HomeMy WebLinkAbout94-04598
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INHIIH"NCf Ch.,I.. a CII... 11,..1.
e .mMI'I4NY ""10".", ~"I'.lId lltol
INSURED
OSCAR P BECHTEL
2P
001655226
$25,000,00 INITIAL FACE AMOUN
POLlCY NO.
SEPTEMBER 9,1991 POLlCYDATE
I
Undqr Ihe !'rovlslum ur Ihls Pullcy MUIIUIll'illol lire Insurllllc~ CUlI1pllllY CUlllracls Iu I'ayt
_ The D"llh lIenellllu Ihe lIellefltlol'Y, If Ihe liuurud dies burul~ Ihe MOlurllY Delet ur
_ The Nel Cosh Vulue III Ihe Owner, If Ilw Illoured II living ulllhe MOlurlly Dale,
'J'hllpullcy II 0 101101 ~UIlII'UCI helweell yuu, Ihe OWllel', ond us, Munulllelllol Lire Insurlnce
CllmpollY, "Wo", "UI" Olld "our" rufor IU MUlllllllelllol I.lf., 11l5111'OllCe CUII1PUIIY, "YllU" Ind
"Yllur" rerer '0 Ihe Owner uf Ihl5 l'ullcy,
IU:All YOlJlll'OI.ICY CAIlt:I'UI.l.\'
TWENTY DAYS TO EXAMINE I'OLJCY. If for UIlY rea SOli yuu uro 1101 IOlllfled wllh Ihls
pllllcy, you muy relurn II III us wllhln 20 dUY5 ufter you receive II. If YllU do EO, we will
cancellhe policy IInd rerund ullpr~mlulll5 Pllld,
Slaned ror Munulllelllul Ufu llllurullce Compllny Blllulillllllre, Maryland,
-,,41 '.
-"
S"ff,Q,Y P,n/dlnt
Form llllO
AdJullahle Deo,h Ilene III
Dealh llenellllPayable al Uelllh llf IllIured before Ihe Mnlurlly Oa,e
Flexible Premlumll'ayuble III MalurllY Un Ie
Nunpartlclpallng - No Dividends
Flexible Premium AdJuSlOhle Life l'llllcy
woo
VOLlCY 6V~CI'ICATtON6
161lUII AIlII 46
OlJPJ.lt::t'. . '-"I..ICY
~','''' '/' 'I ~
...-.-........
IN6UIIEP 05CAIl I' aECIlTEL
6EVTlitlPEII 9, 2040 HATUIIITY P,\TIS
1$25,000,00 FACII MOUNT
VOL ICY NO, 001655226
BIIl'TlltlDEII 9, 1991 l'OLICY P,\TIS
H'NltlUH FACE AMOUNT 15
$25,000
OUTIl BENE~'IT OIlTION B
CONTINUATION PY.JW)lJ I. YMRS
HINIIlUH HON1'lILY CONTINUATION I'REIlIUIl
$45,05
SCIIEDULE 01' BENEfITS ANI) I'REIlIUHS
l'REIlIUHS I'AYABLE HONTIILY
BllNllf IT
IIFFIIC fl YII DM'II
MOUNT
FLIIIIIBLE PRIIHIUIl ADJU5'I'ABLE
LII'1I INSUIIANCE - STANDARO
51101\1111 PREHIUH CLASS
FACE AMOUNT
$25,000,00
611PTEHBEII 9, 1991
HONTIILY COST
OF IN6URANCE PAYABLE FOil
ADDITIONAL BENEfITS
WAl VER OF HONTIlL Y CIIAI\GES
II 61111 ATTACIIED 5CIIEDULII
II
14 YEARIl
CURRENT PLANNED PERIODIC PREHIUH
$45.05 PAYAPLII TO TilE MATURITY DATil
ANNUAL
$540,60
ALTERNATE HODES
SlIlll-ANNUAL QUARTERLY
$270.30 $135,15
$45.05
HONTlIL Y
HONU-HATlC
N/A
IT IS POSSlBLII TIIAT COVERAGE WILL EIIPIRE PRIOR TO TilE HATURITY
DATE CIIOSIIN WilEN EITIIER NO PREHIUHS ARE PAll> FOLLOWING PAYHIINT
01' TilE INITIAL PREIlIUH OR SUBSEQUENT I'REIlIUHS ARE INSUfl'lCIENT
TO CONTINUE TO SUCII OATE,
PAllE 1
102481' 2P-2
('ON'I'lNUATlON Ot' l'Ol.ll'\' HI'I';C1t'ICA'I'IUNH
H~tlltUm
/)1:,.,. lIf 'l'u,ull'rullllulIIlllut.lV.d
I'menl'ae uf I'rellllulII Expullau l'tllll'~e
llKpenll Churae I'UI' 51,000 I'"ute Allluullllull yours)
1'.1' l'ulltY I~KI'OIIII Chul'ae lull yuurs)
NUllu
MllUK
l).3ll
31.H
~~.7~
Ilur """l1h
$lJ,Oll
S~,tKl
$4,0ll
Nonel';, Uuul'urueud 1I1111fulfellUI'0 Vlllil"i IlIe hll5ell "llllIl ('ulIIlI1l55ll1l1orl 1980 HIMlldurd Ordinary Morlallly
Tablo., to"le lIr Felllulo, SlIIukel', Aae 1.1111' IIIl'1hdllY 111111 ~W" IllIerealllel' YUllr,
TAIII.I': ot' HUlllU:Nlllm ('IIAlIUE!i l'E11 51 ,110001' "ACE AMOUNT
81J1lIWNUUl NIIIIIII':NIWIl SIIIlIl"NIII\1l 811/lIlI!NII....Il
UIAlllll, tU,\.lllil': l'UAlllll'; ('UAMOIl
'Mlt: MAI.I'; n\MAU: 'Mil'; MAl.l\ ...III1tALII
0 IUl 1J,ll Jl 26,U~ za,aa
I 'U! , !.~IJ I~ 26,82 2U5
2 14.19 IU2 II n.M 2U4
3 14.16 I !.r,~ 16 l8,52 24.07
4 '~,91 1l,71 J1 29,H 24,73
5 15,12 1!,9, lH 30,~2 25,42
6 '5,12 ,~.1'6 19 II.H 26,15
7 15.5~ IU' ~u 32.51 26,90
8 15,17 108 41 JJ.68 27.69
9 16,01 IU! ~2 IU8 28.52
10 16,21 IUI 41 16,16 29,38
II 16,5~ I~,'I! 4~ 37.50 10,aa
12 16,81 15.11 45 18,92 11.21
II 11.12 15.1~ 46 ~0,41 12.22
I~ 17,~2 '5.lrl ~7 42.1!ll !l.27
15 17,71 15,19 48 43.67 3U7
16 18m 16,112 ~9 45,~5 )5,S]
17 18,1I 16,26 50 47,14 36.75
18 18.62 16,52 51 49,11 38.04
19 18,93 IfJ,78 52 51.45 39.41
20 19,26 17,06 51 5).69 40,85
21 19,6, 17,1l 5~ 56,06 42.16
22 19,91 11.6! 55 58,56 43.96
H 20,16 11,98 56 60,00 45.66
2~ 20,18 18, 1I 51 60,(!ll 47.46
25 2Ll2 18,67 58 60,00 49,39
26 21.10 '9,()4 5'/ 60,00 51,47
27 22,21 19,~~ 61) 60,00 53.70
28 22.16 I'J,8! 61 6U,00 56, II
29 21.1~ 20,29 (,2 60,00 58.70
10 2J.9! 2U,15 61 60,00 60,00
II 2M' 2LlI M 60,00 60,00
12 2UU 21.H 65 and "'Or 60,00 60.00
'Aae Is the Inaured'l Aae l.oll IIlnhduy onltw I'ulky DIIIU or DOle of ln~rellse.
