NATIONAL LIFE INSURANCE COMPANY. ACTUAL RESULTS ON POLICIES ISSUED FROM 1903 TO 1912 Reserve: American 3%. 20 Payment Life-Age 45 at Issue. NET COST, Year PREMIUMS LESS DIVIDENDS FOR YRS. ENDING. If Continued. of Issue 1904 1905 1906 1907 1908 1909 1910 1911 1912 1913 1903 47.21|47.21 47.21|47.21 25.44 40.84 38 70 37.63 37.05 36.57 1904 1905 1906 1907 1908 1909 1910 1911 1912 47.21 42.19 41.92 41.50 39.68 38.64 38.09 37.57 7 326.80 40.85 233.17 93.63 20 Payment Life-Age 55 at Issue. 58.05 55.19 53.88 53.14 52.59 5 272.88 54.58 169.61 103.27 20.66 20 Year Endowment-Age 25 at Issue. Year of NET COST. Issue 1904 1905 1906 1907 1908 1909 1910 1911 1912 1913 ACTUAL RESULTS END OF NO. OF YRS. If Continued. If Surrendered. No. Total Av'age Guar. Total Av'age of Net Ann'l Cash Costless Ann'l Yrs. Cost. Cost. Value. C. V. Cost 1903 48.95 48.95 48.95 48.95 30.07 43.04 41.69 40.81 40.17 39.57 10 431.15 43.12 407.79 1904 48.95 44.76 44.42 44.06 43.48 42.27 41.39 40.78 40.17 9 390.28 43,36 356.80 33.48 48.95 44.76 44.42 43.91 42.82 41.96 41.36 40.78 8 348.96 43.62 307.68 41.28 48.75 44.76 44.30 43.36 42.51 41.93 41.36 7 306.97 43.85 260.34 46.63 47.02 42.78 43.80 43.05 42.45 41.93 6 261.03 43.51 214.66 46.37 45.12,44.22 43.48 42.94 42.45 5 218.21 43.64 179.31 44.69 43.90 43.41 42.94 4 174.94 43.74 137.58 37.36 44.87 43.87 43.41 3 131.65 43.88 97.19 34.46 44.29 43.87 2 88.16 44.08 0.00 88.16 44.29 44.29 44.29 0.00 44.29 1903 150.90 50.90 50.90 50.90 30.51 44.61 42.98 42.00 41.34 40.74 1906 1907 1908 1909 1910 1911 1912 3.83 5.23 6.69 57.78 8.25 55.58 9.26 44.95 8.99 41.92 10.48 20 Year Endowment-Age 45 at Issue. Annual Premium $55.70. 1903 155.70 55.70 55.70 55.70 31.99 48.54 46.31 45.13 44.44 43.83| 1904 55.70 50.33 49.97 49.59 48.99 46.92 45.76 45.08 44.44 1905 55.70 50.33 49.97 49.42 47.52 46.38 45.71 45.08 55.70 50.33 49.84 48.01 48.97 46.32 45.71 53.19 47.77 48.55 47.55 46.87 46.32 50.73 48.98 48.01 47.39 46.87 5 241.98 48.40 182.73 59.25 49.51 48.43 47.90 47.39 4 193.23 48.31 140.66 48.96 48.38 47.90 3 145.24 48.41 48.86 48.38 97.24 48.62 48.86 1 48.86 48.86 7.44 8.81 10.51 11.81 76.39 12.73 0.00 97.24 48.62 48.86 8 472.32 59.04 308.78 163.54 20.44 1 20.32 21.13 68.57 116.13 58.07 22.86 58 35 58.35 Dividends were payable at the end of the fifth year and annually thereafter on the issues of 1903. NATIONAL LIFE INSURANCE COMPANY OF VERMONT. va Twenty Payment Life Option Policy. Amount $10,000 Annual Premium, $372.70. se ful TE Age re re An Insurance of Ten Thousand Dollars is hereby granted on t life of John Doe of Montpelier, Vt., immediately payable upon rece at the Home Office of the Company in Montpelier, Vermont, of w proofs of the death of the Insured during the continuance of this th icy, to his wife Mary Doe. P ir W of lo Change of Beneficiary.-The right is reserved to the Insured, if assignment of this policy has been duly filed with the Company, designate a new beneficiary, from time to time, by filing written no thereof at the Home Office of the Company. Such change shall t effect only upon its endorsement on the policy by the Company. any beneficiary shall die before the Insured, the interest of st beneficiary shall vest in the Insured, unless otherwise provided by: policy. in k a Consideration.-This policy is issued in consideration of the app cation therefor and a premium of Three hundred seventy two Doll and Seventy Cents, to be paid to this Company upon delivery of 1 policy, and of the payment of a like sum on or before the seventh t of February in every year during the lifetime of the Insured, ti twenty full years' premiums have been paid. INCONTESTABILITY.-This policy shall be incontestable after one year from date, except for non-payment of premiums. 3 b t te D PARTICIPATION.