year as shown in Column (3) of the "Table of Death Benefits and Surrender Values" on page two hereof, in addition to the principal sum hereby insured. If the death of the Insured occurs during or subsequent to the twentieth Policy year the full amount insured under this Policy shall be the sum of Twelve Thousand ($12,000) Dollars.

The Insured may elect, however, to apply the Cash Value of the Annual Addition for the ensuing Policy year in part payment of the annual premium due hereon at the beginning of any such Policy year. The amount then due the Company hereon for any Policy year shall be the annual premium stated on page three hereof, less the Cash Value shown in Column (2) of the "Table of Death Benefits and Surrender Values" herein for the year for which said premium is due.

OPTIONS AT THE END OF TWENTY YEARS.-This Policy shall participate in the profits of the Company as follows:

If the Insured is living on the 21st day of November, 1930, and if all premiums have been duly paid to said date, and not otherwise, the Company will ascertain the amount of profits then accumulated on this Policy, and the Insured shall then have the option of receiving:

(1) A fully Paid-up Policy for 10,000 Dollars and cash equal to the amount of profits then apportioned to this Policy.

(2) A Guaranteed Surrender Value of 5,660 Dollars and the accumulated profits then apportioned to this Policy, both in cash.

(3) A Guaranteed Annual Income for life of 420 Dollars, payable at the end of each Policy year and the amount of profits then apportioned to this Policy in cash.

The profits apportioned as provided above may, at the option of the Insured, be applied to purchase additional Paid-up Insurance, subject to evidence of insurability satisfactory to the Company, for any excess over the amount hereby insured.

If no other option has been selected by the Insured within one month from the end of the accumulation period, this Policy will be continued in force as an annual dividend policy, and the accumulated profits will be paid to said Insured in cash.

PAYMENT OF PREMIUMS.-All premiums under this Policy are payable in advance either at the Home Office or to an Agent upon the delivery of a receipt signed by the President, Vice-President or Secretary of the Company.

No officer other than those stated, and no Agent, has the power to make or to modify this or any other contract of the Company in any respect whatever, and the Company is not responsible for, and shall not be bound by, any promises or representations made by any person other than the officers named, and then not unless said promises or representations are in writing and signed by one of the offlcers stated.

If any premium or note or other obligation given for all or a part of any premium or other indebtedness is not paid on or before the date when due, the liability of the Company hereunder shall cease, except as otherwise provided in this Policy.

The method of payment of premiums hereon may be changed at any time after the first Policy year upon application to the Home Office before the end of the month of grace, on the form prescribed by the Company.

GRACE IN PAYMENT OF PREMIUMS.-A period of grace of on month will be allowed for the payment of every premium hereunde after the first, without any interest charge therefor during whic month the full insurance hereunder shall continue in force; if how ever, the Insured shall die within said period of grace, the unpai balance of the premium for the current Policy year will be de ducted in any settlement hereunder.

INCONTESTABILITY.-This Policy and the application therefo shall constitute the entire contract between the Insured and th Company, and shall be incontestable for any cause whatever afte one year from the date of issue, provided premiums are duly paid.

If during the first Policy year the Insured shall suicide, whethe sane or insane, or die as a consequence of the violation of law, th Company shall be liable only for the premium actually paid hereon All statements made by the Insured shall in the absence o fraud be deemed representations, and not warranties.

If the age of the Insured has been misstated, the amount pay able under this Policy shall be the amount which the premium ac tually paid would have purchased at the correct age.

CASH LOANS.-After three full years' premiums have been pai hereon the Company at any time while this Policy is in force wil loan upon the proper assignment of said Policy, and upon the sol security thereof, at a rate of interest which will not exceed six pe centum per annum, a sum equal to or at the option of the owne hereof, less than, the reserve hereon at the end of the current Policy year, including the reserve on any Annual Additions then in force The Company will deduct from such loan value any existing indebt edness hereon, and any unpaid balance of the premium for the cur rent Policy year, and will collect interest in advance on the loan t the end of the current Policy year; said loan may be deferred fo not exceeding ninety days after application therefor is made.