The following pertel1lUBea ore IIpplled 10 ,he Surrender Chllrae durlllg euth I'oll~y year followlnB Ihe I'ollcy Dal.or
Dale of Inerene, Mler lhe lelllh polity yeur Ihere la no surrender thurBe,
Year ", Year 'I,
I 100 6 75
2 95 7 70
3 90 8 65
4 85 9 60
5 80 10 55
2 113l.S
''I'r\Ill.l': lll' MONTIIl.Y llUMlr\NlUm CO~l 01' IN~UIlr\NC~ Il^",~~
MONTlIl.\' (,O~'I' 01' IN~Ultr\Nn:
~'I'r\NI,^IlIl-!iMll'\Im
Mr\l.l': MONllII.Y MM,I': MONnll,\, 1..I'Mh....: MONTIII.\' n:M r\ 1.1': MON'l'IIl,Y
r\TI'r\lNlm llr\H':SI'Ut hIThlNUI Ilhn':~I't-:lt r\'l'l'r\INI'Il Ilr\Tl':~ l'lm r\'I"I'r\INUI llr\H~S I'~ll
,\(11': $I,UUU Mil': 51,111111 Mil'; ~1,lIUII Mm 51,UOO
II 0,21'J2U .10 1),8HiI2H Il O.I.IM~I III 0,56~m
, 0,II8IUI II 0.'/1 ",~~ I O.IJ7lKKll II 0,~051~~
2 0,082107 12 O.'I~'IIII 2 0,II6M71 12 0,612091
I 0,080840 \j I.II~H7l)r, I 0.1I/,101l~ Il 1),7011I1
4 0,077 506 I~ 1.21)72H'1 ~ 0,1164171 14 0, 7\6~01
I Il,071119 l\ 1,]2.141', 1 0,1I62111~ II 0,8 10~17
6 0.009171 ", 1.4M,211 " 1I.1I60Hl7 ,\6 0,864079
7 0,0611)1)4 17 I.IB811 7 0,059170 17 0.91~1~'
8 0,062\0~ 18 1.712091 H 11.I158!17 58 0,96W7
9 0,001670 I~ 1.8\8H7 9 0,017101 5~ 1.016011
10 11,1162\04 "II 2.l)2117~ to 1I.IIIM71l roll 1,0786~1
II 0,()67\1)! 61 2,20I',H8 1'1 11.11.18117 61 I.U717'
12 0,076671 ,,2 2.~lllI0 12 1I,IIC,OU7 ,,2 1.2\8141
13 0,08~ 171 61 2,MIlII II 0,00417' 61 1.J81071
14 0,1013H 04 2,89~2'~ ,~ 0,06H118 6~ I. 5 18 III
15 0,1'18147 C,5 3.168WI II 1I,072\1l1 65 1.6627~0
16 0,132\18 66 3,HOI~6 '6 0.076671 66 1.809917
17 0,141314 C,7 1.14228'. '7 11,080006 67 1.912117
18 0,18420 , 68 ~.04H827 18 1I.09251l~ 68 2,096011
19 0,190036 61) 4,381'611 19 11,091009 69 2,1$2161
20 O,191l7l 711 4,H91'1~ 20 1I,0~7\ 10 70 2,437194
21 0,191371 71 5,1623M, 21 0,09'1,77 71' 2,67ll21
22 0,190016 72 5,629811 22 0.101677 72 2,9191~7
23 0,186702 73 6,148405 23 11,104178 73 3,301~99
24 0,'81700 74 6,71'7321 24 11.106678 '/4 3,691913
25 11,17\864 7\ 7.325777 25 0.109179 75 ~, 118160
26 0,172530 76 7,9~8114 26 0,113346 76 4.1724'19
27 0,170863 77 8.57~5~5 27 11.116680 77 5,omu
28 0,170863 78 9,2118'84 28 11,120848 78 5,5~8914
29 0,173363 79 9,871~94 29 0, 1258~9 79 6,09~'Q.4
30 0,177532 80 10,586llH 30 11.111684 80 6.709720
31 0,183367 81 11.37~5~.1 31 1I,13~~85 81 7 ,4069~0
32 0,190870 82 12,2~'1l)57 32 0,141110 H2 8,200174
33 0,200874 83 13.19<00)4 II II,U0023 83 9,119071
34 0,212541 84 1~.184211 I~ II. U8158 84 10, /16115
35 0,2267'8 8.\ 15,1R01l1I H 11,167528 85 11.1'77727
36 0,241193 8(, 1",IC,IlI.l1 16 11,18171)0 8" 12,29ll~8
37 0,264236 87 17,168U12 37 0.198173 87 13,417176
38 0,287583 88 18,22021l2 38 11,2'7547 H8 I U72l 59
39 0,314265 89 19,268~20 19 0,238390 89 15,917120
40 0,3~5119 911 20.328342 40 0,263403 90 17,344020
41 0,378477 91 21.413071 ~I 0,290084 91 18.862542
42 0,415172 92 22. 717104 ~2 0,316767 92 20,512221
43 0,455207 93 2068882 ~3 0,341451' 93 22,543680
44 0,499416 94 26,629925 44 0,370137 94 25.221010
45 0,546131 45 0,398492
46 0,594520 46 0,427683
47 0.647085 47 0,457709
48 0,703828 48 0.~902~0
49 0,765586 ~9 0,526110
.Ral.. b...d upon Coononl..lon.ra 1980 Slandard Ordinary Morlallty 'I'Ibl... Mal. or I'.",al.. S",oker, h.e La.IOlrlhday,
3 I ilLS
NININUN NONFoln'lmlJRE 'ALlJl,o
QA5l1P oN TIlf. HANNW l'EllIOlllC l'IIENtU/i 01'
545.05 PAYAIILE NONTllLY
ANP A ~'ACE AMOUNT Of 525,000.00
fUR A NALE AT I ijijU~; AllJi ',6
IIt/P OF GUARANTEf.U Nln (ONT I NllAT IoN 01'" INoURANCII PAID UP
nAIl (A!ill OR LOAN 'ALUE YEAIlo PAYS OPTION
1 .uo 0 0 .00
2 .uu 0 0 ,00
3 2,12 0 60 5,34
4 317,31\ I IBO 775,67
5 624.50 2 IBO 1,4BO.56
6 920.92 3 60 2,119.01
? 1,200, 67 4 180 2,682.82
8 1,463.04 4 240 3,176.52
9 1,702,23 4 240 3,593.55
10 1,912.42 4 240 3,927.99
11 2,'98.51 4 240 5,195,118
12 2,693,41 4 210 5,245.91
13 2,751.63 4 IBO 5,223. :t7
14 2,765.80 4 90 5,119.01
15 2,810.12 4 0 5,074.16
16 2,807,17 3 240 4,948,21
17 2,746.92 3 120 4,730.12
18 2,616.04 2 330 4,407.47
19 2,408.24 2 180 3,966,79
20 2,105.30 2 0 3,395.54
AGE
60 2,765.60 4 90 5,119,01
65 2,406.24 2 180 3,966.79
MATURITY DATE 95 .00 0 0 .00
------------------------------------------------------------
TIlE 'ALUES SIlOWN AilE BASEll llPON TIlE fOLLOWtNG ASSUMPTIONS!
(A) CURRENT PLANNED l'ERIOllIC PRENIUN BEING "AlP UNTIL NATURITY DATE.
(B) COST Of INSURANCE BASEl.> ON NAXtNUN CIlAI\GES.
(C) fACE MOUNT Of INSURANCE NOT CHANGEll,
(D) INTEREST ASSUNED AT 4.5%.
(E) NO SURRENDERS OR LOANS HA'E BEEN NADE
IF YOU PAY TIlE PLANNEll PREMlUN AND INTEREST IS (REllITED AT THE GUARANTEED
INTEREST RATE AND TIlE NAXIMUN CUST OF INSURANCE IS CHARGED, YOUR POLICY WILL
CEASE TO BE IN EffECT ON MAY 9, 2015. IN THIS EVENT, YOU NAY CONTINUE IT
IN FORCE BY PAYNENT OF A GREATER PRENIUN,
IF TIlE ACTUAL PRE/ilUN I'AIO DIFFERS fRON THE PLANNEll PERIODIC PRENluM OR IF
A PREMIUN PAYNENT IS SKlI'PED, TilE ACTUAL CASH 'ALUES WtLL Dll'FER FROM THOSE
SHOWN ABO'E. 'A LUES FOR DURATIONS NOT SHOWN WILL BE SUPPLIED ON REQUEST.