-This policy shall participate in the surplus of the Comp and the Company will annually determine and account for the portion of the ible surplus accruing hereon. Dividends, when declared, shall become absolutely property of the Insured and at his option may be: 1st, Paid in cash; or 2d, plied toward the payment of any premium or premiums; or 3d, Converted int ditional paid-up insurance. Unless the Insured under the policy shall elect o wise within one month after any dividend is due, the same shall be paid in c POLICY THE ENTIRE CONTRACT.-This policy and its application, which P made a part hereof and a copy of which is hereen endorsed, together with Gene Provisions contained on the reverse of this page, which are hereby made a b of this policy as fully as if they were recited at length over the signatures bes unto affixed, constitute the entire contract between the parties. In Witness Whereof, the National Life Insurance Company nas, by President and Secretary, signed this policy this seventh day of February, 1908, Montpelier, Vermont. NON-FORFEITURE. GENERAL PROVISIONS. . (a) On failure to pay any premium or any part thereof, o any premium note or interest thereon, when due, this policy, except as otherwise provided herein, shall immediately lapse, if, however lapse occur after three ful years' premiums have been paid, the owner of the policy shall be entitled, at t end of successive policy years, to one of the settlements specified in the foll ing table which are: First, without action of the Insured, Non-participating tinued Term Insurance for $10,000 for the specified term; or, Second, on applicat and legal surrender of this policy within three months, a Paid-up Policy, (partie pating if for one hundred dollars or more); or Third, on application and legal render of this policy within three months, a Cash Value. TABLE OF CONTINUED AND PAID-UP INSURANCE AND CASH OR LOAN! VALUES. i (b) The above table of values represents the full reserves according to the Amer can Experience Table of Mortality with interest at three per cent., less a deduc tion in the table of continued insurance of not exceeding at any time two and one half per cent. of the amount insured; less a deduction in the table of cash or loa ues of not exceeding one per cent. of the amount insured up to the end of the enth policy year, said values for the eighth and any subsequent year being the 1 reserve; and with no deduction at any time in the table of paid-up insurance. corresponding values for intervening and subsequent years will be extended on uest upon a like basis of calculation. To these cash surrender or loan, and paidinsurance values will be added in any settlement the full reserve or face values pectively of any dividend additions in force. c) Should default occur in the payment of any quarterly or semi-annual premium thin the policy year, the cash or paid-up or continued insurance values will be # values at the beginning of the year plus a proportionate part of the increase values by the table for such year. d) Any indebtedness to the Company, unless otherwise provided in this policy, 41 be deducted from the cash value and will also proportionately reduce the sum paid-up insurance and the amount at risk under continued insurance. GOANS,—After three full annual premiums have been paid, the Company will n upon the sole security of this policy while continued in force, and upon rept by it of this policy duly assigned, up to the limit secured by the above specii cash or loan values at the end of the policy year within which application for → loan is made. The rate of interest on such loan shall not exceed six per cent. annum and if such interest be not paid, when due, it shall be added to the ncipal until the limit of said cash surrender value has been reached, whereupon, then the interest be not paid, the policy shall become pull and void, but not til one month after notice shall have been mailed by the Company to the last own address of the person to whom the loan was made and of the Insured and y assignee. NOTE.-If the Insured or any beneficiary is a minor, or cannot make a legal ensfer, no loans will be made upon his signature. No lean will be made on conued Insurances. PREMIUM PAYMENTS.