INSTALLMENT PRIVILEGE.-The insured may change the mode of payment of the amount of insurance as a death claim from payment in one sum to payment in equal annual installments as provided on the fourth page hereof.

INDEBTEDNESS. Any indebtedness to the Company on account of this policy (including any unpaid portion of the premium for the policy year current at death) will be deducted in any settlement or payment under this policy.

MODIFICATIONS.--No condition, provision or privilege of this policy can be waived or modified in any case except by an endorsement hereon signed by the President, the First Vice-President, the Actuary or the Secretary. No modification or change shall be made in this policy except such as is in accordance with the laws of the State in which such change is made. No agent has power in behalf of the Company to make or modify this or any other policy, to extend the time for paying a premium, to waive any forfeiture or to bind the Company by making any promise or making or receiving any representation or information.

STATEMENTS OF THE INSURED.-All statements made by the insured shall, in the absence of fraud, be deemed representations and not warranties, and no such statement shall avoid the policy unless it be contained in the written application.

SELF-DESTRUCTION.-Self-destruction during the first policy year, whether the insured be sane or insane, is a risk not assumed by the Company; but in such event the Company will return the premium paid.

MISSTATEMENT OF AGE.-If the age of the insured has been misstated, the amount of insurance payable shall be such as the premium would have purchased at the correct age.

ASSIGNMENT.-No assignment of this policy shall be binding upon the Company unless such assignment be made in duplicate and both copies filed with the Company at its Home Office, when one copy will be returned bearing the Company's acknowledgment of receipt. The Company will assume no responsibility as to the validity of any assignment.

NON-FORFEITURE PROVISIONS.-The insured may elect at the end of the third policy year or at any time thereafter during the period of grace following any default in the payment of premiums, either

(a) To surrender this policy at the Home Office of the Company for its cash value; or,

(b) To surrender this policy at the Home Office of the Company for a policy of paid-up insurance payable at the same time and under the same conditions, except as to premium payments, as this policy, or,

(c) To have the full amount of insurance continued in force as extended term insurance from the date of such default.

The Cash Value shall be the sum indicated in the Table of Loans and Surrender Values and shall be at least equal to the sum which would otherwise be available for the purchase of Extended Term Insurance. At the option of the Company, payment of the Cash Value may be deferred for not to exceed ninety days after application therefor is made.

The amount of Paid-up Insurance shall, in the absence of indebtedness, be the sum indicated in the Table of Loan and Surrender Values. If there be any indebtedness the amount of Paid-up Insurance otherwise available shall be reduced in the ratio of such indebtedness to the net value of such Paid-up Insurance.

The period of the Extended Term Insurance shall, in the absence of indebtedness, be the period indicated in the Table of Loan and Surrender Values, and, if the insured survive to the end of such period, there shall be paid him in cash the amount of Pure Endowment, if any, stated in said Table. If there be any indebted

ness the same shall be deducted from the sum of the net values of the Extended Term Insurance and Pure Endowment otherwise available and the amount of insurance continued for the period purchased by such difference applied as a net single premium; provided, that, if such difference be in excess of the net single premium which will purchase term insurance for the period indicated in the absence of indebtedness, such excess shall be applied as a net single premium to purchase pure endowment payable to the insured in cash if living at the end of such period.

If the insured shall not, during the period of grace after default, surrender this policy to the Company at its Home Office for its Cash Value as provided in option (a) above, or for a policy of Paid-up Insurance as provided in option (b), the amount of insurance will be continued in force as Extended Term Insurance as provided in option (c).

All net values and net single premiums herein mentioned shall be based on the American Experience Table of Mortality with interest at the rate of three and one-half per centum per annum.

The reserve under this policy shall be computed on the basis of the American Experience Table of Mortality with interest at the The net value rate of three and one-half per centum per annum.

of each benefit in the Table is equal to such reserve less a surrender charge in no case in excess of two and one-half per centum of the amount of insurance under this policy. If fractional premiums in addition to premiums for whole years be paid, due allowance will be made in the above benefits. Values for each year after the twentieth, not shown in the Table, will be equivalent to the full reserve.

The first year's insurance under this policy is term insurance, purchased by the whole or part of the premium to be received during the first policy year and the policy shall be valued according to its terms and the laws of the State of Indiana.

This policy is issued with the express understanding that the insured shall be entitled without the consent of the beneficiary, to

receive every benefit, exercise every right and enjoy every privilege conferred on the insured by this policy.

IN WITNESS WHEREOF, American Central Life Insurance Company has caused this policy to be signed as of the twenty-fourth day of February, 1913. HERBERT M. WOOLLEN,

CARROLET B. CARR,

Secretary.

Attest: V. M. KIME, Associate Actuary.

President.