POLICY 0001655226
POLICY DATE SEPTENBER 9, 1991
INSURED - OSCAR P BECHTEL
INSUI~ANCL! ULiNEFIT!i
II 1110 Illlijl'eU dlel beful'e Iho MUlul'hy IlIlIe ulld whllo (jplllll1 II: lllldel' Ihl~ Opllllll'ho 1I"1I0fll Al11ol111l will
IIIIII/ullcy II III furce, wo will puy IIIl' I)oulh lIel1erh III he "'luul III Ihl' K,e,lIel' uf Iho folluwhlK Oil Iho dllll! of
tho I Ulloflcllll'Y uflCl' wo 1'0cl!Iw UUo pl'oor of uou,h IIl1d U uoulh:
Ilrupor Wl'llIolI dull11, Ulllo55 ulld uII,11 dlulIKe,J 1110 (I)
10llolldlll'Y I~ Iho porloll Ul' porlOll1 1IIIIIIOd III ,110
AppllcllllolI,
II Iho IIIIW'OU II IIvlllK UII 1110 MUIW'IIY 1llll0uI1d Ihll
policy II 111 force, WO will puy Ihe Nel ('lIlh Vuluo IIllho
OWllel',
m:A'I'IIIIl':NI':FI'I'
'l'ho llolllh 11011 II fI I II II," 1I0llellluIIIIIIIIII fur IIIl' Ill'u,h
IIUIIOfll Oplloll 111 IIffecl 011 1110 dlllll of deu,h ,,, IhoWII III
Ihu Policy SpodflcUlloIII, mlllul:
(I) IIIIY Lou II 1I1111111co IlIdudlllK lIc<lij,'d 111101'011:
ulld
(2) UIlY pll51 duo MOl1lhly ChllrKO If Iho IlIIul'o,'
dlol wilhln Iho Orucol'ol'lud,
1l1l"'I'lIl1l\NH'I'J' OI'nON!;
OpllulI A: Undor Ihll ullllullllw 1I0llefll AmOij1l1 will
be equIII III ,ho IIrolllllr of 1110 followlllK UII Iho dlllo of
deulh:
(I) 'l'ho Curl'onl I'lIce AmoulIl IhoWI1 In Ihe Policy
Sp.drlcBllul1l plul Iho CUlh Vuloo: or
(2) 'l'he CUlh Vulije plul II I'CI'lIIIIIIIKO uf Clllh
Vuluo,
'1 he rUIH'1I1 1'lIco Al11uijlll': IhoWII In Ihu Pollc)'
SlroLlflcuI""lllol'
(2) Tho Clllh Vlllull plul II pOrCOIIIIIKu of ClIIh
Vuluo,
'I ho l'O'HIIIIIKe IIf CUlh Vllluo lllUd In uOlorl11ll1ll111
,he Iloulh 1I0llefll II hUlod 1IIIIho II1IUl'od'l UlIlIll1uU allu
Oil 1110 policy ulIl1ll'CIIury prior 10 Iho dll'o of dUlIlh. Thll
POI'COl1ll1g. II I ~O'lu for 1I1111111Ud 118.1 fOri)' ul1d unulIrI
III1U d.dlllOI ouLlI Y.ul' 10 II 1111111muI11 of 0", fur UlIlI
1I1110Iy.f1vr, uccol'dll1K 10 Iho wblo IhoWII boluw,
AlIlIll10u AMol
l'orcelllaMe of ClIlIb Value
150."
115."
85."
50"'-
300;,
20'f0
15'1,
5'1,
5."
ODf,
~o or Ulldor
4~
M)
5~
60
65
70
75
90
95
PIWMIUMS
I'REMIUM I'A YMEN'I'
Plllllnod POl'l odic PromlulIIl rol' Ihll policy UI'. ,howlI
In Iho Policy Spodflcllllof1l, All premluIlI1 uro pllyuhl.
In uuvBnco of Ihl! p.rloulo which Ihoy upply, Tho 111111111
PrOl11lUIII I\IU5I bl! puld 011 01' bofol'ollw Policy llulo,
YIJU lIIuy puy lub,oquolIl premlulII' UI our 11011I0
Orrico or UI ullY offk. wo do,lglllllo or III our lIulhorl,od
repre'elllullw In oKLllunKo ror II recel"I, Thll rocol,,1
will b. ,Iglled by Ilur 1','",ldol1l Ill' Secrelury, 11,,,1
coulllllr,lgllod by Ihe pel'5on oUlhllrll.U 10 uccepl your
premium,
AllY 111110 boforl! Iho MUlurlty DUIO, youl1Iuy:
(0) chulIKo Ihe al1loUnl ulld/or llie frelluency of Iho
I'lullllod Periodic I'roll1lull1l; IIl1d
(b) puy uuultlonul premlul11s,
Any ChllllgO or "uYl11onl of IIddlllollUI "remlul11 will he
lub)ecl 10 our rule, u, Ihl! Ill11e of chllllge or P~Y11101l1.
We re,orYo Ihl! rlghl 10 refuso Ucce"lunc. of UIlY
prel11lul11 pUYllll!rIl which, If I'elllllled, would dl14uullfy
Ihls policy liS II comrucl of IIro III"JI'~lIco ulldor UIlY
feu.ral luw, Any premlul11l "ulU 111 oxcell of Iuch
maxlmul1Isholl be r.fundou,
GRACE l'ERIOl>
If Iho Nel COlh Volue (Clllh Vuluo mlllu, l.uIIII
Uolanco und uny u""lIcublo Surrellder Churge) UII II
MOlllhly Annlversury Duy will nul roYor Ihe MOlllhly
Churge, Ihe Policy will rOI11Ul1l III rorce for II Oruco
Period or 61 duys.
If B promlum surrlclolll Iu cover Iho Monlhly churge
Ihen due und Ihl! neKI Monlhly ChurKo ure 1101 ,,"ld by
Ihe end or Ihe Orllco Pl!rlou, your Pullcy will ,""nhulle
wlthoul yulue, We will mull you nOllro of Iho r.4ulred
Form 1300
prol11lul11 wholl Ihe Nel CII,h Voluo hecom.s 11I5U((l,
dom, If Ih. Il1Iurod ulol wlthlll Iho (Jruco I'erlou, Iho
DOOlh 1I01l0fll will bo roduceu by Iho Ul110Ulll or ,h. Ihon
required pl'ol11lul11,
DUI'II1K Ihe COlIlllIUUllolI Porluu shown 011 Ih. Policy
S"eLlflcullulI' l'uK. Ihe policy will rOI11Ulllln forco If Ihe
,ul11or Iho Prel11lul11s puld 10 dUIII II III leulI e4ijullO Ihe
MllIllI1um MUlllhly l'rollllul11 IIIllO' Ihe nUl11hl!r of
11101l1h, olllp,ed IIIICO Ihe Pull~y Ilulo,
REINSTATEMENT
Wo will relll'I,M Ihl, policy Ul ullY Ill11e wilhln Ihe
flw yeur, fruIII tho UUILl of loplo UIIU prior 10 Iho
MUlul'lty DUIe If It Illll IIlll huon ,urrolluorou for III Nel
CII,h Vllluo, To rrlll5lUle Ihl, policy you musl:
(II) "1'010111 oyldellce of III,urubllily 5Ullsfllclory 10
us;
(h) "uy II "rol11lul11 which I, luffldelll 10 keep Ihe
"ollcy 111 forco fur IWO mOlllhs; III1U
(c) puy or rolll5lllllluny l.uun lIululICO,
If Ihls pulky Iuples und II relmlnleu uijrlnll Ihe
cUIIIIIIUUllolI period, you will oho hUVIIlo PBY u pro ralU
ponlul1 Ilr tho Illrroll<lor churgo Ul Ihe end of Ihe
LOnllllUUllulI "erlod, blllod Oil Ihe p.rlud or lime Ih.
