FOUNDED BY JOHN F. D RYD EN
PIONEER OF INDUSTRIAL INSURANCE IN AMERICA.
FEB 17 193O
In consideration of the paymnet of the weekly premium herein specified, on or before each and every Monday in every year
'" during the continuance of this Policy until twenty full years' premiums shall have been paid, will pay at its Home Office,
Newark, New Jersey the amount payable at the end of the endowment period, as specified in the Schedule below, to the Insured, If then living; or irf the event of the prior death of the Insured, if all premiums have been paid in full to that time, the Company immediupon receipt of due proof of such death will pay to the executory or administrators of the Insured the amount of insurance specified n the Table of Amounts of Insurance set forth in the Schedule below, unless payment be made under the provisions of the next succeeding paragraph; subject to the "General Provisions" on the second page hereof, which are hereby made part of this contract.
FACILITY OF PAYMENT.—It is understood and agreed that the said Company may make any payment or grant any non-forfeiture provision >rovided for in this Policy to any relative by blood or connection by marriage of the Insured, or to any person appearing to said Company to be squitably entitled to the same by reason of having incurred expense on behalf of the Insured, for his or her burial, and the production by the Company of a receipt signed by any or either of said persons or of other sufficient proof of such payment or grant of such provision to any or either )f them shall be conclusive evidence that such payment or provision has been made or granted to the person or persons entitled thereto, and :hat all claims under this Policy have been fully satisfied.
PRELIMINARY PROVISION.—This Policy shall not take effect if the Insured die before the date hereof, or if on such date the Insured be not n sound health, but in either event the premiums paid hereon, if any, shall be returned.
SCHEDULE.
Name of Insured
|
JOHN
|
PAaLIA
|
AGE NEXT BIRTHDAY
3
If incorrect, notify Company
|
Weekly Premium
|
1 0 cts
|
TABLE OF AMOUNTS OF INSURANCE.
These amounts of insurance are for each five cents of weekly premium. If the weekly premium on this Policy be a multiple of five cents the amounts of Insurance will be determined accordingly; that is, if the premium be ten cents, the insurance will be twice the amount shown in this table; if fifteen cents, three times the amount shown; and soon.
AMOUNT PAYABLE FOR EACH FIVE CENTS OF WEEKLY PREMIUM IF DEATH OCCUR AND POLICY HAS BEEN IN FORCE FOR
|
Amount Payable for each five centsof weekly premium at End of Endowment Period, 20 Yeara
|
Less than 1 Year
|
1 Year
|
2 Years
|
3 Years
|
4 Years
|
5 Years
|
6 Years
|
7 Years
|
8 Years
|
9 Years
|
|
$15.00
|
$17.50
|
$20.00
|
$22.50
|
$25.00
|
$30.00
|
$35.00
|
$40.00
|
$45.00
|
$50.00
|
$50.00
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_____After reaching the maximum amount the insurance will remain the same until the Policy becomes payable as an Endowment, when all insurance will cease._____
Maximum Amount of Insurance.—If the Insured be already insured under any policy or policies issued by this or any other company, and if the amount >f insurance payable at the death of the Insured under such policy or policies be less than the limit of insurance fixed by the following table, but when added " o the insurance payable under this Policy shall exceed the said limit, the amount payable under this Policy shall not exceed the difference between the amount ' ;pecified in the said table of limitations and the total amount of insurance payable under such policy or policies already in force on the life of the Insured, but f the amount of insurance payable at the death of the Insured under such policy or policies already in force be equal to or shall exceed the said limit of insurance, Jiis Policy shall be void, except as provided below:
. Limit of Insurance at Ajje Next Birthday at Time of Death.
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Limit Between Ages 14 and 14 1/2
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1
|
2
|
3
|
4
|
5
|
6
|
7
|
8
|
9
|
10
|
11
|
12
|
13
|
14
|
|
$20
0 |
$50
|
$75
|
$100
|
$130
|
$160
|
$200
|
$250
|
$320
|
$400
|
$500
|
$600
|
$700
|
$800
|
$900
|
Should the amount otherwise payable under this Policy be reduced as hereinbefore provided, the Company will return the total premiums paid upon the imount of such reduction, together with three and one-half per cent, per annum compound interest.
Loss of Eyesight or Limbs.—If the Insured while this Policy is in full force and effect and while there is no default in the payment of premium shall sustain i physical impairment such as specified below, total and permanent disability shall be deemed to exist and the disability benefit hereinafter provided shall be granted immediately upon receipt of due proof of such impairment: in event of the loss by severance of one hand or one foot, an amount equal to one-half of the imount of insurance at the time of such loss shall be paid in cash; or in event of the loss by severance of two hands or two feet, or one hand and one foot, or the permanent loss of the sight of both eyes, an amount equal to the full amount of insurance at the time of such loss shall be paid in cash; and in either event no further premiums shall be required thereafter and the Policy shall be endorsed as fully paid-up for the amount of insurance as specified in the Schedule above. The amount payable in cash under this provision on account of disability as herein defined shall in no event exceed an amount equal to the full amount of insurance ; under this Policy.
