PAGE 1 A IL .. ... E. ...TL ... PAGE 2 ..t n.. ...e.d.. .. ..,, (ne PAGE 3 expiaton f treeyeas aterthetilte riten roo o .... .. rqi dt b rn hd... "( I Ay pr 1, na olos PAGE 4 co:ger.satien anything ,artaininr to an occupati on so clanified, the inmarer will ay or-ly such portion of the i unr.1 t les provided is: this poli cy as the are:1tum pai.] would have pu--chased at the rates and within the li::::t!; "ixed by the insurer for such .ore hazardous occupatier:. If t.:e insured changes his occupation to one cla205 Red by --he --:1'iurer as le:Is hazanlous than that stated in this pol-.cy, the insurer, upon receipt of proof of Euch chanre af occupatiers will reduce the pre:uium rate accordincly, ar.d will returr: the excess pre-rata unearr.ed ;.reari-im froo the date of change of occuj-ation or from the policy anniversary ate jmediately preceding receipt af si:ch proof, whichever is the more recent. In apply:nr this provision, the classificatier. of ace:ga-tioral risk arid the premium rates shall be mich as have heer liist filed by the insurer prj.or to the occurrence of the ~Ms for '.tica the inaurer is liable or prior to date of goof of charly in occupation -dith the state offj.cial havir., supervisia:1 af ir:surance in the state olare -1.3 ir.suru resided at Oc tirse this colicy wra W:aad; but if s:c: !-ilir.g was not requireda then C r c".;:::::i;:a:ttior, of pu:1:rition...l r1G, and 11-.e 7:rc --12 m. r s r"...l'. N t i-.oce last a!.;-.de e f fective by t!-:C i ns.3:-er ir. Esb state pri or to the accurra:ice of the loss or prior to the date c:0 ;.rcof of che et in occupation, hf6 li provistor. 46 follriwa : is--statseent of Age: If the age of C;c i7Irr-r' trie la-en mis-stated, all a--lo.mts payab~.ai under this 131 !cy shall he such its the prert~r pai. Trould have purclase at the currect age. '(3) ji provision an follows: "Other Insurar.co ir. this insurer: If an acci.-lent or sickness or ac.eldent aur1 sickness policy -12- PAGE 5 .i y f r .......... PAGE 6 "(ftefrgigp ly .ro.....n.. PAGE 7 -os h ny 1iab1lty -sc bnfit ndrIp l. .h11l -e -.n pr rin f d e ,tb-~ ~ ..-. 1 1 -Ilk -I'II I l f14If1 1 1I1I1 PI-111-11 1 -1d I fuhprino th pe i ..id as pp-ecd th y o T,(IfD th e --egin pof c -h oi -h are a t -3gpIr.,, in-ud -, ,hspovs b, d -lnfio 1" -he vai ovr ," -p1-ve a t formor o~e scase Cmisione, wi chdefni Mon hal PAGE 8 .n.... .. .... ....... .... .plig h orrigpl prcy..mr: ~ ~ ~ .. 51tidprylaiiy oeaesalb n PAGE 9 at ~ ~ ~ ~ ~ .1.1. ts opton -rlud inti rviinadfiiino "-j-i loy oftm ovr-, apoe a ofr -b -rh-t-~c Iamsinryahdfinto shal -e y i insuact tertocvesg roiddbygoenmA tlagnce cr y rraiztio~ssubec tore -a il b nua -a rIInu Fnc auh1,te o.ths r nyoters (7) de: tdSae r Apr ineo a do ay -tr o lag h n-o -Y rihma eaprvdb the ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ .1-.,ne1'msinrcr n oaiato fsc covera ~ ~ ~ ~ ~ ~ ~~7 .es .....bec f uhdfiiinsuhtr shlireircldean cvea -toided b-.sd isue pursnre ~ ~ -, ., yn o~laybnftsaue(nldn n 11,men do~rstoo mlye' ibl ttt) or ~ ~ ~ ~ ~ ~ b benefit ir.ddb ro efrepaso yepoe PAGE 10 co-p-td ,y the us f -. 1-r-rt -al atfld Aae .A inu-1 balt e "(9) A ArvIsin A I.oll s "tn -ty ...I tbh t t-tts Any b. r frso -fti o y hi, n -t ffcie a A th th e Is.. d, o.f -h -tA I. ..it the ~ ~ ~ ~ ~ ~ ~ ~ ~ ~~h inue.esdso sc a. .hrby .edd ocn "(10PAA A Aoi.io As fll s 11llegal Thu.io: Te nue thal pt-dt belalefry los -r ... c .1 cn bting i,ae ,'.b the Inue' C.-s-,o rateptt cm (--1 -A ,rAvlAiA as p...As: pnr cecqcf h -n--, d' b.,y i xia d ... -nder PAGE 11 pr-irin o 'at of the Prov-o in -u1, 1.ne as ..-k t --r,"io s otand in -h '-lc ---"sen -it the covcrage-. -rv e thy the plicy "G Ode o crtinP -i y --gsin "T1 e b. vsin tih aete uj. p,,,, 1-setin th e;.itd t iosc t oder ofp rvs-'si uhr,,d tion -r, P-th ,ptono thr --Jyi ofee, !