"ullcy wu, Iup,.d, The pro rlllu portion of Ihe surrl!nder
churge UI Iho .nd uf Iho ~ollllnuullon porlod II Ih.
UI11UUIII ul 11lL' ,urronuer churge Ul Ihlll lime limes Ihe
lIul11h.r of full 11111111h, Iho policy wu, In B IBpI.UIIBIUI
ulyluod by Ih. nUl11her of monlhl In Ih. conllnualloll
porlou, ull ulylded by (I minus Iho llllrcelll of premium
IOllu).
If Ihls "ullcy IlIplel uurlllg Iho conllnuallon period
IInu Is rolnsllllod IIflor Ihe cllllllnunllon period, you will
5
11300
U ao lUVU to I"IY Ihu UnU66, If UIlY, IIf ,hu KIIIT~lId~1'
chMrMu uvel' Ih~ cUlh VUIIIU, IIlI,h III~U611I'ed III 111" IIIIIL'
thll policy Iupm,
111" .'IfL'c,lw ,ju,~ IIf II 1'I!IIIuuII!d 11111 Icy will bu Ihl
MlIllIhly AIIIIIVI'I'KUI'Y !luy UIIIII' IIUHI fllllllwlllllhu dall
w~ uppruvu YIIUI' uppllculllI/I fill' l'elmlUllllllullI.
POLICY CIIANOEH
MINIMUM I,'r\l'l'; AMOUNT
Tlw MIIIIIIIUIII I'UCIl AIIUIIIIII ulIlI\\~d ulu!el' Ihl,
policy I, IhUwllllllhe Polley Speclflcllllll1l6,
CIIANlmS IN FAn; AMOUNT
YOII IIIMY chulIlll! Ihll I'UCI! A 11I11 III II ul Ihl6 I'"l1cy III
u/lY 1111I11 unel' Ihl! C'lIIlhllJllIIIIII I'~I'I",I hll' I'u6'"ll 111111
I'l'lur lu Ulll! H5,lluw"vllr, IlIl'I~U61!' IlIlhe I'UC" AIIIIIlIIII
will 1101 he ullllw~d ullllr u"e 75,
AllY deCl'eUie III Ihl/ I'UCIl AIIIIIIIIII will:
(u) till I!llecllvl! UII Ihe Mlllllhly AlllllvllIiul'Y Iluy
011 ur lIeHI followllIll ullr rec"II'1 of your I'e.
~ue61: ulld
(b) he upI'Illlll 111'61 u"ulml UllY IIICI'IlIl'"' III Ihe
I'uce AIIIOIIIII, hllllllllllllll willi Ih.' 11111" I'~Celll,
Ulld IIIlllIllllulmlllie 111111111 I'lIce AIIIOllllI.
Tu IIIcrl!U61llhe I'uce A 11I1111 II I y"u 11111'1:
(u) I're6el1l "vld""Ce 01 Imul'IlIIIIIIY ,ull!luCIIII'Y III
wi: lUll!
Ih) puy IIIe 111'61 Il1UII,h'! CU'I ul III'UI'UI1L",
If WI uppl'ove UII Il1rreUhC III I'IIce Al1llllllll, II will h"
effecllvu UII Ihe du," !hoWI1 III Ihe Pllllcy SpecllkulllIl1'
for luch Il1cr"u!ll,
CIIANOI=:S IN Ill':ATIIIlENEnT 1I1'nONS
You lIIay chul111" Ih" lJeulh lIel1efilllplloll IIIUI1Y IllIIe
ufler Ilw COl1lll1uUllul1Perlod hu! pU6s"d ulld pl'lul' III u"e
85,
If you chol111" fl'ulII Opllul1 A IU Opllol1 II, 111" l1ew
Face AmuulII will he ,he lIel1l!lIl AIIIIIUI1I ulldel' Opllul1
A 01 of Ihe eflecllve UUII! of ChUIIKI!,
If yuu chul1111! frolll OpllulI II hI Oplllll1 A, IIIe lIew
face amuullI will he Ihlllllll1lllll AIIIOUI1I IIl1der Opllul1l1
II1II1UI Ihe Cush Vulue U! of Ihe urlecllvu dUle of chul1ge,
We may re~ulre evldel1ce of lJ15uruhllllY !ulllfllclury III
UI.
'111" ,'If"I'llvl' dllll! III "'lUl1gll will he Ihu MOlllhly
AIUllvel'6uI'Y IlIlY 1111 or /lIIXI folluwll1l Ihll dUIII Wll
Ill'ltl UVl' yuur "L'IIUlHil,
l'lIANliI':S IN MATllllll'\' /)An,;
IIw l\luliJl'l,y llulll, u, KhUWI1 III Ihe Pullcy Sllllclllcu-
1111116 1"I~e. IIIUY Ill' dllll1K"d IIpUI1 WI'IIIIlII rll~ueu 10 UII
"IUII~I l\lulUl'llY I)UIIl un,,1' Ih~ "lid of Ihll 1""lh policy
Y"Ur. Illlw,'v,'I', II", I1"W I\lIlIlJrIIY llul" IIIUII hu a Policy
I\IUllv"IKUI'Y ul 1"11'1 lwei V" 1II1111lhl Il'ulII Ihu dUlu WU
fl!l'I.dvl! II wl'llhm I'l"IUI.!~llllInl!rOI',
('ONlIIlIONS OF CHANGE
All d\lIIlKe' III I'uc" AlIIllUIII, llllulh lIellefil Oplloll ur
MUlurlly Iluw ul'e MlhJ"CI III our rule! UI Ih~ IIIlW uf
.-I III 11 Il'" hl'"IJI wllh IIUI' I'lll1illlll, IIU 1110ru Ihull Ulle
ChUIIUe will h" I"'l'l11ll1ed wilhlllulwl!Iv" 11101llh pllrlod.
Wc will 11111 IllIllW II chJllIge III Ihu I'uce Amourll or
Il""lh IIcJld11 Oplloll II !uch dlllll(l.U would r~ducu Ihu
I'IILI! AIIIOUIlI III fllIcl! below Ihe MllIll11um I'uco
AmoullI,
SUllIlENIlEIll.'llAIlUE ON FACE AMOUNT
CIIANGES
Whcllcvul' Ihcl'l! I! 1111 IIICI'eu!e III Ihl! Fllce AmouIII,
II," SUIT"l1del' e1111!'lle 1I!5ucllIWd wilh Ihlll IIIcrll05e will
hll hu~cd upulllhe lll!ured'~ Ihellllllllllwd UII!,
Whelley"r Ilw!'c I! II dllcreu!llllllhll Fllce AmoulII, Ihe
SlIlTl!lIUl!1' Chlll'llc IIPllllcable 10 Ihlll dl!creale will be
dllduCI"d fl'ul11 Ilw Cush VlIllIl!. Thl! uUlllalldlllg IUrren-
d"1' churll" will hI! redllcl!U III Ihe Ill11e of ullY porllal
!lIrrellUer which I'cdu~e5 Ih" I'acu AtllOUI1I,
NONFORFEITURE PROVISIONS
NET PREMIUM
A Nel Premium 15 III1Y prCl11lUIII plllL! tllll1l15 III"
I'~rcetlluge ul Premlul11 E.peme Chllrg"s ~hllWII III Ihe
Policy Spl!drlCllllolIl.
