17. Have any two members of the family, grandparents included, had consumption, cancer, paralysis or apoplexy, disease of heart, disease of kidneys ? Signed this....day of... ..., 189... (Party to be insured sign here)..... XII. A Form of Policy of Life Insurance. This policy witnesseth that the........ Life Insurance Company, in consideration of the statements and agreements in the application for this of day of .... the life of Policy, which are hereby made a part of this contract and of the sum of dollars to it in hand paid by .............. and of the annual premium ...... dollars to be paid at or before twelve o'clock, M., on the .... in every year during the continuance of this policy, does insure in the amount of .... ....... dollars, for the term of his executors, administrators or assigns, at its office in the City of ........, upon due and satisfactory proof of interest and of the death of the said insured, deducting there from all indebtedness of the party to the company, together with the balance, if any, of the then current year's premium. life, payable to Provided, that in case the said premiums shall not be paid on or before the several days hereinbefore mentioned for the payment thereof, at the office of the company in the City of........, or to agents when they produce receipts signed by the President or Treasurer, then, and in every such case, this policy shall cease and determine, subject to the provisions of the company's NON-FORFEITURE SYSTEM as indorsed hereon, with accompanying table. This policy does not take effect until the first premium shall have been actually paid; nor are agents authorized to make, alter or discharge this or any other contract in relation to the matter of this insurance, or to waive any forfeiture hereof, or to grant permits, or to receive for the cash due for premiums anything but cash. Any error made in understating the age of the insured will be adjusted by paying such amount as the premiums paid would purchase at the table rate. No assignment of this policy shall take effect until written notice thereof shall be given to the company. This policy, after two years, will be INCONTESTABLE, except for fraud or non-payment of premium. IN WITNESS WHEREOF, the said ..... Life Insurance Company has, by its President and Secretary, signed and delivered this contract, at the City of........................, this .......... day of ............, one thousand eight hundred and ....... ..... .... ..... Secretary. President. NON-FORFEITURE PROVISIONS. WHEN AFTER TWO FULL ANNUAL PREMIUMS shall have been paid on this policy it shall cease or become void solely by the non-payment of any premium when due, its entire net reserve by the American Experience Mortality and interest at four per cent. yearly, less any indebtedness to the company on this policy, shall be applied by the company as a single premium at the company's rates published and in force at this date, either, first, to the purchase of non-participating term insurance for the full amount insured by this policy, or, second, upon the written application by the owner of this policy and the surrender thereof to the company at ..... within three months from such non-payment of premium, to the purchase of a nonparticipating paid-up policy payable at the time this policy would be pay ....... able if continued in force. Both kinds of insurance aforesaid will be subject to the same conditions, except as to payment of premiums, as those of this policy. No part, however, of such term insurance shall be due or payable unless satisfactory proofs of death be furnished to the company within one year after death; and if death shall occur within three years after such non-payment of premium, and during such term of insurance, there shall be deducted from the amount payable the sum of all the premiums that would have become due on this policy if it had continued in force. The following table shows the amount that the company agrees to loan (being one-half of the reserve) upon a satisfactory assignment of the policy as collateral security; also the additional time for which the insurance will be continued in full force after lapse by non-payment of premium; or the value of the policy in paid-up insurance upon surrender within three months from date of lapse. The figures given are based upon the assumption that the premiums (less current dividends) have been fully paid in cash. If there be any indebtedness upon the policy, the values as stated in the table would have to be reduced proportionally upon the principles stated in the policy. The indebtedness, if any, may be paid off in cash, in which case the figures in the table will apply: A Form of Policy of Accident Insurance. The...... Insurance Company, in consideration of the warranties in the application for this policy and of .................... dollars, does hereby insure ... under classification .... ... (being a ...... by occupation) for the term of ........ months from noon of ... ........, 189.., in the sum of dollars per week against loss of time not exceeding ........ consecutive weeks, resulting from bodily injuries effected during the term of this insurance, through external, violent, and accidental means, which shall, independently of all other causes, immediately and wholly disable him from transacting any and every kind of business pertaining to his occu ....... pation above stated. Or if loss by severance of one entire hand or foot results from such injuries alone within ninety days, will pay insured onethird the principal sum herein named, in lieu of said weekly indemnity, and on such payment this policy shall cease and be surrendered to said company, or in event of loss by severance of two entire hands or feet, or one entire hand and one entire foot, or loss of entire sight of both eyes, solely through injuries aforesaid within ninety days, will pay insured the full principal sum aforesaid, provided he survives said ninety days. Or if death results from such injuries alone within ninety days, will pay dollars to ........ if surviving; in event of his prior death, to the legal representatives or assigns of insured, provided ....... 1. If insured is injured in any occupation or exposure classed by this company as more hazardous than that here given, his insurance shall be only for such sums as the premium paid by him will purchase at the rates fixed for such increased hazard. 2. This policy shall not take effect unless the premium is paid previous to any accident under which claim is made; and the company may cancel it at any time by refunding said premium, less a pro rata share for the time it has been in force. 3. The company's total liability hereon in any policy year shall not exceed the principal sum hereby insured; therefore, in case of claim for full principal sum, any sums paid as indemnity within such policy year shall be deducted therefrom. 4. Immediate written notice, with full particulars and full name and address of insured, is to be given said company at ........ of any accident and injury for which claim is made. Unless affirmative proof of death, loss of limb or sight, or duration of disability, and of their being the proximate result of external, violent and accidental means, is so furnished within seven months from time of such accident, all claims based thereon shall be forfeited to the company. No legal proceedings for recovery hereunder shall be brought within three months after receipt of proof at this office, nor at all, unless begun within one year from date of alleged accident. 5. This insurance does not cover disappearances; nor suicide, sane or insane; nor injuries of which there is no visible mark on the body (the body itself in case of death not being deemed such mark); nor accident, nor death, nor loss of limb or sight, nor disability, resulting wholly or partly, directly or indirectly from any of the following causes, or while so engaged or affected: Disease or bodily infirmity, hernia, fits, vertigo, sleep-walking; medical or surgical treatment, except amputations necessitated solely by injuries and made within ninety days after accident; intoxication or narcotics; voluntary or involuntary taking of poison or contact with poisonous substances or inhaling of any gas or vapor; sunstroke or freezing; dueling or fighting, war or riot; intentional injuries (inflicted by the insured or any other person); voluntary over-exertion; violating law; violating rules of a corporation; voluntary exposure to unnecessary danger; expeditions into wild or uncivilized countries; entering or trying to enter or leave a moving conveyance using steam as a motive power (except cable cars), riding in or on any such conveyance not provided for transportation of passengers, walking or being on a railway bridge or roadbed (railway employees excepted). 6. No claim shall be valid in excess of $10,000 with $50 weekly indemnity under accident policies, nor for indemnity in excess of money value of insured's time. All premiums paid for such excess shall be returned, on demand, to insured or his legal representative. 7. Any medical adviser of the company shall be allowed, as often as he requires, to examine the person or body of insured in respect to alleged injury or cause of death. 8. Any claim hereunder shall be subject to proof of interest. A copy of any assignment shall be given within thirty days to the company, which shall not be responsible for its validity. The company may cancel this policy at any time by refunding the unearned premium thereon. No agent has power to waive any condition of this policy. In witness whereof, etc. By the XIV. A Form of Policy of Marine Insurance Cargo. Insurance Company. ........ on account of .... In case of loss, to be paid in funds current in the United States, or in the City of New York, to ....... do make insurance, and cause to be insured, lost or not lost, at and from .... upon.... ... laden or to be laden on board the good........, whereof.... is master for this present voyage . ......g or whoever else shall go for master in said vessel, or by whatever other name or names the said vessel, or the master thereof, is or shall be named or called. BEGINNING the adventure upon the said goods and merchandises, from and immediately following the loading thereof on board of the said vessel, at... ........ as aforesaid, and so shall continue and endure until the said goods and merchandises shall be safely landed at ........ as aforesaid. AND it shall and may be lawful for the said vessel, in her voyage, to proceed and sail to, touch and stay at, any ports or places, if thereunto obliged by stress of weather, or other unavoidable accident, without prejudice to this insurance. The said goods and merchandises, hereby insured, are valued (premium included) at ........ dollars. TOUCHING the adventures and perils which the said ........ Insurance Company is contented to bear, and takes upon itself in this voyage, they are of the seas, men-of-war, fires, enemies, pirates, rovers, thieves, jettisons, letters of mart and countermart, reprisals, takings at sea, arrests, restraints and detainments of all kings, princes or people, of what nation, condition or quality soever, barratry of the master and mariners, and all other perils, losses and misfortunes that have or shail come to the hurt, detriment or damage of the said goods and merchandises, or any part thereof. AND in case of any |