N. B.-Answers to the following questions must be elicited and recorded by a regularly appointed Examiner of the Company, with no one present but the Examiner and the person examined. 13. A. Have you ever had Inflammatory or Articular Rheumatism? n. If so, state the A. 14. number of attacks. o. The duration of each attack. D. In what pears, and parts affected. 15. Has sugar, albumin or casts ever been found in your urine? 16. Are you ruptured? B. If so, do you wear a truss constantly except when in bed? A. 17. A. Are you drawing or have you ever applied for a pension? B. If so, A. 18. Have you had since childhood any chronic or constitutional disease or severe in- II-Continued REVIEW THIS PAPER CAREFULLY BEFORE SIGNING. DO NOT USE DISHES OR DITTO MARKS. WHEN COMPLETED HAND TO AGENT. I certify that the above is a record of a careful examination of the person described in and whose signature is affixed to the foregoing declarations, and that the examination was made N. B.-THIS EXAMINATION MUST BEAR DATE OF DAY WHEN ACTUALLY If not a regularly appointed Examiner of the Company, state where graduated.. ADDITIONAL HEMARES.-State anything discovered by you which may influence the character of the isk, and which is not set forth fally in the foregoing answers. II-Continued Read these Instructions as they are Imperative and must not be deviated from in any manner. Note I. The answer to Question 6 must be definite and convey a clear idea as to the past and present habits of the Insured in the use of stimulants. Such answers as "moderately." "temperately," or "not to excess," and the like, will not be accepted. If there is a history of over-indulgence or a free use of stimulants, a full explanation will Note II. Full details should Recompany the application where Insured is engaged or Note III. If a member of Insured's family bas tuberculosis or within two years has died Note IV. The speelfe disease must be stated. Indefinite terms mast not be used in VOUCHER. Fees for Medical Examinations are paid only through At the close of each quarter a Company check for amount Maturity & John Doe Hartford Hartford.County of... Wife Dollars ......the Insured, State of... Connecticut........ during the continerance of this contract and before its maturity as an endowment. First day of... The Insured, if living on the....... This contract is issued in consideration of the signed application for this insurance which is made a part When Bapable/ Where Papahle Bate Ellectibe Incontestability Four Hundred Twenty-eight Annually or a Secretary and countersigned by an authorized (The annual premium includes a premium of $.. The first such payment shall be made on the delivery of this contract, and a like payment on or before the.. First in each year until premiums for.. Twenty February full years shall have been paid or until the prior death of the Insured, but no such payment will be required during permanent total disability after receipt by the Company of due proof thereof remiums shall be paid in advance at the Home Office or to an authorized agent of the Company. This insurance shall be effective from..... February 1st.19.19. The Insurance Years, and all subsequent provisions for Cash Loans, Cash Values, Paid-up and Automatic Term Insurance are computed from that date. This contract shall be incontestable after one year from date of issue, except for non-payment of premiums. It is free from conditions as to residence, occupation, travel or place of death, including military or naval service unless such service shall be restricted by indorsement hereon at the time of issuance of the contract. This contract is subject to the privileges and conditions recited on the subsequent pages hereof. Witness Whereof THE 4NSURANCE COMPANY has caused this instrument to be signed by its President and a Secretary, at First day of........ 20 YEAR ENDOWMENT. PREMIUMS PAYABLE FOR 20 YEARS. NON-PARTICIPATING. IN EVENT OF PERMANENT TOTAL DISABILITY PREMIUMS WAIVED AND MONTHLY INCOME PAYABLE WITHOUT |