of death and circumstances connected therewith as may be required by the Directors, and upon proof of the age of the Assured, (if that shall not have already been supplied and age been admitted by the Company), and upon the title of the persons claiming the money being shown and established, and upon the execution and delivery of a discharge to the Company by all necessary parties, the Company will pay unto the said Assured's Executors, Administrators, Appointees, or Assigns, or other the person or persons whose title thereto has been so established, at the Head Office of the Company in Hamilton. on demand, the said sum of Ten Thousand Dollars, together with such further sum or sums, if any, as shall have been assigned to or in respect of this policy pursuant to the Rules and Regulations for the time being of the said Company, as or by way of Bonus or addition to the sum hereby assured, but subject to addition or diminution, as the case may be, in accordance with the practice of the Company, in case it shall appear that the age of the Assured has been incorrectly stated, and subject to increase or diminution when the Policy becomes a claim, according as the Bonus Additions declared by the Company during its currency shall have exceeded or fallen short of a rate of one and a quarter per cent per annum. 4. Provided always, That in the event of this Policy becoming a Claim during the currency of any year from the anniversary date written in section two hereof, and while the Premiums under this Policy may be payable by Semi-Annual or Quarterly installments, the Company shall be entitled to deduct any unpaid Semi-Annual or Quarterly installments, applicable to that year, from the sum payable under the Policy at, settlement. 5. Provided also, That this Policy, and the Assurance hereby effected are and shall be subject to the Conditions and Regulations hereupon indorsed, so far as the same are and shall be applicable, in the same manner as if the same respectively were here repeated and incorporated in this Policy. 6. In Testimony Whereof, the President and Managing Director and Secretary of the said Company have hereunto set their hands, and caused the seal of the said Company to be hereunto affixed, at the City of Hamilton, this Twenty-ninth day of January, in the Year of our Lord one thousand eight hundred and ninety-four. Age admitted. A. G. RAMSAY, President and Managing Director. Entered and countersigned, C. J. DIXON. R. HILLS, Secretary. 1 CONDITIONS OF ASSURANCE. 1. Thirty days of grace are allowed for payments of Premiums, but should the payment due upon a Policy, or any installment thereof, remain unpaid beyond that time, it may be revived at any period within six months, upon evidence being given which shall be satisfactory to the Directors that the party or parties continue good assurable lives, and payment of the premiums in arrear, and a fine not exceeding five per cent thereon; or at any period within twelve months, upon similar evidence, and upon the payment of the Premiums in arrear, and a fine not exceeding ten per cent thereon; or within the same periods, upon similar evidence where a policy has been in force for not less than five years, a Policy will be granted, representing the equitable value of Premiums already paid, without liability to further ordinary Premiums. Policies which have lapsed, through unintentional omission to pay a premium, may be renewed, in the discretion of the Directors, within thirteen months after said Premium became due, on payment of all arrears, with a fine of one per cent per month. 2. Policies which have been in existence for two years shall be indisputable on any ground whatever. Policies of less than two years' standing on the lives of persons who shall die by suicide, dueling or by the hands of justice, shall be void, excepting in cases where the Policies have been effected by one party on the life of another, or where they have been assigned to third parties for valuable consideration. 3. Policies of not less than five years' standing will be purchased at a fair valuation, according to the rules and regulations of the Company for the time being. Residence is permitted within any part of the Dominion of Canada and of the United States as far south as to include the States of Virginia, Kentucky, Missouri, Kansas, Colorado, Utah, Nevada and California, if the person on whose life the Assurance depends be not engaged in mining pursuits; and also in any part of Europe. Travel only not permanent residence-is permitted in any part of the United States between 1st November and 1st June in any year. Persons may voyage as passengers in good seaworthy vessels, in time of peace, from any port within the said limits of residence to any other port within the same, either in America or in Europe; excepting, however, voyages from ports on the Pacific Coast to others on the Atlantic Coast of America, or vice versa; and also excepting voyages from the said Pacific Coast to Europe, or vice versa. If the person or per⚫sons assured shall reside beyond the boundaries thus described, or travel beyond the limits thus fixed, without previously obtaining permission by the Directors for the time being, the Policy shall be immediately forfeited, and all assurance thereon shall cease; excepting in cases where Policies have been effected by one party on the life of another, or where they have been assigned to third parties for valuable considerations, when forfeiture shall not take place, if satisfactory evidence be given to the Directors that the facts were communicated to the Office as soon as they were known to the parties interested, and payment be made of the extra Premium required to cover any additional risk incurred. A. G. RAMSAY, President and Managing Director. February 1891. R. HILLS, This condition, No. 4, shall be ALTOGETHER CANCELED Notice is hereby given that no Receipts for Payments shall be valid or binding upon the Company except those issued from the Head Office, upon the Company's printed forms, and signed by the President or Vice President, Managing Director and Secretary. N. B.