Failure to repay any such loan, or to pay interest thereon, shal not avoid the Policy until the total indebtedness hereon to the Com pany shall equal or exceed the loan value at date of default.

LOANS WITHOUT REQUEST OF INSURED.-If any premium hereo shall not be paid when due, and if no other surrender option has been chosen by the Insured within the month of grace, the Company will, without request on the part of the Insured, charge the amoun then due hereunder as a loan against the Policy, with interes in advance at a rate not exceeding six per centum per annum, if the loan value hereon at date of default, including the loan value of any existing Annual Additions, is sufficient to secure all indebted ness hereunder with interest. If the premium is so charged, this Policy will be continued in force the same in all respects as though said loan had been requested by the Insured. The same benefit will be applied from time to time as the premiums become due hereunder and are not paid, as long as the balance of the loan value hereon at the last date of default is sufficient to pay for one day's insurance on a pro-rata basis.

Notice of such loans will be mailed to the Insured when made and said Insured may resume the payment of premiums hereon at any time without medical re-examination while the policy is so continued in force. The indebtedness hereon may be repaid wholly or in part in cash, or may be allowed to remain as a loan against the Policy.

In any settlement of the Policy the indebtedness to the Company hereon shall be a first lien in priority to the claim of any Beneficiary or assignee.

GUARANTEED SURRENDER OPTIONS.-After three full years' premiums have been paid hereon, if any subsequent premium is not paid when due, this Policy may be surrendered to the Company within the month of grace, and the Insured shall upon request be entitled to one of the following options:

1. CASH. A cash payment equal to the loan value hereon at he date of default, including the loan value of any existing Anual Additions, and said cash payment shall be equal to the amount therwise applicable to the purchase of Paid-up or Extended In

urance.

2. PAID-UP INSURANCE.-A Paid-up Policy payable at the same ime, and under the same conditions as this Policy, including any outstanding Annual Additions.

3. EXTENDED INSURANCE.-Extended Insurance for the face amount of this Policy, and the value of any existing Annual Additions in cash.

The amounts of the Loan or Cash Values and Paid-up Insurance and the term of the Extended Insurance if the Cash Values of annual additions have been applied in the payment of premiums hereon, are shown in columns five, six and seven respectively, of the Table of Death Benefits and Surrender Values shown herein and are qual or equivalent to the full reserve hereon at the date of default, according to the American Experience Table of Mortality, with interest at the rate of three and one-half per centum per annum.

If all premiums hereon, as shown on page three, have been paid in full to the Company, the Cash Value in case of default in premium payments will be the sum of columns four and five, the Paid-up Insurance will be the sum of columns three and six, and the Extended Insurance will be as shown in column seven and in addition the Cash Value in column four.

Additional values not shown in the table will be allowed for parts of a Policy year's premiums paid for, and the values for later years not shown in the table will be equal or equivalent to the full reserve on the Policy.

TABLE OF DEATH BENEFITS AND SURRENDER VALUES.

REINSTATEMENT.-If, in event of default in any premium payments hereon, the value of this Policy shall be applied to the purchase of Paid-up Insurance or Extended Insurance, and if such Paid-up Insurance or Extended Insurance shall be in force and this Policy shall not have been surrendered to the Company for its Cash

The

Surrender Value and been canceled, the Policy may be reinstated a any time, upon evidence of insurability satisfactory to the Company and the payment of arrears of premiums with compound interes thereon at a rate not exceeding six per centum per annum. indebtedness hereon if not greater than the loan value at the date of reinstatement may be allowed to remain as a loan against the Policy.

METHOD OF PAYMENT OF DEATH BENEFIT.-The face amount of this Policy unless otherwise requested by the Insured will be pay able in one sum immediately after receipt of due proofs of the death of said Insured.

The Insured may, however, change the method of payment to annual instalments for a limited term of years, or during the lifetime of the Beneficiary, as explained in the table shown on the fourth page hereof.