DIVIDEND PROVISION.
Annually, during its continuance in force, the proportion of the divisible surplus accruing upon this Policy shall be ascertained and apportioned by the Board of Directors and credited to this Policy at the end of the policy year as a dividend. Such dividend shall be in the form of a paid-up addition to the amount of insurance.
(Notice to Policyholder.—Owing to the low rate of premium at which policies of this nature are issued, the surplus accruing thereon will probably not sufficient to enable the Company to credit any dividend to this Policy before the fifth year.)
If this Policy lapse for non-payment of premium after premiums have been duly paid for three full years or more, the Insured, without any action upon his or her part, will become entitled to non-participating Extended Insurance for the respective term specified in the following table. The amount of insurance payable if death occur within said term shall be the same amount as that which would have been payable if this Policy had been continued in force, except as to dividend additions subsequent to the date of lapse, and if the Insured be living at the end of the term stated, the Pure Endowment, if any, specified in said table will then be paid.
Or, in lieu thereof, the Insured may surrender the Policy within three months after such lapse and will then be entitled at his or her option to receive either a non-participating Paid-up Endowment Policy or payment in cash as specified in the following table.
If there be any indebtedness under this Policy, such indebtedness will be deducted from the Cash Surrender Value, or the term of the Extended Insurance and the amount of the Pure Endowment, if any, or the amount of the Paid-up Endowment Policy, will be reduced to such term and amounts as the net single premium value of the respective provision reduced by such indebtedness shall provide according to the mortality table hereinafter specified.
Extended Insurance
and
Pure End' t. .
|
3 Yrs
|
4 Yrs
|
5 Yrs
|
6 Yrs
|
7 Yrs
|
8 Yrs
|
9 Yrs
|
10 Yrs
|
11 Yrs
|
12 Yrs
|
13 Yrs
|
14 Yrs
|
15 Yrs
|
16 Yrs
|
17 Yrs
|
18 Yrs
|
19 Yrs
|
20 Yrs
|
17 Yrs
$4.20
1
|
16 Yre
$7.60
"h |
15 Yrs
$10.80
nded In we
|
14 Yrs
$13.90
surance ekly pre
|
13 Yrs
$16.90
Period c mium; t
|
12 Yrs
$19.80
ates fro le amou
|
11 Yrs
$22.50
m the df nts of F
|
10 Yrs
$25.40
ite to w! ure End
|
9 Yrs
$28.20
lich pre owment
|
8 Yrs
$30.80
-niums h are for
|
7 Yrs
$33.40
ave beei each fiv
|
6 Yrs
$35.80
i paid a e cents <
|
5 Yrs
$38.20
nd is ths if week
|
4 Yrs
$40.50
i same 1 y premi
|
3 Yrs
$42.70
or any um.
|
2 Yrs
$44.80
amount
|
1 Yr
$46.80
of
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Policy Pay-- able
|
Paid-up End't Policy
|
$8.00 | $11.00 | $13.80 1 $16.50 1 $19.20 | $21.70 These Paid-up End
|
$24.20
owment
|
$26.80 | $29.30
Policies are for
|
$31.80
each fiv
|
$34. 10| $36.40
; cents of weekl
|
$38.60
f premi
|
$40.80 | $42.90 1 $44.90 | $46.80
jm.
|
|
Cash Surrender Value
These Cash Surrender Values are for each five cents of weekly premium.
The basis of the non-forfeiture values is the net reserve according to the Standard Industrial Mortality Table with three and one-half per cent, interest per annum. The figures in the above tables up to the end of the twentieth year include a surrender charge of not more than two and one-half per cent, of the amount of insurance. Should the amount of insurance be increased by dividend additions the reserve thereon shall be included with the net reserve on which the non-forfeiture values are based and the total surrender charge shall not be more than two and one-half per cent, of the total amount insured. At the end of twenty years no surrender charge is made.
In computing values from the foregoing tables, due allowance will be made for each completed quarter of a year's premiums paid over and above the full number of years there indicated.
This Policy contains the entire contract between the parties hereto.
President. ANNUAL DIVIDENDS.
(OVER)
In Witness Thereof, the President and the Secretary of said Company have signed this Policy at its Home Office in the City of Newark, N. J., on the above date.
PREMIUMS PAYABLE FOR TWENTY YEARS. DISABILITY BENEFITS. ACCIDENTAL DEATH BENEFIT.