-The Company does not recognize or hold itself bound by any notice or Intimation of any assignment of, or charge upon, any Policy, unless served upon the Managing Director or Secretary at the Head Office in Hamilton, Ontario; and holders of Policies requiring to make these are recommended to adopt that course, so that there may not be any question of their priority or position. Forms of Assignment of Policies may be obtained from the Company, but ersons must satisfy themselves in each case as to whether or not the Form recisely suits their particular circumstances, the Company not undertaking ny responsibility in that respect. 20 PREMIUMS LIFE GUARANTEED AND INVESTMENT No. 99999. POLICY. AGE, 35. THE CANADA LIFE ASSURANCE CO. Incorporated by Act of Parliament. Chief Office, Hamilton, Ontario. AMOUNT, $10,000. Dated 29th January. ANNUAL PREMIUM, $327.00. Guaranteed Reserve and Investment System. Tontine Profits Life 20 Annual Payments. THE CANADA LIFE ASSURANCE COMPANY, in consideration of the written application for this Policy by William Brown of Hamilton, Ontario, Merchant, the assured, dated the Twenty-ninth day of January, 1894, which is hereby made the basis of this contract, and in further consideration of the annual premium of Three Hundred and Twenty-seven Dollars, to be paid in advance, and of the payment at the head office of the Company in Hamilton, Ontario, of a like sum every Twelve months, from the 29th January, 1894 during the contin⚫uance of this contract, until Twenty full annual premiums shall have been paid, or until the death of the said assured, hereby agrees and promises to pay_Ten Thousand Dollars in gold at its head office, aforesaid, to Emily Brown, his wife, or in the event of her prior death, to the said assured's executors, administrators, appointees or assigns, together with such further sums, if any, as shall have been assigned to this Policy by way of profits, pursuant to the rules and regulations of the Company for the time being, upon the receipt and approval of the proofs of the death of the said assured during the continuance of this contract, and upon the title of the person claiming the money being satisfactorily shown, and on the delivery to the said Company of this Policy and a valid discharge therefor, This Policy is issued and accepted upon, and subject to, the privileges and conditions hereon endorsed as fully as if the same were herein stated over the seal and signatures hereto affixed. In Testimony Whereof, the President and Managing Director and Secretary of the said Company have hereunto set their hands, and caused the seal of the said Company to be hereunto affixed, at the aforesaid City of Hamilton, this Twenty-ninth day of January in the year of our Lord, One thousand Eight Hundred and ninety-four. Age admitted. R. HILLS, A. G. RAMSAY, President and Managing Director. Secretary. PRIVILEGES AND CONDITIONS. "1. Thirty days of grace are allowed for the payment of renewal premiums. 2. Should any payment due upon this Policy remain unpaid beyond the days of grace, said Policy will become void, but it may be revived within twelve months thereafter, on production of satisfactory evidence of continued good health, and the payment of overdue premiums, with a fine not exceeding ten per cent per annum thereon, 3. Loans will be made upon this Policy by the Company after it has been three full years in force. 4. After being in force two full years this Policy shall be indisputable on any ground whatever, age having been admitted. 5. After being in force three full years this Policy may be exchanged for a non-participating paid-up Policy for as many twentieth parts of the sum assured as there shall have been complete annual premiums paid, provided written application be made for said paid-up Policy while there is no default in the payment of any Premium, or within twelve months after such default, and that the Policy be validly discharged. 6. After five or more full annual premiums have been paid, and while there is no default in the payment of any premium, or within twelve months after such default, this Policy may be surrendered to the Company for not less than the following cash surrender values: From the fifth to the tenth year of this Policy, 75 per cent of the reserve, as computed by the present government standard; from the tenth to the fifteenth year, 85 per cent of said reserve; after the fifteenth year, 90 per cent of said reserve. Provided that at the end of the tontine period, and all premiums fully paid up, the full reserve may be withdrawn. 7. In the event of this Policy becoming a claim, any loan or indebtedness to the Company, and the unpaid balance (if any) of the current year's premium will be deducted from the sum payable under the Policy at settlement. 8. Policies of less than two years' standing on the lives of persons who shall die by suicide, dueling, or by the hands of Justice, shall be void, excepting in cases where the Policies have been effected by one party on the life of another, or where they have been assigned to third parties for valuable consideration. 