CASH V AWE
Th~ CBlh Yolue 011 OilY MOlllhly Alllllverlllry IlIlY I!
equallu (I )-(2) +(3) +(4) wlwl'u:
(I) 15 Ihe CU5h Vuloe UII Ihl! preclldll1g MOl1lhly
AI1nlver5ary Day:
(2) II Ihe MOlllhly Charge for Ihll11101llh preceding
Ihe Monlhly Alll1lverlllry lluy;
(3) II olle mOl1lh'l IlIlerl!lI 011 I Will 0)-(2);
(4) I! Ihe 'UIl1 of 011 NUl I'l'emlullls rec"lved ~llIell
Ihe precedlllg MOl1'hly Anlllver!ury IlIlY,
'1 he cu!h yulue 011 Ihl! I'ullcy Illlw will he Ih" N"I
Premium paid ol1lhul dOle,
"orm 1300
TI\lII (101'11011 ul II", CIIKh Vuluc "'luul 10 ul1Y Loall
IIl1lullc" shull h" credll"d wllh Il1Ierell Ullhe BUarol1leed
rule IhuWIIIII Ihc SpeclllcUllot15l'oge,
NET ('ASlI V Al.II!' Is Ihe COlh Vulue reduced by
III1Y l.ulIII IIl1lul1ce II1.-1udllll! IIccruCtI IlIwrell, and by Ihe
IIppllcuhle Surr"l1der Charll". U5 ~howlI III Iho Tobll! of
Surr"l1ucr Churgc5,
UUARANTEEIlINTEREST
Excepl 01 !lIl1eU IIboV<' UI IU LUIIII IIl1lal1ce, IIIIere51
will hc cumpoulldl!d IIl1d credhed 10 Ihe C05h Value
lIIolllhly 11111 ruw Ox"d by Indl!x, The role uf Il1Ierell will
h" Ihul I'IlIIl which whel1 compuullded 1110111hly 15 equlv-
IIlelll III 75% 01 Ihll uV<'ruge price (dllcounl rale) on
!J1I1,"d SllIll!lTl'eusury IIl1ls huvlllK U 26 week IeI'm,
6
11300
NONJo'OIU'I!ITUIU! I'llOVISIONH (( "1/11111110,1)
We will mmhllle lJie Ilr ,1111 IIhll'. fUI III '"1111 II v"
Y""11, llle"'III1"" we IIII1Y, 11/1,,1' UlvlllU YIlII 11'111'11'11
1I1l1iL'" Illle Y"1I1' III II,IVIIII'", 1'II111'1UI! hy l'ulll'Y 11111"11,1.
IIIUIlI 111I! IlIdl!. <II l'llUlhlld ul 1'111l'l1l1l111l1l IIlI' '''"111'
IIlIllPIl'"lhl/ll, AllY IUIII 1'IlIiL'y 11I11U1hllll"1I1 10111111111111111
Ilr 1IIII!r ,III1I1W" will 1If11,ly rul' II p"I'''"1 ur III II!IIlI "Ill!
YUllr,
Ir 111I! IJ,~, '111!1I1111 y 11111111,..'1<111 IlIu~l'lIl1lll1"ul<f III'
dlllOlllllllll!d, WI' will illh51IIlM II 1llllllllll'IIhll! 11I<l1!'
IlIbJ1!11 Iu 111I! IIPIIIUVIII ur 111I! 11111111111"" 11'1""1111"111 uf
Ihu SllIlullI whl~h Ihll Pullry I. <lell VI!I ,'d,
WI! Wllllrlllll"1! 111111 111I! 11111''''11 "III! '.'1'"1111"<1 will
IIlwIIYI Ill! III 11!1I11 IIII! Willi "" II ",',1 1'1I11! IhllWII 111 1111'
SIIedllell"ulIIl'uWu,
AlllllllONAI.INn:.lI':!i'l'
AI UIlI' IIlII! dl'l'lellllll 11',' IIlIlY '....1111 111"1111""111
111I01"11 Ilwr 1111,1 IIh"Vl! II1I! (hill' 11111.,.',1 1111""'.1. /I will
bit ctl'LJlll'd III ~lJdl ItIIUUlI.!f 111111 hll hill'll IlInllllJ U!'t lJ.IiI
deddl!, -
MUNTIII.\' t'IIMlCll':
Thl! Mu'"hly ChlllUl! rul' II p"lky 1I1"lIlh h 111I! .1Il1lur
Ih. rulluwlllU:
(II) Thl! CUll rf IIllurllllel! rul' III" pull..y; 111111
(b) 'l'hl! lu'l Ilr IIddllllllllll hl!lIdlll I""v"'"<I hy
rld"rl; IIl1d
(c) 'l'hl! 1'"1' lhllullllld I'xpl!l1Il! ChIlI'U"1 1IIIlIIIplll!<I
by III" IIl1l11bl!r ur ,hllUIIIII<I. '"~ 111111111 Fill"
Anllllllllllr IlIlrl!lIle III "''''l! ^IIIIlUIII; IIl1d
(d) 'l'11I! I'l!r I'lIl1ey Exp"lII" CIIIII'U",
COS'I' 01' INSlIIlANn:
Th" Cull Ilr 11I'"l'lIl1e" rul' II pulky 1II"11I1I I,
(o),"II11lplled hy Ih" re.lIl1lllf 1(1) mlllu, (ell IIl1d <llvl<ll!d
by 1,000, wllere:
(II) Ihe CUll III 1Illl1rllne" Illlll!:
(b) Ihe Delllh lIen"rll IIllhe hoUIIIIIIIIU ur "it' fluliL'y
1II0l1lh rllr Ihe DOlllh ""'Wrll IlllllulI 111I!1I 111
erreel divided hy I plu'lh" UUllrlInWell """1'""
ralo IhOWIIIIIIII" Sp"driL'IIII"", I'IIB": IIl1d
(c) Ihe ('lIlh Vlllul! al Ih" hl!ulnlllllB ur Ih" fl"'iL'y
IIIlll1lh,
If D""lh Ih'II"1I1 01'110111111 111 dr"CI 1II1<1lh"," IIl1w
b.en IIICr"al"1 III Ihe Face alll"unl, Ihe Cluh Vllluc II
1111I lullIrllellld rmlll Ihe 111111111 Fllee ^IIIIlUIII, If Ihe
Cuh Value "XC""dllhe Inlllal Fllc" ^lIIounl, Ih" "XC""
II lubtraellld rl'OIll uny Incr"al"~ III 1110 Fllee ^llIUlull In
Iho ordcr luch IIICr"III"5 OCCUII'"d,
C:06'1' OF IN6UllANCE R^'I'E
'l'he COli or IIIlltrllllce Illll" rul' II I'llllcy lIIul1Ih I,
dOlermlned blll"d un "ur I'ruJocllUflS or huur" 1II0nllllly
experience, We d","nnlne 'helc rlll"1 unlfo"nly blllcd
on Ihe IlIIured'l Alllllned ^we, Il!X, pullcy durllllun IInd
Premium CIOII,
I'orm 1300
'lilII 111111 ,,,' 1111' 11l1111l11'lIlu A 1I111l1ll I 15 hlllud Ulllhll
1', "1I11ulIl ('Ill" Oil IIII' l'ulll'Y Ihllll, 'IIw rlllu rur any
111"1 01l~1'~ III 1'111' hll'C AIII"'"11 II IlIIml UII Ihu l'rullllulII
('III~'lln 111,' 1I1"'rllvc dill" Ilr 1110 IIII'IUIl50,
'/liI' ('11'1 III 111111111111'1' ttlllc fill II pullcy llIumh II
1I11~1'1' ~I "IIIC' Ihllll Ihl! IluIII'OIIl"1!I1 ('uII or hllUIIIICU
Iloll'~ ~lltlwlI III I III! Tllbl" Ilr MUlllhly II1111 rlllUuud ClIlIllr
111I111 a'II'I' /lllll", '1 Ill' lIlllIl'II'""l!d I'll" ur IlIIurllllce
1111'1'1 1I1l' 111111,,1 "" III" ('Ulllllll~~luIIl'II 1980 SllInd.rd
M",'"ll1y Illhh'~, I"IJII.I"" rul' lIue lu~1 bl/llldllY,
l'AHIl HLJlllllil'mUI
^'"I1Y IIIIII! 1'11,,1' I" Ih" MUluIIIy Illlle IInd wlllla Ihu
IIIIUI""I I.llvln~, YUIlIlIIlY:
lu) SIIII'I'lId"1 11111 1",III'y r,,1' II. N"I (',lIh Vlllllel ur
(h) Muhll 1'11111111 SUII"ndcl' Ilr Ihll Polley rur III
IIll1mllll "," 1111I11110" NCI CIIlIo Vullle,
^ SUIIl!''''''1 ('hlll'~I" II. IhUWII III Ihe 'l'lIble uf
Sill II!IIII.,I' ('hili BCI, will hc d"dllcl"d rrulII Ihu Cuh