INSTALLMENT PRIVILEGE.-The insured may, at any time while this policy is in force, elect by written request on the Company's form therefor that, instead of being payable in one sum, the amount payable to the beneficiary as a death claim shall be payable in equal annual installments of any number from two to twenty-five, or in equal annual installments for twenty years to continue so long thereafter as the beneficiary shall live.

The installment privilege shall not be operative if the beneficiary be other than a natural person or if the amount payable as a death claim be less than $1,000.

The amount of each installment shall be as indicated in the following table, which is based on $1,000 insurance but which will apply pro rata to the amount payable under this policy.

In the event of the death of the beneficiary before all the provided installments have been paid, those remaining unpaid will be commuted at the rate of three and one-half per centum per annum interest and payment of the commuted amount will be made in one sum to the beneficiary's estate.

The beneficiary shall have the right to assign any unpaid installments only with the consent of the insured evidenced by endorsement on the policy.

49

59

PREMIUMS FOR LOAN INSURANCE BASED ON $100
and applying pro rata to other amounts

APPLICATION.

I hereby make application for insurance in American Central Life Insurance Company of Indianapolis, Indiana, and agree that the statements and agreements herein and the statements to the Medical Examiner in Part II of Application are made for the purpose of securing this insurance and declare that all such statements are complete and true without exception unless such exception is indicated.

and I

7. I desire policy to be issued as of date.. agree that the period to cover which the first premium is paid shall end one year after said date, and that each insurance year shall end on successive anniversaries of said date. I also agree that the insurance applied for shall not take effect until the payment of the first premium thereon, and the approval of this application by the Company.

14. I further agree that any physician may disclose to the American Central Life Insurance Company, its successors or assigns, any facts or information communicated to, or acquired, by him as my physician, and I waive any and all provisions of law which now, or may hereafter, exist exempting or prohibiting any physician from disclosing any facts acquired in his professional capacity or rendering_such physician incompetent as a witness.

15. I further agree that no action shall be brought against the Company under policy issued on this application after the lapse of six years from the time when the cause of such action shall

accrue.

16. I have settled for the first premium on policy applied for with the Agent.. .in the following manner: Cash $ Note.. for $. due. ..on condition that, if risk is not assumed by the Company the sum paid by me shall be returned in accordance with the provisions of the binding receipt which I have accepted subject to the provisions thereof.

MEDICAL EXAMINER'S FORM.

In continuation of and forming a part of my application for insurance to the American Central Life Insurance Company of Indianapolis, Indiana, dated.

..191..

I hereby certify that I have read the above questions and that my answers thereto are true.

20 PREMIUMS (FIRST YEAR TERM AND 19 PREMIUMS LIFE POLICY.

STANDARD POLICY PROVISIONS.

No. 99,999.
AMOUNT, $10,000.00.

AGE, 3

PREMIUM, $383.4

AMERICAN NATIONAL INSURANCE COMPAN HOME OFFICE, GALVESTON, TEXAS.

INCORPORATED BY THE STATE OF TEXAS.

Agrees to Pay Ten Thousand ($10,000) Dollars to his siste Mary Austin, Beneficiary, or to such other Beneficiary as ma be designated by the Insured as hereinafter provided, at th Home Office of the Company, immediately after receipt of du proofs of the death of Stephen F. Austin, the Insured, whil this policy is in force:

And Further Agrees to Pay Ten Thousand ($10,000) Dollar in twenty equal annual instalments of Five Hundred ($500) Dollars each, in the event of the total and permanent loss of sight of both eyes, or loss of both arms, or both legs, or on arm and one leg, or one eye and one limb, of the Insured, o if the Insured should become totally and permanently disabled to such an extent as to render it impossible for him to engag in any gainful occupation whatever, such total and permanen disability occurring before the Insured has reached the age of sixty years, and this payment being in lieu of all other benefits designated in this Policy.

THE SUM OF Ten Thousand ($10,000) Dollars in twenty equal annual instalments of Five Hundred ($500) Dollars each, the first instalment being payable immediately after receipt by the Company of due and satisfactory proofs of such total and permanent disability, or such injuries as above defined. If the Insured should die before all of the said twenty instalments have been fully paid, then in such case the remaining instalments may be continued to the Beneficiary hereunder or may be commuted at three and one-half per centum compound interest and paid in one sum to said Beneficiary.

The above Disability Benefits are payable as hereinafter provided.

GUARANTEED ANNUAL ADDITIONS.

If this Policy is kept in force by the payment of premiums hereon in full as stated in the "Consideration" paragraph shown on page three hereof, the amount of insurance payable hereunder at the death of the Insured will be the sum of Ten Dollars ($10.00) for each One Thousand Dollars of the face amount hereby insured multiplied by the number of full annual premiums paid hereon, less one, in addition to said face amount, making the total sum payable hereunder in any Policy