9. Residence is permitted within any part of the Dominion of Canada and of the United States as far south as to include the States of Virginia, Kentucky, Missouri, Kansas, Colorado, Utah, Nevada and California, if the person on whose life the assurance depends be not engaged in mining pursuits; and also in any part of Europe. Travel only not permanent residence is permitted in any other part of the United States between 1st of November and 1st of July in any year. Persons may voyage as passengers in good seaworthy vessels in time of peace, from any port within said limits of residence to any other port within the same, either in America or Europe-excepting, however, voyages from ports on the Pacific Coast to Europe or vice versa. If the person or persons assured shall reside beyond the boundaries thus described, or travel beyond the limits thus fixed, without previously obtaining permission by the Directors for the time being, the Policy shall be immediately forfeited, and all assurances thereon shall cease, excepting in cases where Policies have been effected by one party on the life of another, or where they have been assigned to third parties for valuable consideration, when forfeiture shall not take place if satisfactory evidence is given to the Directors that the facts were communicated to the office as soon as they were known to the parties interested, and payment be made of the extra premium required to cover any additional risk incurred. Persons shall not enter into any military or naval service without previous license, in writing from the Directors for the time being; or being or becoming military or naval men shall not enter into actual active service without permission from the Directors; and shall not engage in sea-faring occupations, or in navigating the seas, lakes or rivers, without a previous compliance with the special condition or conditions which the Directors may, in each particular case, impose. Failing to observe such regulations, the party or parties assured shall forfeit all claims otherwise existing under the Policy; excepting in cases where Policies have been effected by one party on the life of another, or where they have been assigned to third parties for valuable considerations, when forfeiture shall not take place if satisfactory evidence be given to the Directors that the facts were communicated to the office so soon as they were known to the parties interested, and payment be inade of the extra premium required to cover any additional risk incurred. This condition (No. 9) will be altogether cancelled and dispensed with after two years, provided the assured shall not during that time have traveled or re120 g1 to $1145] 9 sided beyond the boundaries and limits specified, nor engaged in military or naval service, nor in sea-faring or navigating occupations. 10. This Policy is to be interpreted and construed according to the laws of Canada. 11. This Policy is issued and accepted on the Company's tontine profit system, the particulars of which are as follows: (a) That the tontine period for this Policy shall be completed on the thirtyfirst day of December, 1914. (b) That the profits on all Policies of the tontine system shall be computed by the Company according to their rules and regulations for the time being, and shall be shared in by those Policies in force at the maturity of their tontine period, and by those only. (c) If this Policy be in force at the completion of the tontine period and all premiums fully paid up, the assured, or other person entitled, shall receive one of the following benefits: First. To withdraw in cash the full value of this Policy, that is, the full reserve, amounting to Five Thousand and Thirty dollars, and in addition thereto the profits apportioned to this Policy. Second. To withdraw in cash such profits and continue the Policy for the original amount, it being fully paid up and participating in future profits. Third. To convert such profits into a bonus addition, upon satisfactory evidence that the assured is in good health, and continue the Policy in force for the original amount, it being fully paid up and participating in future profits. Fourth.-To convert such profits into an annuity for life, and to continue the Policy in force for the original amount, it being fully paid up and participating in future profits. 12. Proof of the assured's age will be required before payment of the Policy, unless it has been previously admitted by the Company. Notice is hereby given that no receipts for payments shall be valid or binding upon the Company, except those issued from the head office, upon the Company's printed forms, and signed by the President or Vice President, Managing Director and Secretary. N. B.-The Company does not recognize or hold itself bound by any notice or intimation of any assignment of, or charge upon, any Policy, unless served upon the Managing Director or Secretary at the head office in Hamilton, Ontario; and holders of Policies requiring to make these are recommended to adopt that course, so that there may not be any question of their priority or position. Forms of assignments of Policles may be obtained from the Company, but persons must satisfy themselves in each case as to whether or not the form precisely suits their particular circumstances, the Company not undertaking any responsibility in that respect. The Declaration mentioned in the Policy and contained in the application for Assurance is in this form. I, Alfred Edward Evergreen, the above designed, do hereby declare that to the best of my knowledge and belief, I am at present in good health, not be ing afflicted with any disease or disorder, external or internal; and that the above statement of my age, and other particular is true. And I, Alfred Edward Evergreen (the party in whose favor the Assurance is to be granted) do hereby agree that this Declaration shall be the basis of the contract between me and the CANADA LIFE ASSURANCE COMPANY, that I will accept and take up the policy hereby applied for, when issued by said Company; and that if any untrue averment has been intentionally made, or any material information has been willfully withheld in this declaration, or in the replies to be given to the Company's medical adviser in connection herewith, all sums which shall have been paid to the said Company, upon account of the Assurance granted in consequence thereof, shall be forfeited, and the Assurance be absolutely null and vold; and further, that the continuance of the assured in the same state of health at the time of the payment of the first premium is a condition of the Assurance taking effect. |