the same rate. The loan with accrued interest may be repai the Company at any time. Failure to repay any such advanc to pay interest shall not avoid this Policy unless the total ind edness hereon to the Company shall equal or exceed the cash v at the time of such failure, nor until one month after notices have been mailed by the Company to the last known address of Insured and of the Assignee of record, if any, at the Home C of the Company. (If a loan is desired before three full ye premiums have been paid, the unpaid balance of the three years' premiums may be paid by deduction from the loan w made if the amount which can be loaned is sufficient.)

ASSIGNMENT.-No assignment of this Policy shall be bin upon the Company unless it be filed with the Company at its Home Office. The Company assumes no responsibility as to validity of any assignment.

OPTIONS ON SURRENDER OR LAPSE. After this Policy shall been in force three full years, the owner, within three months a any default in payment of premium but not later, may elect eit

(a) to surrender this Policy for its cash value less any debtedness to the Company hereon (this balance is hereinafter ferred to as the net cash value); or,

(b) to have the insurance continued in force as term insur from the date of such default, without future participation without the right to loans or cash value, for an amount equa the face amount of this Policy and any outstanding dividend a tions less any indebtedness to the Company hereon; or,

(c) to purchase non-participating paid-up life insurance able at the same time and on the same conditions as this Policy

The cash value under option (a), after premiums have paid for three full years or more, will be the reserve at the dat default for the face amount of this Policy and for any divid additions hereto, computed according to the American Experi Table of Mortality assuming interest at the rate of three per cen per annum, less a surrender charge which, in no case, shall be n than one and one-half per centum of the face amount insured this Policy after premiums have been paid for ten full year: more there shall be no surrender charge.

The term for which the insurance will be continued under op (b), or the amount of the paid-up life insurance obtainable ur option (c), will be such as the net cash value obtainable ur option (a) will purchase at the attained age of the Insured at of default when applied as a net single premium according to American Experience Table of Mortality assuming interest at rate of three per centum per annum.

If this Policy shall not, within three months after defaul payment of premium, have been surrendered to the Company at Home Office for its cash value as provided in option (a), or paid-up insurance as provided in option (c), the insurance will automatically continued as provided in option (b).

TABLE OF LOAN AND SURRENDER VALUES. The values in the following table are computed in accorda with the above provisions and upon the assumption that premi have been paid in full for the number of years the "policy has b in force." If there be any indebtedness to the Company on Policy, or if there be any outstanding dividend additions, the val will be modified as hereinbefore provided.

The cash and loan values and the paid-up life insurance sta in the following table apply to a Policy for $1,000. As this Po' is for $10,000.00 the cash, loan, or paid-up life insurance availa at the end of any policy-year will be ten times the amount stated the table for that year.

The period of paid-up continued insurance remains the sa for a Policy of any amount.

The figures contained in this table represent the actual amounts vailable after deduction of the surrender charge, if any, but withut allowance for dividend additions or indebtedness.

Values for later years will be computed upon the above stated basis and will be furnished upon request.

*The cash value provided for in the above table for the end of policy-year, less interest thereon at the rate of six per centum per annum to the end of such policy-year, can be obtained during Buch policy-year provided all premiums due prior to the end of such policy-year shall have been duly paid.

**The loan value provided for in the above table for the end of policy-year can be obtained (less interest) during such policyyear as explained in the above clause entitled "Loans."

Any dividend deposits standing to the credit of this Policy at date of surrender or lapse shall then be payable in cash in addition to payment of the cash value or to the granting of the paid-up He or term insurance above provided for.

REINSTATEMENT. Unless it shall have been surrendered for its ash value, this Policy may be reinstated at any time within three Jears from date of default in payment of any premium, upon evidence of insurability satisfactory to the Company and upon payment of the arrears of premium with interest thereon at the rate of five per centum per annum, and, at the option of the Insured, either (a) pon payment in cash to the Company of any indebtedness which existed at said date of default together with interest thereon at the rate of six per centum per annum, compounded annually, or (b) apon reinstatement of such indebtedness increased by the amount of interest thereon at the rate of six per centum per annum, compounded annually, provided such reinstated increased indebtedness does not exceed the loan value at the date to which reinstatement is made.

MODES OF SETTLEMENT. If election be made as hereinafter p vided, the net sum payable under this Policy at death of the Insur provided such net sum be not less than $1,000, will be settled in of the following methods in lieu of being then paid in one sum:

(1) By the payment of interest at the rate of three per cent per annum on said net sum, payable at the end of each year dur the lifetime of the beneficiary, and by the payment upon the de of the beneficiary of the said net sum together with any accrt interest for the year then current, unless otherwise directed in notice of election, to the beneficiary's executors, administrators assigns.

