indebtedness hereon or secured hereby shall equal the Loan Value, nor until thirty-one days after notice shall have been mailed to the last known address of the Insured, and any Assignee of record at the Home Office; but failure to repay such loan after the total indebtedness, as aforesaid, shall equal said Loan Value and after giving such notice, shall render this Policy void. BENEFICIARY-CHANGE OF Provided the Insured has reserved the right to change the beneficiary in the application herefor, the Insured may at any time while this Policy is in force, by written notice to the Company at its Home Office, change the beneficiary, such change to take effect only upon endorsement of the same on the Policy by the Company, whereupon, all rights of the former beneficiary shall cease; proIvided that no such change of beneficiary shall be valid if the Policy or any interest therein be assigned at the time of such change. If any beneficiary shall die before the Insured, the interest of such beneficiary shall vest in the Insured. POLICY MAY BE REINSTATED. In event of default of premium payments, unless the cash surrender value has been paid, it is agreed that this Policy may be reinstated upon presentation at the Home Office of evidence of insurability satisfactory to the Company and payment of arrears of premium and the payment or reinstatement of any indebtedness to the Company hereon or secured hereby, with interest at a rate of not exceeding six per cent per annum. ANNUAL DIVIDENDS. After the first policy year, upon payment of the premium for the second policy year, and annually thereafter upon payment of the premium for each policy year, this Policy will be credited with a dividend as apportioned by the Company. Dividends will be credited annually to this Policy after it shall have become fully paid-up by the payment of all premiums required by the terms hereof to be paid. OPTIONS.-Dividends may be: (a) Taken in cash; or, (b) Applied toward the payment of any premium; or, (c) Applied to the purchase of participating paid-up additions to the Policy; or (d) Left to accumulate to the credit of the Policy at a rate of interest not less than three and one-half per cent per annum, and payable at the maturity of the Policy, but withdrawable on any anniversary of the Policy. Unless the Insured shall elect otherwise within three months after mailing by the Company of a written notice requiring the election of one of the four above options, the dividends will be applied as provided in option (a). Paid-up additions may be surrendered at any time for cash, and the cash value thereof shall not be less than the original dividend. |