Vullll' ulllll' 111111' '"~ III1Y rllllur IIunlullllrJ'unour,
I'lIrllul SIIIIl'II,11!1' 1'"IIIl,el Ihl! ('lIlh Voluu IlId Ihu
I IClllh 1I1'IWllllllll'"1' Ihe lI"ulh 11"11"111 01111011111 erru~111
IlIe 111110 Ilr I'unllll Sumlll'or, AllY I'unlul Surrendur II
luh)""II" ""1 nil.." III Ih" ,llIIc ur I'lInlul Surrendul', Wo
will """ IIl1uw UIlY 1'11/11111 SUlrclld"llhlll would r"d'lce
IIIl' 1'111'1' ^1II'"ulI III rll',," h"low Ihc Mlnlllllllll Foeu
^'1I'"J111, "I' I'c<lUC" IIIl' N"I CUlh Valu" r"mlllnlllU III len
IhuII 5500, ^ 'l'IlJIIIUllllllI Chul'U" III 525 will bu churwed
'1IIl1ny "unllll SUI'I'""dl!l',
If yuu '"I'I"'IIIJ"1' Ihl. pullcy wllhlll 30 dUYI uher II
I'ullcy Ulllllvl!I"uI'Y, Ihl! N"I Clllh VUluuunlhe lurrcnder
dlllll will 'Illl h" lell Ihllll II WUI UII Ihlll anlllverllry,
IIllnu. IIny l'ullcy 1.0uIII ur l'lInlal Surronoerl mode
.llIle ,he IIIHllwl~III)I, AllY rullul' plll'llllllurrellder will
1111') h" I'"duccd hy Ih" allluunl ul III,"I'CII In exeen or
4'.,", whlrh WUI el'cdlllld dUl'lnu Ih" Iwelve prior monthl
UII Ihe III11"Ulll ,ulTcndor"d, WL' CIIII defer pllymcnl or
lurl'c,"I"I" rul' six /IIomh!, "XIClll whon ludl p"Ylllenl
wUllld he ulod I" IIuy pr"lIIluml ,1/1 p"lIclel Ih" IlIIur.d
mllY hllve 11I1"I'..e wllh UI,
CON'I'INlWI'IlIN 01' INSUllANt'E
If you 11"1' I'lIylllU premlu/lll ulld"r Ihll I'ollcy,
IrIlUIIJIIC" will cUlIIlIIUC ulllllllw curllor or:
(II) Ille M"nlhly Alllllvmury Iluy un which Iho Nel
('II~h Vlllue will nUl cuvcr Ih" MUl1lhly Charge lor
Iho rolluwlllg I'uli<:y lIIu'lIh; ur
(h) lite MIIIlIl'IIY IlI1 III ,
Th" 1I1110Ul1l '"~ II15UrllllCc under Ihc pullcy II Ihe
1I"nelll ^1II"UIll rul' Ihe lJeulh IICII",II Ollllon In errecl.
The UIIIIIlJIII or IIII1Irunce ullller OilY Illder 15 Ihe 10m. BI
II Will when III'l!lIIlunll were being I'uld,
Thll plUvlllllll will fllll CUflllllue llie pullcy beyond Ihe
Mlllurlly DIIIll nr IlHlIIIIU" IIny Illd"r beyond Ihe T.r'
mlnlJllll1l Dille pl'nvldl!d IlIlhe rider,
You 1II11Y ('lI,h SUl'render Ihl5 pullcy while II II In
rnl'ce ullder Ihls pruvlllon,
7
11300
NONJ'()IWI!l'J'LJIU! ..IUJVISIONS (('IIIIIIIIUO~)
YUIIIIIUY bUI'fUII~OI' IlIlb \llllkY '''1' 1I110W Ill11Il'Y 1661",,1
UII U l.ul~ lip hll6lb, ^'llIull 11I011116 I'lIl1ry 111,,1 III1Y 1'1011'1'6
will W 101'l1l1IlU'O~, TllII NOI ('lIbh VIIIIII' IIr IlIlb I'1I1ky
will ho uI'pllo~ Ui II NUl ShlKlo 1"011I111111 III 11111""1160 II
101'11I 1', ^go Y5 hOlloll1. H 1110 N,'I ('1I6h Vllhll' w"III<I Ill'
lurrldulII IU pnlvl~o UII 1IlI1lI1IIIru 111I11111111 gl'olllOI' Ihllll
1110 ..lInom 1>011111 1I0llurlI UIIIIIIIII<I,"1' h1161., 1110 0~r06'
NOI CUlh VIIIIIO will Iw I'1I1~ III rll6h, Tlw 1'111<1 III'
hlllnullc<' lIIuy ho ,uIl'lIl1do,oll 1,,1 U 1101 rll.h vIIIIIO "II"1I1
IU Ihu 1I0111llg'o fll'ollllulll rUI II," 10'11I 111i1l1'1I110~ 1'"11",1
rOlllaltllllllul Iho 111110 ul b'HWII~OI',
llMilS 0'1 ('OM"II'l'^'I'ON IW 1'01.1('\' V^'.U";!i
MIIIIIIIIIIII ('1I6h VulllL", NIII SllIlIlo Pru1II1II1II1 an~
l'ul.1 III' VIIIIlL'6 1110 hll.o<l 1111 11111 (""l1l11ll1luIIUI"1 1980
SIUI"III"J ()IIIII1111 Y Mllnllllly Tuhlol, udjullod Iur 1110
IlIbl hlnlllluy 1111<1 ullIIg Iho lI"uIIIII,ood Imol'ul 1'1111
6huWII III I Ill' sI','rlrlrulllIlIl Pllllo,
Tllo '''"1''1111'111110 VUllIOl (ur Ihll Ill.llry 111'0 011111111<)
III 1111111' ,llIllIlhll'o 1'0'11111011 hy luw, ^ ~olllllod 11111011I11111
III' 111,. 1I101hu<I IIr I:III111'IIIIIIM VUIlJlli 11111 11l'01l (lIod with
IIII' IIIIIIIIIIIro '1I1,oll'j'III'Y IIf11dlll IIr Iho 111110 III whl~h
Ihll I'lIl1ry II dollvolO~,
POLlCV LOANS
,'oLle\' I.O^N
\'IIU I1II1Y IIhllllllll Pullcy 1.111111 1111 Ihl. I'lIl1eY 1111 hll'
o NIII CUlh VUI1Ju, Thlb I'lIlh:y will Ill' Iho IIl1ly ,0"IHlly
lur Ihll I'ulley 1.111111 II lid IllII" h., U"I"II"1111I 110, W,' rUII
~1I1111' II PlIlley 1.111111 rill' up III .IH 11llllllhi ,l'lIl11lhll <11110
we rerolw yuul' lO'iIlOII. llullIlIll( III. holllK lIiO~ h) pllY
I'rellllulIIllU III,
LO^N INTUtES'l' llA'm
Interell UII UIlY IUlln II III UII crrol'llw II III1UII I 1'1110,
'I'hl. rille mllY dlUIIKO 11'0111 YOIII' Iu YOUI', I'lId, YOIII' wo
will coml'ule Ilw rOle Ihol wllllll'I'ly rul' IIIl' 1I0HI Pullry
Year. Nulllcrellle III rille Ihlllllll'ply 1111111 30 ~uY' 1'1'1111'
wrlllellllollre hUI heelll!l Veil,
The 10uII 111101'011 1'1110 Ii hUie~ 1111 II Pllhlllhe~
MUlllhly ^verUKO, lhul AwrUKe will he:
(a) The MOlllhly Averllge 1I( Ihe CIlIlll'II,lIe Yield
on Curpuru'e Bundl al I'ublllhe~ hy Moudy',
Invellul'I Servlcel. IIIC, ur III1Y Iuccellllr 101 111111
5l!rvlce: or
(b) II 111111 MUlllhly Avcru6e Is 1101 1.lI1ger puhllshed,
U IUh5WIlllfllly slrnllur flVerll"O 115111hllshed hy
regulllllull IlIlIed by Ihe IIlSUl'lIllCe 5upel'vllul'Y
ullldll' ur Ihe 51llte where Ihll pullcy wus
~ellvered,
The IUBn Inlerell rOle (ur Ihll Pullcy Yeul' Is Ihe
l'ubll.he~ Munlhly AveroKe (III' Ihe clllen~ar fIlolllh
form 1300
"I1IlIng Iwu 1lI'"I1I" hefol'" IIIL' culell~IIr lIIulllh In which
,hili Pullry Yelll h"61115. OIl' 1"10 lllllllho HIIlll'anlee~ rale
shllwn In Iho SI"'rlllrllllunIPlIge. whichever II higher.