-terd --ssud. -B -'i d htyine hp tha. heinurd it apr te in -rbl inee t r inertebenefin rg pr,.;ded th.rein. 1o 6,s tah, l tf the tnsre thtbeeiiayta "() Ay poliy of .domi tc-ru my whni-.ed I.,r dtlier in .y othr stat .r ct ry, -riay -r=ii pemte trrqie y the -tw tf PAGE 12 "(2) The time at which the insurtakes effect and terr.inates is expressed thereini "(3) It purports to ins-.ire only --F rs:..n, except that a pol icy may incure originally susegunnt amer.dment, upcn the application of an t E.e-lher --f a fa.TJ.1y to shall be dee:lled the policyar, any tra or mere eligible merhers of that falnily, 1-ig husband, wife, dependent children or og children r a specified age mich shall not exceed nineteer years any c*.her person rieper;der:t upon the policyholder; and "(O The style, arrangement arad over a marance of the poney give no undue prominence to i ..li~ypi .te ..... ..--ae ..y ..... PAGE 13 -I ~ -1 IP -. Other -y Provi -i.n s. "(I T po iy prviio -h d i tsb -scto Uan o ti At hllmP ea olY .or terefe s fvorbl i .1 -ny res .ct ortebnfcayth h poiinste PAGE 14 (3). Elo alC rtir o ay ri, e PAGE 15 .r-:'' y .....i -.r..l -... ..e L c m e f c i or ~ ~ ~ ~ ~ ~ ~~~() wer) Weca~ ro ote cetrc fs. prri-.o ruurr ~sn th, -l -11-. 1-tei ~ue PAGE 16 Eectir 4. Should any part of this act or any provis:: t::ereir. or paragraph tharsof, be declared to be ut.ex.rst.itutior.al, ir.eperative er void such fact shal~a ir, ac -:lis-.affect '.he va'-idity of the remaining pcrtions -yi l.hiu act -23- PAGE 17 "(6) E yah su l-, u n dn r t, h.11 b, Identified by i. th, 1-1 1 t--d e f the tst ; ythe of; a "(7) ttayntan proisonpuy ot 'at tktyttaaafhyy~ait~hia by-l-, f the inur a pa t fh ay t.p-, p-rti, t frh i futh. --y, -x-pt i. the tt rayes atr a i yicato tf risk, ta hot-a ate tyb fil.d .ihhe in ncan "() Approved lb, h insuanc comto, -h ,at-y a -n f t x d d i t -tc .l beeihlno -d .ppy p.-uc -oiy by t. -f ny ah pa ay 'tataptfrdeath f-o -ny J.sei audred a fda-, live -uh ,l-y froh e ta 'p a.i.a. tatt --a al' -r diaa aiava ..c rmisinrmy bymin ettesad ds etf-rth in thi, .-tin ah suhp.liy 1-eytoaypesni thi ts PAGE 18 vison spciiedinths sbsctin n he ors i wiy PAGE 19 "(A PI-y Inich the insured ha the ri,. boootinue -h t it f c ubje -t ts t-s by tily pyet of .peu., (1) Intil t est ae 51 ( i ob poly iss I-! fage -, for t 11st fiv yrfro itsdte of is-ue, 1a cntai 000 of the -oregobng th fclloeing provision (fo hc h cas nperatheces -ny bo oitote tthe nsuro'I ption) nd theocapti o TAoLo : ".Aftthis policy -ee bee. in orI foe-od of th-ec yoaos d-ring the lieti-e of the insr (elrdiny peid drig -h the inIred i disabld), it -ol beoe ntesbl -to the cstt .ortooInd in tho spplicatoo) "(b) II clots fot incrrgd r abilityy (s defined in the poliy) eoeiog aitr thre par fo the d t o bssue of this policy halt bse iedced oo r l d onied bo eo on htt disser ph or.onotxludd fropsovr by e o.r pecifIc deoeetoe effebies on thoe dote of loos hd .p tP the erfectos dtf oosoege oof ti polio., "(Fo tho promee of I-ttinc toueropposeanioropoIey in oseoe1 st.es, the instopr-er erotted to prit i the oliy ftein requircpoisons (2) (a) -nd (2) (b) ebote the test 'tree yr'. erhles-, the poiios of the ontct od teot If t-o tt the on-r-y owithstendipg, the tie liot tsorsd tetootos ude yotrt-It dli..orod otor r dtto -o tn ptsopin bois ottoothall PAGE 20 )A p r.. ii fs f.-1-: i A pr1 period of Ieet -ubrntls t-a "T' -o ic-e, "1"f., .onthly pr-ium pl-all .th-r bolci) da-il 1. grat -ahpeimfalling d-"te the first i ga Perid the poli-y -1al co-ind r hvi Pio.r -1d, It -he PP P io: "ujc -tt th lpit .tP p-i. -Pplp p If, 'I P t prpiti-prtep e bF,, r ... t .-?u tfr~ pea halh, a .h-1.,rd te i urer .wri.e not-ed ierd t. Imby ith th therith -n i su-:ppptr l ute at p--, PPdtin te ,-t-liy; .rsuh .-etrqur PAGE 21 :ove -nly loss r ul i r-~ -uc -c-d-a injur as --ue to -uc likesa a egin -1r than -e d-y --te 11c dat. ta...e repcsteisrd nd in u... shl hv he sa ilhts thereunder bs thy -a underth 4-lcyimedatly 'If-r th -u baof the ---ute >rcasbe t, .. y pr--ii-n end-d h.... o ,ttaihd heeoin -oncio h the entaeet Any .y ti, u , -oa~ perio --r than -ity daspirt. -a ergh ocnill1,n I.rsbject to it em by ,hethol pymnt f reius l)untl t eat ge50, -r "(5) A Proviina follo1-1-T 9r 1e ient t e -nur1 rit-I t-ety dlys -11e .olc:, r a sonthreate a isres--by p-, itle yr oteisrra -, .-.l t( -sr t.... lc bf-rnt-1n ui.ient tl id-nify -h --urd, sa b .e n e t, the n rr PAGE 22 .--------.-::. -ri ---.| -. : .r. .-.-; -- PAGE 23 ..r.e d.y .. te .... e fsel os ai et .ur s .r p.so .ih t ....~i .euie .h l .o