-All premiums, both first and renewal, are payable in vance at the Home Office or to an agent of the Company upon delivery, on or fore date due, of a receipt signed either by the Secretary or Actuary of the Comny and countersigned by said agent. Notes for premiums will be accepted on e sole signature of the Insured, provided this policy be not duly assigned, so long the free loan value of the policy is sufficient security therefor, and such notes 11 be a lien on the policy as fully as if executed by all persons having an inrest therein and accompanied by proper assignment thereof. GRACE.-A grace of thirty-one days will be granted for payment of every pre um after the first, holding the insurance in full force, but if death occurs dur g said period, the overdue premium will be deducted in any settlement of this licy. INSTALMENT SETTLEMENTS.-(a) The Insured, provided this policy has not en assigned, on written notice to the Company and the return of this policy for ch endorsement may provide for the payment of its proceeds as follows: (1) To have the Company retain all or part of such proceeds, subject to its payent annually to the beneficiary of three per cent. interest thereon, first payment he year after maturity of this policy. If this mode of settlement is used, the ompany will pay pro rata interest for the year in which the beneficiary may die, ⚫ at any anniversary, upon request of the beneficiary, it will pay the proceeds full in determination of its entire obligation. (2) To have all or any part of such proceeds paid to the beneficiary in equal early instalments, as per table on fourth page hereof, first payment immediate. (3) To have all or any part of such proceeds paid to the beneficiary in a given umber of instalments certain and also during the after lifetime of the beneficiary, est payment immediate, as per table on fourth page hereof. (b) The guarantees next immediately preceding are subject to these further mual understandings: (1) The Company will pay the beneficiary at any time the commuted value of npaid instalments certain, computed at three per cent. interest yearly, unless herwise directed by written notice from the Insured. rom (2) The beneficiary may make use of any of the modes of payment by instalments erein provided unless the Company has been otherwise directed by written notice the Insured and provided this policy does not stand assigned. REINSTATEMENT.-In case of lapse of this policy, provided it has not been urrendered to the Company, it may be reinstated at any time on written appliation therefor, and the payment of all its premium arrears and reinstatement or ayment of any indebtedness existing at the date of original default, with interst not exceeding six per cent. per annum, and provided satisfactory evidence of nsurability is supplied. MISSTATEMENT IN AGE.-If the age of the Insured has been misstated, on satsfactory proof thereof the amount payable under this policy shall be such as the remium would have purchased at the correct age, or at the option of the Insured he premium may be adjusted and credit given to the Insured or to the Company, according to the Company's published rate at date of issue. 1 ASSIGNMENTS.-No assignment of this policy shall be binding upon the Com. any until it be filed with the Company at its Home Office. The Company assumes 10 responsibility for the validity of any assignment. NOTE.-The claim of any assignee shall be subject to proof of interest. The interest of any minor (beneficiary or assignee) must be released by a legally appointed guardian, duly authorized by the appointing court, before the surrender value can be paid in cash. Number of Instalments. SETTLEMENT.-Any indebtedness to the Company on account of this policy, cluding any deferred premiums for the uncompleted policy year, will be dedon in any settlement of this policy as a claim by death. REPRESENTATIONS.