2. Full name of Beneficiary, if any. NOTE-Contingent Heneficiary, if any, should be named by separate request over Applicant's signature, 3. Do you reserve the right to change such Beneficiary? 4. What is your occupation, profession or employment? APPLICATION FOR LIFE INSURANCE-PART I It is understood and agreed (1) that if the premium for the insurance hereby applied for is not paid to the Agent at the time of making this application, no Insurance shall be effected and no liability shall exist until a policy as applied for is issued and delivered to me and the first premium thereon actually paid during my lifetime; and (2) that if such premium is paid to the Agent at the time of making this application and if the Company shall be satisfied as to my insurability upon the plan and for the amount of insurance hereby applied for on the date of the medical examination therefor, the insurance shall be effective in accordance with the provisions of the policy applied for from the date of such medical examination, and such policy shall be issued and delivered to me or my legal representative, the Company baving until the delivery of such policy to consider the question of auch insurability on the date of said medical examination; and (3) that if the Company shall reject this application the amount paid as premium shall be returned, and that the failure of the Company to deliver a policy as applied for within sixty days after the date hereof may at my option be deemed a rejection of this application. IF THE PREMIUM IS PAID AT THE TIME OF APPLICATION THIS RECEIPT MUST BE COMPLETED AND GIVEN TO THE APPLICANT; if it is not so paid the receipt must not be detached. No other Form of RECEIPT FOR ADVANCE PAYMENT OF PREMIUM will be Recognized by the Company. the sum of Dollars, as the first (Ansual, Semi-Annual or Quarterly) for $ -plan, for which application has been made to THE MUTUAL LIFE INSURANCE COMPANY, such premium being paid in accordance with the conditions of agreements (2) and (3) contained in said Application. (Copy of agreements on back hereof.) premium insurance on his life on the. (Place and dete) I APPENDIX I hereby certify that I personally solicited and secured the application of the above named Applicant and know he is the person described in Parts I and II of this Application. I know of nothing affecting the risk which is not fully set forth in these papers, and 1 unqualifiedly recommend the acceptance of the risk by the Company. I-Continued Copy of Agreements Contained in Application. It is understood and agreed (1) that if the premium for the insurancs hereby applied for is not paid to the Agent at the time of making this application, no insurance shall he affected and no liability shall exist until a policy sa applied for is losund and delivered to me and the first premium thereon actually paid during my hfetime and (9) that if such Premium is paid to the Agent at the time of making this application and if the Company shall be satisfied as to my inability upon the plan and for the amount of insurance hereby applied for on the date of the medical examination therofor, the insuranen ehall be efsetivo in accordance with the prytalons of the policy applied for from the date of each nudist pomination, and such polley shall km jovand and delivered to me or pur legal representative, the Company having until the delivery of such pollyg to consider the question of such |