20 PREMIUMS LIFE POLICY. (NONPARTICIPATING).

No. 99,876 A.

AGE, 35,

METROPOLITAN LIFE INSURANCE CO (INCORPORATED IN THE STATE OF NEW YORK.)

AMOUNT $10,000.

ANNUAL PREMIUM 8296,10,

In Consideration of the answers and statements contained in the printed and written application for this policy upon the life of George L. Jones, of Oak Park, County of Cook, State of Illinois, hereinafter called the insured, all of which answers and statements are hereby made part of this contract, and of the payment of the annual premium of two hundred ninety-six dollars and ten cents, on or before the delivery of this Policy, and of a like amount on or before the Fifteenth day of November, of each and every year during the life of the insured, until Twenty full years' premium shall have been paid to the Company.

Doth hereby agree, subject to the conditions set forth on the reverse side hereof, each and all of which are hereby made part of this contract, and are accepted by the insured and assured as part thereof as fully as if herein recited, to pay at its Home Office, in the City of New York, the sum of Ten Thousand dollars, to Martha S. Jones, wife of the insured herein called the assured, if living, otherwise to the legal representatives of the insured, upon the receipt by the Company at its Home Office and its approval of the proofs of death of the insured made in the manner, to the extent and upon the blanks required by Condition Sixth, and upon the surrender of this Policy. No obligation is assumed by the Company until the first premium has been paid, or prior to this date, nor unless upon this date the insured is alive and in sound health. In Witness Whereof, THE METROPOLITAN LIFE INSURANCE COM. PANY has, by two of its officers, signed and delivered this instrument, at its office, in the City of New York, on the Fifteenth day of November, 1895. GEO. B. WOODWARD, JNO. R. HEGEMAN, Secretary,

President.

CONDITIONS

REFERRED TO ON THE FACE OF THIS POLICY AS PART OF THIS CONTRACT. FIRST.-The Company shall be released from all liability under this Policy if the insured shall within two years from the issue hereof, become engaged in or connected in any manner with the manufacture or sale of ale, wine, beer or liquor, unless written permission from the President or Secretary of the Company be first obtained. If the insured within two years from the issue hereof die by his own hand or act, whether sane or insane, the Company shall not be liable for a greater sum than the Premiums which have been received on this Policy.

SECOND.-If any answer or statement in the application herein referred to is not true or if any alteration be made in this Policy, except by an endorsement signed by the Secretary, or if any premium or installment of premium be not paid when due, this Policy shall be void and all premiums paid shall be forfeited to the Company, except as provided below in Paragraph First of "Concessions."

THIRD.-In no case will the amount payable on this Policy be more than the premium charge will purchase by the company's rates in use at the date hereof for the true age of the insured; absolute proofs of age may be required with proofs of claim hereunder.

FOURTH.-Premiums are payable at the Home Office in the City of New York, but at the pleasure of the Company suitable persons may be authorized to receive such payments at other places but only on the production of the Company's receipt signed by the President or Secretary, and countersigned by the person receiving the payments. All premiums are considered payable yearly in advance, but when paid in semiannual or quarterly installments, that part, if any, which remains unpaid at the maturity of the Policy shall be deducted; but this provision does not affect the provisions of the second paragraph respecting for. feiture for non-payment of installment of premiums.

FIFTH.-Any assignment of this Policy is void unless assented to in writing by the Secretary; but in no case does the Company guarantee the validity of any assignment, and the Company may demand proof of interest in case of claim by an assignee.

SIXTH.-Proofs of death shall be made to the Hone Office in the manner and to the extent required by blanks furnished by the Company and shall contain answers to each question propounded to the claimants, physicians and other persons indicated in the blanks, and shall further contain the record and verdict of the coroner's inquest, if any be held. The proofs of death shall be evidence of the facts therein stated in be. half of, but not against the Company.

SEVENTH.-No suit shall be brought or action commenced against this Company after two years from the date of death of the insured, and it is expressly agreed that if such suit or action be commenced after two years the lapse of time shall be conclusive evidence against any claim, the provisions of any and all statutes of limitation to the contrary being hereby expressly waived.

EIGHTH.-The contract between the parties hereto is completely set forth in this Policy and the application therefor taken together, and none of its terms can be varied or modifled, nor any forfeiture waived or premiums in arrears received except by agreement in writing signed by either the President, Vice President or Secretary, whose authority for this purpose will not be delegated; no other person has or will be given authority.

NINTH.-This Policy is not entitled to participate in the profits or divisible surplus of the Company.