TOTAL DISABILITY.-The benefits provided on page one hereof for Disability shall become null and void after the period for the payment of premiums hereunder, or if upon default in the payment of any premium, Paid-up Insurance or Extended Insurance has been requested by the Insured and is in force. The Total and Permanent Disability referred to must be such that there is neither then nor at any time thereafter any work, occupation or profession that the Insured can sufficiently do or follow to earn or obtain any wages, compensation or profit. The Insured must furnish from time to time evidence satisfactory to the Company of continued Total and Permanent Disability, and if the Insured shall recover from such Total Disability sufficiently to earn or obtain any wages compensation or profit, the Insured shall resume payment of pre miums on the next succeeding due date of premium. The instal ments already paid shall not in such case be an indebtedness against the Policy.

METHOD OF CHANGING BENEFICIARY.-At any time while this Policy is in force, the Insured, if there be no existing assignment of this Policy filed at the Home Office of the Company as herein provided, may designate a new Beneficiary or Beneficiaries under this Policy by filing such request at the Home Office upon the form of the Company for this purpose, accompanied by the Policy for endorsement thereon. Such change shall become effective only when said endorsement is made on the Policy by the Company whereon the rights of any former Beneficiary or Beneficiaries shall cease. If no Beneficiary hereunder is living at the death of the In sured, the proceeds of the Policy will be paid to the executors, ad ministrators or assigns of the Insured.

ASSIGNMENT.-This Policy may be assigned by the Insured, but no such assignment shall be binding upon the Company until a dup licate copy thereof has been filed at the Home Office of the Com pany, which shall not be responsible for the legality of any assign ment, and any claim hereunder by an assignee shall be subject to proof of assignment and extent thereof.

INDEBTEDNESS.-Any indebtedness to the Company hereon will be deducted in any settlement hereunder upon the death of the In sured or in the payment of any other benefit. If this Policy shall lapse and there shall be an indebtedness hereon, the said indebted ness will be deducted from the Cash Value of the Policy at date of default, and the balance will be (A) paid to the Insured in cash or (B) applied to the purchase of Paid-up Insurance. or (C) ap plied to extend the face amount of the insurance hereunder, at the option of said Insured, and said values shall be calculated upon the same basis as the values herein shown in the Table of Death Benefits and Surrender Values.

RIGHTS OF THE INSURED.-It is understood and agreed that the Insured may obtain every benefit, exercise every right and enjoy every privilege conferred upon said Insured by this Policy, without the consent of the Beneficiary.

CONSIDERATION.

The consideration for this Policy is the application herefor, which is made a part of this contract and a copy of which application is attached hereto or endorsed hereon, and the payment in advance of an annual premium of $383.40 for term insurance for the year ending on the 21st day of November, 1911, and the payment of a like sum on or before the 21st day of November in every year thereafter until full premiums have been duly paid for twenty years from the date hereof, or until the prior death of the Insured.

In Witness Whereof, THE AMERICAN NATIONAL INSURANCE COMPANY has caused this Policy to be signed by its President and its Secretary, this 21st day of November, Nineteen Hundred and Ten.

L. H. COLLIER,
Secretary.

W. L. MOODY, JR.,

INSTALMENT BENEFITS.

President.

The Insured may change the mode of payment of this Policy as a death-claim, if the Policy is not assigned, from payment in one sum, as provided on the first page, to payment by annual instalments, as stated below.

The following tables are based upon a Policy of $1,000, and will apply pro rata to the amount payable under this Policy, provided the amount is not less than $1,000; if the amount is less than $1,000, these Instalment Benefits shall not apply, but this Policy will be payable in one sum only.

LIMITED INSTALMENTS.

Annual Instalments limited to the number stated below; any number from two to twenty-five may be selected by the Insured. The amount of each Instalment will be increased by such Profits as the Company may assign to Policies of this class.

Amount of each Instalment..... $107 $116 $127 $140 $158 $181 $214 $264 $345, 508

*ILLUSTRATION.-If payment is to be made by 20 Instalments, the amount of each Instalment will be $68 for each $1,000 pf Proceeds.

ote

CONTINUOUS INSTALMENTS.

Twenty annual Instalments at least to be paid, but Instalments

e o continue during entire life-time of Beneficiary.

Вед

The amount of each Instalment will be increased by such Profits as the Company may assign to Policies of this class. (Payment by Continuous Instalments can not be selected if there is more than one Beneficiary under this Policy.)