-All statements made by the Insured shall, in the sence of fraud, be deemed representations and not warranties, and no such cat an inf he ment shall avoid this policy or be used in defence of a claim upon it unles thi tained in the written application hereon endorsed. tr an ize ALTERATIONS.-No one except the President, a Vice-President, Secretary Actuary of the Company, has power, in behalf of the Company, to make or m this policy, to extend the time for paying any premium, to waive any forfeit or to bind the Company by making any promises or by accepting any represe tion or information not contained in the application for this policy. These pomy will not be delegated. wi LIMITATION OF ACTION.-No action at law or in equity shall be comme co against the Company for claim under this policy after six years from the lin cause of action shall accrue, and it is agreed that, in case of claim by death, a an of action, if any, shall accrue on the date of death of the Insured. Or W NOTICE TO MEMBERS.-The Insured is hereby notified that all claims m ti this policy are payable at the Home Office in Montpelier, Vermont; that hel member of the National Life Insurance Company during the continuance of policy and of any paid-up or continued insurance arising therefrom, and that annual meetings of the Company are holden at its Home Office in Montpelier, mont, on the 3d Tuesday of January, in each year, at 10 o'clock A. M. INSTALMENT TABLE. Instalment Settlements on Basis of $1,000 of Insurance Proceeds. PROVISION NO. (2) PROVISION NO. (3) 1000.00 $ under 40.62 40.12 89.52 88.88 88.28 50 $ 68.09 11 1234 64.44 61.26 57.30 52.984 65.85 62.32 57.98 58.35 97.54 91.29 85.95 15 81.88 77.29 78.74 70.59 11.23 40.70 40.08 89.41 88.72 53 67.82 68.41 58.66 53.694 54 68.87 64.52 59.38 54.0142 14 41.45 40.91 40.28 39.60 88.90 15 41.68 41.14 40.49 39.80 89.08 55 70.47 65.64 69.97 64147 16 41.91 41.87 40.71 40.00 89.27 56 72.18 66.76 60.58 54.4% 42.17 41.61 40.94 40.22 89.47 18 42.43 41.86 41.18 40.44 89.68 42.70 42.12 41.48 40.68 89.89 42.99 42.89 41.69 40.98 40.11 21 43.29 42.68 41.96 41.17 40.34 61 43.93 43.29 42.58 41.70 40.82 44.27 43.62 42.84 41.98 41.08 67.78 65.26 29 44 68 43.96 43.16 42.28 41.84 27 45.40 44.69 43.84 42.90 41.89 67 98.67 77.66 64.85 55.74 57 78.89 67.89 61.17 64.7994 75.69 69.01 61.72 55.00 77.55 70.12 62.24 55.17 64 79.46 71.20 62.71 56.32 81.48 72.26 68.15 55.44 88.42 78.29 68.54 55.54 85.46 74.27 63.89 55.61 87.51 75.20 64.19 55.67 65 89.57 76.09 64.45 55.71 91.63 76.91 64.67 55.78 95.68 78.35 64.99 55.75 69 97.67 78.96 65.09 AGREEMENTS IN APPLICATION. I hereby certify that I have read all the statements and answers in this applion, and agree, on behalf of myself and of any person who shall have or claim interest in any contract issued hereunder: That no material circumstance or ›rmation has been withheld or omitted touching my past and present state of 1th and habits of life, and that said statements and answers, together with declaration, as well as those made to the Company's medical examiner, are ▸ and shall be the basis of the policy hereby applied for; hat there shall be no contract of insurance until a policy shall have been issued delivered to me and the premium thereon paid to the Company, or its authorI agent, during my life time and good health; 'hat if, within one year from the date of the policy, I shall suicide or destroy self, sane or insane, the policy hereby applied for shall be null and void; or if, hin that period I shall be personally engaged, without the Company's written sent, in blasting, underground mining, submarine labor, the manufacture, handor transportation of explosive or inflammable substances, or in service upon railroad train, except as conductor, baggage master or mail or express agent passenger trains, or as an ordinary seaman, or in the handling of live electric or dynamos, or in aeronautic ascensions, or in military or naval service in e of war, the policy hereby applied for shall be null and void while so engaged. es |