20 PREMIUMS LIFE (ENDOWMENT AT 85) POLICY. WITH DISABILITY BENEFITS. No. 99999. AGE 35. PREMIUM $373.30. THE ETNA LIFE INSURANCE COMPANY OF HARTFORD, CONNECTICUT. Hereby Agrees to Pay for the surrender of this policy at its Home Office the sum of Ten Thousand Dollars (herein called the sum insured) upon receipt of due proof of the death of Richard Roe of Windsor, County of Holland, State of Connecticut (herein called the insured). This policy is issued and accepted subject to all the conditions, benefits and privileges described on the subsequent pages hereof, and which are hereby made a part of this contract. In Witness Whereof, the said Ætna Life Insurance Company has by its President and Secretary (or Assistant Secretary) signed this contract in the City of Hartford and State of Connecticut this First day of March, 1913. C. E. GILBERT, 1 CONSIDERA TION 2 PREMIUMS 3 Secretary. M. G. BULKELEY, THE FOREGOING AGREEMENT is made in consideration of the application for this policy, which application is hereby made a part of this contract and a copy of which is attached hereto and in further consideration of the annual premium of Three Hundred Seventythree and 30-100ths Dollars to be paid to the Company in advance at its Home Office or to its agent at or before five o'clock P. M. of the first day of March in each and every year until twenty full years' premiums have been paid or until the prior death of the insured. The amount becoming due from the Company by reason of the death of the insured shall be payable to the death beneficiary as follows: Mary Roe, wife of DEATH the Insured, if she survives the Insured, otherwise to BENEFICIARY the Insured's executors, administrators or assigns, less any unpaid premium for the current policy year; and the amount due from the Company by reason of the maturity of the endowment, or the cash value or the loan value, or the dividends if paid during the lifetime of the insured, shall be payable to the party herein called the life beneficiary as follows: the insured and all such payments shall be subject to the rights BENEFICIARY herein granted for varying the provisions of this policy and to any indebtedness to the Company on account of this policy including all loans made by the Company as herein provided. LIFE 5. CHANGE OF BENEFICIARY.-The beneficiary above designated may be changed before this policy matures as an endowment, provided the policy is not then assigned by the life beneficiary and is then returned to said Company with a request for such change duly signed by the life beneficiary alone, and such change shall take effect on endorsement of the same hereon by the Company. OR 6. PREMIUMS MAY BE PAID ANNUALLY, SEMI-ANNUALLY QUARTERLY.-The Company will accept the premium payable for annual, semi-annual or quarterly periods, according to its published rate for such at the time this policy is issued, provided that before any change is made from the method of payment herein stipulated the policy shall be forwarded to the Home Office of the Company for proper endorsement. 7. CONDITIONS REGARDING PAYMENT OF PREMIUMS.-This policy shall not take effect until the first premium hereon shall have bee R actually paid during the good health of the insured, a receipt for which payment shall be the delivery of the policy. If any subsequent premium be not paid when due then this policy shall cease, subject to the values and privileges hereinafter described; except that a grace of thirty-one days, during which time the policy remains in full force, will be allowed for the payment of any premium after the first, provided that with the payment of such premium interest at the rate of six per cent per annum is also paid thereon for the days of grace taken; but for any reckoning herein named the time when a premium becomes due shall be the day herein stipulated therefor without grace. No renewal premium shall be considered paid, unless a receipt shall be given therefor bearing the original or lithographed signature of the Secretary or Assistant Secretary of this Company and countersigned by the agent. 8. INCONTESTABLE AFTER ONE YEAR.-This policy and the application herefor constitute the entire contract between the parties hereto and it shall be incontestable after one year from its date of issue except for non-payment of premium; but if the age of the insured has been misstated the amount payable hereunder shall be such an amount as the premium paid would have purchased at this Company's published rate now in use for the correct age. 9. STATEMENTS OF INSURED NOT WARRANTIES.-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 or be used in defense to a claim under it unless it is contained in the written application herefor and a copy of such application is endorsed upon or attached to this policy when issued. 10. SUICIDE.-If the insured shall commit suicide within one year from the date hereof, while sane or insane, this policy shall be null and void. 11. DIVIDENDS.-Until this policy becomes a claim it shall be entitled to share in the divisible surplus of the participating business of the Company at the end of each policy year, and the amount of surplus accruing under it shall then be determined and accounted for, provided the insured is then living and there has been no default in the payment of premium. 12. APPLICATION, OF DIVIDENDS.