II IIIl' ....10 rOIl' II Pullry ,"eliI'll lell than 1',.,. hlaher
Ihllll Ihe nile III errec, (III' 1I1'l'evlulIl ,"our, Ihe rale will
nol IlIrll'lIs11 h'lhe new nlle, II 11111 nile 101' 0 l'ullcy Year
Is leli Ihull Ihe 1'1111I rOIl' Ihe prevluul Yeur, Iho 1'1110 will
deneuie 101 Ihe 1I0W rule, bUI nUl heluw 1'10 plul Ihe
KUllrllllleed rOle .huwn In Ihe SJled(kullonll'aHe.
l.lMN IIM.ANn:
^, uled In Ihl, pulley, l.llUn Illllunre meun. Ihe Ium
lit III1Y UIIJluld I'ullry I.uunl ond ellrne~ l.uun Inlerell
which hilS ellhel' IIcel'ued ur he ell ud~e~, We will dedocl
uny l.uulI IIlIlunee (rulII uny Oflluunll puyoble under Ihll
pullcy,
IlEI'^YMENT
Yuu IllUY ..ep"y IIllul' fillY pilI'! u( Ihe l.uon lIulllnce al
!lny lime while Ihls pullcy II In ,urce, Fllllure IU rer,ay
Ihe I.ulln 1IIIIIIn.... will nul lennlllllle Ihll pulley un ell
Ihe LUll II IIlIlullre eHcee~1 Ihl! COih Value Ie.. Ihe
SUl'l'en~el' Chlll'"e Ihen uppllcllble, II Ihll huppllnl, we
will 'en~ U nOllce ur lennlllullon lu yuu und uny Dulanee
ur which we hllvc U rccol'~, We will mull Ihele nOllcellu
Ihe lUll uddl'elle' IIvullllble IU us III leuII Ihlrly.one ~oYI
belure Ihe Icnnlnollun,
.........-
8
11300
OL!NI!I{AI. I'Iu.>VlfiIONfi
ANNUAI.IUWlIltT
!'Udl yeul' II 1'"111111' will he IUIII ", 'h" OWIIUI' whlrll
IhIlW' Ihe <un elII' <ulll vllluu, PI"IIIIIIIIII pullJ. 1111
<huI'N"' IIII<U ,h" hll' '"!lllll ulIll 11111111111111118 plllh'y
Iou III,
I'HOme-I'ION 11l':1'l1ll'1'
Upllll 1'"'IIWII 111111 IIIIYIIWIII III U $10,00 I,'" (U~<"PI
Ihul Ihe nl''' Iup"n III UIlY plllil'y Y"1I1 will h" r,"U), WI'
will IUII~ y"u u 20 yuul' plll)u<111I1I (hili 11111 hl'YIIIIII 11ll'
~uIU Ill' /lI1II'lIl'liy) Ill' <llIh vllluUI, UIIIIK IhuII <l1I,"11I <lIhll
vulllul u<<lIl11l1lul"~ ul HIIIIl'lIll1uud ulld IhulI <unulIl rnluN
or "11'1'1'"" UII~ IUIIlH IIIUHIIIIIIIII nll~ IhuII <UI'lU1I1 IlIhUI"
UII<U dIUI'HUI, l'ulpu<,lvuly,
OWNI';H!illll'
Ullh'lI 11Il~ UIIIII <hUIIH"'1. II," l)wllel' III' Ihlh l'IIlky Ih
Ih" flUl11I1I IIUIIW~ III ()WIll'1' III IIIl' Appllnlllllll, A
ehUIIH" III IIWIIUl'lhlp lIIuy h" IIl1l1b' III Ihe 'Ullle 1111111111'1
UI U dlUlINU III' hUllefldl'I'Y, II 1111 1I\\'11l'1' II IIIIII,"~ Ill' If
110111' II IhellllvlllH, IhuII III" 111""1'11 II nllllldul'"d III h"
Ihu OWIIUI', lilliI'll IIlhul'wl.u 1'!'lIVld"d, dllllllK ,h" III'
lure~'1 Ilfulllllu IIII' OWIIUI' Ihu I huvu IIII' 1111" pllWUI' III
eHerdlu ulI rlghll UII~ prlvlluK"1 III Ihl. Plllley,
Ill':NI':l'lCIAltV
11111"11 IIlhul'whu Il'ruvlll:llhly du.lglIllI"~, YIIU, III"
OWIIUI' lIIuy dlllllg" 11ll' IJCllcfldul'Y d"llglIlII'IIIII III 1111,
Pulley, llowewl', II IIIUlI hI' ~Illle III Wl'llllIg 1111 U fllllll
llIIllfllclllry III us UII~ fIIell III IlUI' 1I<l1l11' Office, Whell
fIIe~, U chulINe will luke urr"el Ulllf lis ~IIIU, reglll~lell IIf
whelher or 1I01lhe hllured II IIvlllg 11111111' ~IIIU III1 filed.
II 110 hellefldllry 01 CIIIIllIIKell1 h""urldIlI'Y I' Ilvlllg
when Ihu IrllUl'e~ ~Ies h""eflIS will he flllld III 11ll'
ln5ufl.!d'6 l!61111e.
ASSlGNMl':NT
We OIlUllle 110 l'espollllhllllY fill' Ihe vulldllY Ilf III1Y
Ullglll1lelll IIf Ihll Policy 1I11~ will 1101 h" cOllsldel'ed III
how kllowledge or II UIII"15 II II flied III llUI IIlllltU
Ornce, When 1115 fIIe~, y"ur I'lghl5, Ih1l5" or Ihe 11I5Ul'ed,
Oll~ Ihose of OilY hellefldol'Y will he luhjee,'o II.
ISSUE AGl': AN/) SEX
II Ihe lllsure~'1 ~Ule llf hlnh Ill' lex lUll heCIIIIIIS5ll1ll'd
III ,he AppllcllllolI, Ihe OIllOUlllllf InsurJlnce 5huII he 111111
Which woul~ he l'UrchD5e~ hy Ihe lIloll I'ecenl CIIII IIf
In5UranCl.! l>l.'dUCliuns at the cOrrl!rllJ~~ und sex.
AOE
Age meOlli IIge 11111 blnllduy IIl1d 1I11llllled IIg" mellm
oge on Ihe prillI' Polky Annlvel'5111'Y,
SUICIIlE
We wlllllulpoy heneflll for deo,h hy suld~e, whelhel'
sone or Il1I0no, ~urlnglho r1nl'wo polley yeun fromllle
Form 1300
Imll' Ollie III' dllll' IIf 1111 IIICI'"llle III I;u~e Al1101111l DI 10
Iudt 111<1'"111", III suell <lIle, wo wllll'erUII~ Ihe l,ruml'
IIml plll<1 {('Oil IIf hIIUIII""" III III" clIse IIf 1111 IneruDlu)
I"sl II11Y 1111111, lIeelue~ IlIlul'eSI olld pOl'llllllllrrun~erl.