(2) By the payment of equal annual instalments for a specif number of years, the first instalment being payable immediate in accordance with the following table for each one thousand d lars of said net sum.

(3) By the payment (a) of twenty equal annual instalme certain, whether the beneficiary lives or dies, the first annual inst ment being payable immediately, and the twentieth annual inst ment, being payable nineteen years later, and (b) of annual inst ments of a like amount thereafter throughout the remaining li time of said beneficiary, the first of such annual instalments be payable one year after the twentieth annual instalment certain p vided said beneficiary be then alive, the payments terminating w the last annual instalment preceding the death of said beneficia in accordance with the following table for each one thousand doll of said net sum.

Any instalments payable under (2) or (3) which shall not ha been paid prior to the death of the beneficiary shall be paid, unl otherwise directed in the notice ection, to the benficiary's ecutors, administrators or assigns.

The above modes of settlement (1) and (3) are not availa if the beneficiary be a corporation, a partnership or an associati The election of any of the foregoing modes of settlement m be made by the Insured and the beneficiary jointly; or, if the rig to change the beneficiary has been reserved, by the Insured alo or, after the death of the Insured, if no election shall have be made, by the beneficiary. If the Policy be assigned, the assign must join in any election. Such election shall be made by givi the Company written notice at its Home Office. This Policy, up its maturity, if such election shall have been made, shall be su rendered to the Company and a supplementary contract shall issued for the mode of settlement elected. Such supplementary co tract shall participate annually in the excess of interest earnin over three per centum per annum, at the same excess rate each ye as is used in the dividend calculations of that year in the case policies issued in the same year as this Policy, but if settlement made under mode of settlement (3), only that part of the suppl mentary contract providing for instalments for the fixed period twenty years shall participate.

Unless otherwise specified in the written notice making electio of one of the foregoing modes of settlement, the supplementa contract may at any time be surrendered to the Company and ti Company will pay for the legal surrender thereof, (a) where mo of settlement (1) has been elected, the said net sum together wi interest thereon to date of surrender at the rate of three per centu per annum for the fractional part of a year, if any, for which inte est shall not have already been paid, (b) where any other of th above modes of settlement has been elected, the commuted or pre ent value of the payments certain yet to be made, exclusive of par ticipation, computed at three per centum interest, compounded a nually; provided that no such surrender and commutation will made under mode of settlement (3) except after the death of th beneficiary occurring within the aforesaid twenty years,

TABLE OF ANNUAL INSTALMENTS FOR EACH $1,000.

If so requested in writing when making the election, these intalments will be paid in fractional parts, semi-annually, quarterly, or monthly, the total of the fractional payments each year being qual to the annual payment provided for by this table.

Agents are not authorized to modify this Policy or to extend the time for paying a premium.

In Witness Whereof, the Company has caused this Policy to be executed this eighteenth day of February, 1913.

W. J. EASTON,

Secretary. Countersigned...

CHARLES A. PEABODY,

President.

..Registrar.

APPLICATION

Is made to THE MUTUAL LIFE INSURANCE COMPANY OF NEW Y All the following statements and answers, and all those tha make to the Company's Medical Examiner, in continuation of application, are true, and are offered to the Company as an ind ment to issue the proposed policy, which shall not take effect ur and until the first premium shall have been paid, during my tinuance in good health, and unless also the policy shall have 1 issued during my continuance in good health; except in cas binding receipt shail have been issued as hereinafter provided.

14. Do you wish the privilege of changing the beneficiary f time to time provided the policy has not been assign During the period of one year following the date of issue of Policy of Insurance for which application is hereby made, I will engage in any of the following extra hazardous occupations or ployments: retailing intoxicating liquors, handling electric wires dynamos, blasting, mining, sub-marine labor, aeronautic ascensi the manufacture of highly explosive substances, service upon railroad train or track or in switching or in coupling cars, or any steam or other vessel, unless written permission is expre granted by the Company.

It is understood that the risk of death will not be covered the policy provided such death occur by my own act. whether s or insane, during the period of one year next following the date issue.

I have paid $.. in cash to the subscribing Solici Agent, who has furnished me with a binding receipt therefor, sig by the Secretary of the Company, making the insurance in f from this date, provided this application shall be approved, and policy duly issued.

MEDICAL EXAMINER'S FORM

I certify that my answers to the foregoing questions are correctly corded by the Medical Examiner.

i