-Such dividends shall be payable at the option of the life beneficiary by one of the following methods, providing that if no election is made the dividends will be paid in cash. First Methoď: In reduction of the premium on this policy if the remainder of such premium is paid as herein required. Second Method: In cash. Third Method: In paid-up additions to the sum insured for an amount in each case bearing the same proportion to the amount of the dividend that the paid-up policy at that time shown in Table A bears to the corresponding cash value. Fourth Method: In being left with the Company to accumulate at a rate of interest not less than three per cent per annum. The dividends so accumulated, or any portion thereof, will be paid to the life beneficiary when desired during the lifetime of the insured, or, after the death of the insured, will be paid to the payee of the policy in addition to the sum insured; but no premium shall be construed as paid either wholly or in part by reason of dividends remaining with the Company. 13. DIVIDENDS MAY REDUCE THE NUMBER OF PREMIUMS OR HASTEN THE MATURITY OF THE POLICY.-When the total cash value of this policy, consisting of said accumulated dividends, the cash value of dividend additions, if any, and the cash value shown by Table A, less indebtedness, if any, secured hereby, equals the net single premium for a policy of the same amount and kind as the sum insured, issued on the same life and due at the same time, a paid-up participating policy will be issued for the sum insured if this policy is then duly surrendered to the Company for that purpose. Said single premium will be the same proportion of the sum insured that the tabular cash value at that time bears to the corresponding paid-up policy shown by Table A. Or when such total value equals the sum insured the said sum insured shall then be due and payable. 14. LOANS. After two full years' premiums have been paid hereon, before default in the payment of premium, and before the policy becomes a claim, the Company will loan upon the sole security of this policy at six per cent interest payable annually in advance the whole, or, at the option of the borrower, any part of the cash value shown by Table A at the end of the current policy year and the cash value of dividend additions, if any, less all indebtedness to the Company hereon and less also any unpaid portion of the premium and interest on the loan for the remainder of the current policy year. For the purpose of such loan the policy shall be returned to the Company together with a proper assignment of the same and said assignment may be executed by the life beneficiary alone provided the interest of such beneficiary is not then assigned. 15. AUTOMATIC PREMIUM LOAN.-If a request for the automatic premium loan privilege has been signed by the life beneficiary and assignee, if any, and is received at the Company's Home Office together with this policy before default in the payment of premium, such privilege will be endorsed hereon by the Company, and thereafter, until a written revocation of said request signed by the life beneficiary and assignee, if any, has been endorsed hereon by the Company, the amount of any premium not paid in cash when due or within the days of grace less any dividend applicable thereon, will, without further action by the owners, be loaned by the Company in payment of such premium and charged as an indebtedness secured by this policy, subject to interest at the rate of six per cent per annum as above described for loans, provided that the net loan value as above described is sufficient to pay the premium and interest then due. 16. WHEN INSURANCE WILL TERMINATE FOR NON-PAYMENT OF INTEREST.-Interest on any indebtedness hereon not paid when due shall be added to the principal and reckoned as a part thereof. Failure to pay any loan or interest due thereon will avoid this policy when the total indebtedness hereon to the Company shall equal or exceed the loan value at the time of such failure, but not before that time, nor until one month after notice of the same has been mailed by the Company to the last known address of the person to whom the loan was made and of the insured, and assignee, if any. 17. NON-FORFEITING VALUES, EXTENDED INSURANCE.-After two full years' premiums have been paid hereon and any subsequent premium becomes due and is unpaid the entire reserve then existing under this policy, including that of dividend additions, if any, less not more than two and one-half per cent of the sum insured and dividend additions and less also any indebtedness hereon to the Company, will, without action by the owner, be applied as a net single premium at the then age of the insured to extend as nonparticipating term insurance without the right to loans the sum insured by this policy and dividend additions, if any, less any indebtedness to the Company secured hereby. The reserve and single premium named herein shall be computed according to the American Experience Table of Mortality and three per cent interest. said net single premium is more than sufficient to purchase such term insurance to the end of the endowment term of this policy the excess thereof will be applied in like manner to the purchase of a non-participating pure endowment payable at the end of such endowment term if the insured is then living; or If PAID-UP POLICY.-If requested by the life beneficiary and assignee, if any, and if this policy is surrendered to the Company within two months after the first unpaid premium becomes due the said net single premium will be applied to the purchase of a paid-up non-participating stock policy payable at the end of the endowment term of this policy if the insured is then living, or at the prior death of the insured; or CASH VALUE.