S»&'*'ls=i**^'^~ ^^
Secretary. INFANTILE TWENTY-YEAR ENDOWMENT POLICY.
INO 15200 11-24
This Policy, if not satisfactory to the Applicant, may be surrendered within two weeks after its date at the Branch Office of the Company, the address of which appears on the premium receipt book accompanying this Policy, and the premiums paid hereon will be returned.
GENERAL PROVISIONS.
Payment of Premiums. — All premiums are payable at the Home Office of the Company, but may be paid to an authorized representative of the Company such payments to be recognized by the Company must be entered at the time of payment in the premium receipt book belonging with this Policy. If for an; reason the premium be not called for when due it shall be the duty of the policyholder, before said premium shall be in arrears four weeks, to bring or send sail premium to the Home Office of the Company or to one of its district offices.
Period of Grace. — Should the Insured die while the premium on this Policy is in arrears for a period not exceeding four weeks, the Company will pay th amount of insurance provided herein, subject to the conditions of the Policy, but after the expiration of the said period of grace the Company's liability unde this Policy shall cease, except as herein provided.
Incontestability. — After this Policy shall have been in force, during the lifetime of the Insured, for one full year from its date, it shall be incontestable except for non-payment of premium, but if the age of the Insured be misstated, the amount payable under this Policy shall be such as the premium would hav purchased at the correct age.
Policy When Void. — If at the time of the issuance of this Policy there be in force upon the life of the Insured hereunder an Industrial policy or policie issued by this Company, this Policy shall be void unless it contains an endorsement, signed by the President or Secretary, permitting this Policy to be in fore concurrently with such other policy or policies previously issued; but it is expressly stipulated that the issuance of this Policy without such endorsement shall no be considered a waiver of this provision should there be then in force any Industrial insurance policy or policies previously issued by this Company upon the lif of the Insured hereunder.
If for any cause this Policy be or become void, all premiums paid hereon shall be forfeited to the Company except as provided herein.
Reinstatement. — If this Policy lapse for non-payment of premium, it will be reinstated within one year from the date to which premiums have been dul; paid upon payment of all arrears, provided evidence of the insurability of the Insured satisfactory to the Company be furnished, but such reinstatement shall no take effect unless at the date thereof the Insured is living and in sound health.
Modifications, etc. — No condition, provision or privilege of this Policy can be waived or modified in any case except by an endorsement hereon signed b; the President, one of the Vice Presidents, the Secretary, one of the Assistant Secretaries, the Actuary, the Associate Actuary or one of the Assistant Actuaries No modification or change shall be made in this Policy except such as is in accordance with the laws of the State or Province in which the same is issued. No Agen has power in behalf of the Company to make or modify this or any other contract of insurance, to extend the time for paying a premium, to waive any forfeiture, o to bind the Company by making any promise, or by making or receiving any representation or information.
PROVISIONS AS TO ACCIDENTAL DEATH BENEFIT.
Upon receipt of due proof that the Insured after attainment of age 15 and prior to the attainment of age 70, has sustained bodily injury, solely througl external, violent and accidental means, occurring after the date of this Policy and resulting in the death of the Insured within ninety days from the dati of such bodily injury while this Policy is in force, and while there is no default in the payment of premium, the Company will pay in addition to any othe sums due under this Policy and subject to the provisions of this Policy an Accidental Death Benefit equal to the face amount of insurance stated in this Polic; less the amount of any disability benefit which has become payable under this Policy on account of the same bodily injury, except as provided below:
Exceptions. (1) If the bodily injuries referred to above shall be sustained by the Insured while engaged in employment in or on the premises of an; open pit or underground mine, or shall he sustained by the Insured while on or about the premises or right of way of any railroad company while the Insured i: following the occupation of gang, track, or roadway laborer; track walker; yard, freight or mixed train brakeman or flagman, the additional Accidental Deatl Benefit referred to in the first paragraph hereof shall be one-half of the face amount of insurance stated in this Policy, less the amount of any disability benefi which has become payable under this Policy on account of the same bodily injury. (2) No Accidental Death Benefit will be paid if the death of the Insure! resulted from suicide or from having been engaged in submarine or diving operations, or in aviation as a passenger or otherwise, or from military or nava service in time of war.
These provisions are granted without specific extra premium being charged therefor, but the cost thereof is included in the premium for this Policy.
THE PRUDENTIAL INSURANCE COMPANY OF AMERICA,
mo 11393
IMPORTANT
NOTICE TO
POLICYHOLDER
If it becomes impossible to continue the payment of premiums,
*
PRESERVE THIS POLICY*
because of the pro-tection which may be afforded under its provisions.
READ THE NON-FORFEITURE PROVISIONS IN
YOUR POLICY