CONCESSIONS.

FIRST.-A non-participating paid-up Policy, payable in the same manner as the original Policy, will be granted for the amount specified in the following table of paid-up values, after the premiums for three full years shall have been paid and this Policy satisfactorily released and surrendered therefor to the Company at the Home Office while in force, or within six months from default of payment of any premium. TABLE OF PAID-UP VALUES AT THE END OF

1500 2000 2500 3000 3500 4000 4500 5000 5500 6000 6500 7000 7500 8000 8500 9000 9500

ğ 17 yrs.

18 yrs.

g19 yrs.

20 yrs.

The amount of "of Paid-up Values" for other periods will be furnished upon application.

"

SECOND.-The Company will loan the amounts specified in the following table at six per cent. interest, payable in advance, upon receiving satisfactory assignment of this Policy as collateral security while in force. TABLE OF LOAN VALUES AFTER PAYING FOR

280 380 490 620 770 940 1120 1310 1520 1750 1990 2260 2540 2840 3180 3530 3900 4310

The amount of "Loan Value" for other periods will be furnished upon application.

THIRD.-After two years this Policy shall be non-contestable except for the non-payment of premiums as stipulated, or for fraud or misstatement of age.

10000

IT IS HEREBY DECLARED, AGREED AND WARRANTED BY THE UNDERSIGNED: That the answers and statements contained in the foregoing Application, and those made to the Medica. Examiner, as recorded in parts A and B of this sheet, together with this declaration, shall be the basis and become part of the contract of insurance with the METROPOLITAN LIFE INSURANCE COMPANY; that they are full and true, and are correctly recorded, and that no information or statement not contained in this application, received or acquired at any time by any person, shall be binding upon the Company, or shall modify or alter the declarations and warranties made in this application; that the persons who wrote in the answers and statements were and are our Agents for the purpose and not the Agents of the Company; and that the Company is not to be taken to be responsible for its preparation or for anything contained therein or omitted therefrom; that any false, incorrect or untrue answer, any suppression or concealment of facts in any of the answers in the foregoing questions, any violation of the covenants, conditions or restrictions of the policy, any neglect to pay the premium on or before the date it becomes due, shall render the policy null and void, and forfeit all payments made thereon.

That the policy hereby applied for shall not be in force until the actual payment to and acceptance of the premium by the Company during the lifetime and good health of the person on whose life insurance is applied for.

It is expressly agreed that the provisions of the policy for the issuance of paid-up insurance are accepted in substitution for and in waiver of any law of any State relating to the lapse or forfeiture of policies of life insurance.

The provisions of Section 834 of the Code of Civil Procedure of the State of New York, and of similar provisions in the laws of other States, are hereby waived; and it is expressly consented and stipulated, that in any suit on the policy herein applied for, any physician who has attended, or may hereafter attend the insured, may disclose any information acquired by him in any wise affecting the declarations and warranties herein made.

1

GUARANTEED

CASH VALUE.

On the surrender of this bond, duly receipted by the insured and beneficiaries within 3 months after the expiration of the fifth within three months after the end of any subsequent five year period for which premium has been paid, the Company, will pay the cash values specified in the. following table:

year or

AMOUNT.

Hereby agrees and prom- GUARANTEED ises to pay the sum of Ten Thousand Dollars, the amount of this accumulative Bond, at its home office, in

Payable in event of the death of the insured occurring within the first or any subsequent year, specified in the following table. This guarantee is subject to the conditions and agreements related in this bond.

1sty'r$10,545.00 2d "11,090.00 3d "11,635.00

4th

12,180.00

the City of Detroit; to Richard Johnson, of Detroit, County of Wayne, State of Michigan, at the expiration of twenty years from the date of this contract, or in case of his previous death to pay the said sum of Ten Thousand Dollars, and, in addition thereto, an amount equal to all annual premiums paid to the Company on this Bond prior to such death, the sum so to be paid being indicated and guaranteed upon the margin hereof (any balance of the current year's premium, all indebtedness on account of this bond being first deducted therefrom) to his wife, Mary A. Johnson, if living, if not living, then to his administrators, executors or assigns, when due notice and satisfactory proofs of death have been received by the Company. This bond is issued in consideration of the application therefor a copy of which is hereto attached and is made a part of this contract, the same being accepted by the insured on the following conditions: The annual premium of Five Hundred and

END OF 5th y'r $1,708.80 10th " 8,846.90 15th 6,541.80

20th

10,000.00

5th

12.725.00

6th

13,270.00

7th

13.815.00

8th

14,360.00