-Under the conditions applicable to the issue of the paid-up policy above described, or after all premiums required hereon have been paid, the Company will pay for the surrender hereof a cash value at least equal to the sum which would otherwise be applicable to the purchase of the extended term or paid-up insurance above provided. The extended term insurance or the paid-up policy above provided will be entitled to a cash surrender value of the entire reserve existing thereon at the time of surrender according to said table of mortality and rate of interest, and the paid-up policy will be entitled to a loan equal to its cash value upon the conditions herein prescribed for a loan under this policy. TABLE A. This table shows the non-forfeiting values above described for $1000 of insurance at the end of completed policy years when there is no indebtedness to the Company secured by this policy and no existing dividend additions. The paid-up policy, the cash value, and the pure endowment, if any, for insurance of a greater or less amount than $1000 will be proportionate. Each full quarter of a year that has elapsed after the end of any policy year and for which quarter year the premium due has been paid will increase the cash value and the paid-up policy one-fourth of the increase for the full year. The term of the extended insurance will be reckoned from the time when the first unpaid premium becomes due, and will not vary with the amount of the insurance. No deduction from these values will be made for a surrender charge. EFFECT OF DIVIDEND ADDITIONS AND INDEBTEDNESS ON NON-FORFEITING VALUES SHOWN BY TABLE A.-The cash value of dividend additions, if any, will be paid in addition to the cash value shown by Table A. The cash value shown by Table A will be decreased by the amount of any indebtedness. The paid-up policy shown by Table A will be increased by the amount of the dividend additions, and decreased in the same proportion that any indebtedness bears to the cash value hereof. The cash value of dividend additions, if any, will be the same proportion of such additions that the cash value shown in Table A at that time bears to the corresponding paid-up policy. 18. CASH VALUE IN EVENT OF PERMANENT TOTAL DISABILITY.— Twelve months after proof is received at the Home Office of the Company that from causes originating after the delivery of this policy, the insured has become wholly, continuously and permanent ly disabled and will for life be unable to perform any work or conduct any business for compensation or profit, then in lieu of all other values, benefits or privileges herein provided, without further payment of premium, all premiums previously due having been paid, the Company will pay in full settlement of this policy upon request duly executed by the life beneficiary and assignee, if any, onetwentieth of the sum insured and dividend additions, if any, and will pay the same amount annually thereafter until twenty such payments in all have been made; or will pay the amount of annuity shown by the following table of annuities for the age of the insured at the last birthday preceding the receipt of such proof, and the same amount annually thereafter during a fixed period of nine years (making ten annuity payments certain) and for as many full years longer as the insured shall live, provided that at every such annuity payment after the tenth satisfactory proof is furnished that the insured is then living. Any indebtedness to the Company on account of this policy will reduce the amount of either of said annual payments in the same proportion that said indebtedness bears to three-fourths of the sum insured and dividend additions, if any. TABLE OF ANNUITIES FOR EACH ONE THOUSAND DOLLARS IN THE SUM INSURED AND DIVIDEND ADDITIONS. The Company will extend the privileges and benefits for permanent total disability above described to cover the irrecoverable loss of the entire sight of both eyes, or the total and permanent loss by removal or disease of the use of both hands or of both feet or of such loss of one hand and one foot all from causes originating after the delivery of this policy and before default in the payment of premium. Any benefit for disability within the meaning of this policy is conditioned upon the Company being permitted to examine the insured when desired within one year after the receipt of the proof, and such benefit will not be included in the paid-up policy herein provided to be issued on default in payment of premium. 19. REINSTATEMENT.-Within five years after default in any premium payment, if this policy has not been surrendered, it may be reinstated upon evidence of insurability satisfactory to the Company and by payment of arrears of premiums with interest at the rate of six per cent per annum and by payment or reinstatement of whatever indebtedness to the Company existed hereon at the date of default with interest from that date. 20. MODES OF PAYING THE INSURANCE.-If the policy is not assigned by the life beneficiary the life beneficiary may elect, or the payee after the death of the insured without such election may elect, by written notice filed at the Home Office of the Company, befere any payment on the sum insured has been made, to have the net sum payable by the Company under this policy either as a death |