1'01.1('\' IIA'I"';
'I he 1'lIl1ey 1 )111" liS sllllwllllllllu Plllky SpudflellllullI
I'IIK" will he 1I1e~ III ~elermllle prellllulIl ~ue ~OIUI,
I'lIlky 1III1IIv"lSlIrles, IIn~ Ih" polky 1II11111hl UII~ ~eol'l,
11I'"I'III1<e b"nllllel efl'Hllve us provl~"~ IlIlhe Applleu'
,lilli,
IN('()NTE!iI'AIlII.ITV
'l'hls Plllky will he 11I1'1I111l'1Iuhle, exeelll for nOli'
pllYlllell1 lIf p"'mlullIb, Oflel' Ii hilI heell III force durlnN
IlIe Ilf"lllIIe uf Ihe IlIlure~ fill' IWU yem frol1l hI Policy
!lllle, We <1111 I'UIIII'5I III1Y IIICI'"UI" IlI,hll I'lIce AI1IOUIII
1111111 IlIdl 1II"II'ule hili I,,'ell III force for IWo yeurl
dlll'IIIK Ih" 1If,'IIme of Ih,' IIIIUI'"'1. Thll will no' opply 10
IIIIY h"lIefll III dh'c, UII~"I' U J{1~ul' for ~llohllhy or for
lIecl~""1111 ~elllh, Tiley UI'" cUlltuilllhle III OilY lillie,
CON'I'IlACI'
W" Issue 11111 Polley III CIIIIII~ul'lllloll of Ihe Appllco.
11011 1111.1 PUYll'""1 IIf pl'ellllul1ls, Tills Polley, fllus the
Applleolloll, IIl1d OilY rI~el'l olluched, 1II0ke Ihu ulI\lre
CllIIIIII<t. A l'l'PY of IlIe AppllcUlllI1I Ii olloche~. The
slutunwlIlI II1l1de IlIlhe Appllcollon will be looked uflon
UI Irue l'epl'"lellllllllllll hUlnol UI WllI'lUIlIluI. VOU AND
TlIF IN5UJ{FlI 51101l1.11 J{EVIEW THE ANSWERS
GIVEN ON '1'111; AllACIIED API'LlCATlON AND
AIlVl5E US OF ANY INCORJ{ECT OJ{ INCOM.
I'l.En' INI'OJ{MA'l'lON Oil IWAI.T11 IllSl0J{V. If
w" cllollenge U dlllm, we IIgree nllllo Uie ony IIlIlemenll
"He"pllhllle I1III~e IlIlh" OppllCIIIIlll110 obloln IlIluronce.
CIIANCiE IN l'OI.lCV
YIIIIIllIlY, 1I11111Y 11111'1, requellll chllllge Inlhllplon of
InIIlI'OI1<U, If we IIgl'"" III IIIl1ke lho chullge. 0 new policy
eun Ill' I5SU"~ llr Oppl'opl'lolu chollge5 mo~e In Ihll
Plllley,
NON-I'AllnClI'AlION
Thl5 Polley does 1101 rllrllclPllle III our profll or
5ul'plus, on~ dues 1I0lPOY ~ vl~en~s,
AUTUlIIlIn' IN MONUMlCNTAl.l.l...lC
Tlw lIulhul'lled offk"1'5 uf MIIIIUmel1l01 LIfe Inlur'
IInee ('ol1lpllny III'e our "I'esl~enl, our Secrelury. and our
Vke Prell~ul\I5, No III1U el5e (IIn~ speclflcolly no ogenl)
hll5 oUlhllrlly III eXlen~ Ihe limo In which premluml can
ho pol~, or III II1l1ke IIny chongo, or wulve any provisions
of Ihlll'ollcy,
9
11300
~I\TIU\Ml!NT (WJ'JONS
Neelillllllf "II lip/Mil - ^IIY II/'lll:~"dij IU I," /111"1 111111"11111. /1"1 ley IIIIIY 1111 /1"111 IU 1111 III<UI11O IIl1dul' IIIIY III1U IIr
IlIu 1I/1111111i IlUlud hulllW, Thu "1""llul1l1r 1111 ulllllll1 UI dlIlIlU" ur I'I'Iul' 1''''<111111 III iii I hll lIIulI~ III wrlll118
III Ihll CIlIn/lUI1Y uI11l Ill/II," 011'I<". II 1111 1I1"11l11 I. ""1 Clllli"" hy 11111 OWI1I1I' /11'1,,1' Iu ,lIu ,1L/UIII III' Ilia
11ll1l1'1I/1, Ilw 1I1'I/IluIy hlll1l1l1dulY IIII1Y /Illlkll ill<1I 1I1~<llul1,
UI1II11S 11I1Il'IlIll/l011y UUIII~~ 1I111"IWlil', OilY ijllclI /I"YI1II'/Ili wllllw 1111111" ul1ly 1IIIIIIIIIUIIIIIIII,'6l111 u~11118
111 hl~ IIwl1ll~1I1. ^"Il/lllllI1 IIIUY h" "1""11I11 ulIly II Ilw 111II1l1l111 ur III" IIIU<~~di I~ $2.000 III' mol'U, Tllu
CII/Il/lOI1Y "IUY chulIIU Ih~ 1111"IYIII ur /I"YlllulI'i 'U 3, 6, III 12 lI1u'uhi, II 1111<"UOl'y III IIICI'IIUIU IlIu
IlIurol1ll1ull IIUY/Il~111111l1l1 1~1I1l 520,00 III1CIl,
OPII'III It - IlIs",I/""'III,\"I[ " .\/II'<'I[/I'd ,t'/(1I11111 - I'IIYIIIUI1I~ ur III1I1UI~~II III1IUUIIIIU h~ /IlulI~ uu~1I Illomll ulllll
,lIu IH'"cuudi Ulld II1IUI"i1l1l'~ UXIlUllilllll,
OpI/1l1I1I - 1111.",1/11/1"115 fi/r II ~/II'I'III"" 1"'1"''' .. l'IIYII1~lm IU I," lIIulI~ "11<11 Inuluh rul' 1111 o~rulIII nU/llbul' IIr
YUllr5.
Oplllill C - I./fu IlIn/l/lt - I'UYIII~l1lij IU 1I1111111d" 1111<11 IIIUl1lh rUI ,II.III~II/Il. ur II," /loy"~, 1111 IlIUl'onl~ud Ihlll
lIuy/Illlllll will h~ /Iludu rill' 1111I111111I11111 ur 10, 15, UI' 20 y"1I1'1 Ui 1I11'~~1I u/lUI1,
Opl/IIII /J - /11I1'1'".11 -, l'uylII"lm ur 1111.I'~il 1111 III. IIIII,,"~d~ 1I.ld hy II," CUlllflllllY. TII" O/llllll111 or Il1luIeal
1111 Y/ll "" I II <ul<ululIIlI 1I11h~ <ulIIlIUUl1dlld 1'111" ur 3% p~1' Y"UI, II1WI'~I'III1YIII"1I11 will h" lIIud" In 12,~, 3
01 1.1I111111h IlIIlIIvulI UllIII'~lId II/1UI1,
SlIppltll/tlllar)! 011I/,.,,0 - WII~IIII1. /lIU<""11ll1r IlIlij lIulley 1I~<IlIll" lI"ylhl", II ijUP/lI~IIIUI1l1lIY <ulllruclleul118
ronll III" '"l'1l11llr IlIlIulIll"Il'iIUi"" will h" Im,"" Iu III~ pllY.II, 'III. rll.IIIIIYlllelll 1I1111~1' Ollllon ^, U, III'
C IlIulI hll lIuyuhle UII III~ "rr.';lly. 11111" ur ill<1I 1111l1011, TII. 111'.1 II"Y11I1111I IIl1d.1' 01111011 L> shull be
IIl1yoblu u"hll ul1d IIr III" III'5IIIUI".1I pUYIIlIIIllIIII"IYIII.
IlIIerm - TII" 1111"1"" I'UIII rul' 0111""" ^, U, 111111 I) will 11"1 h" IlIii 111011 3% 1'"1' y"UI', TIIII 1111111'061 rille rill'
011111111 C will 1111' he I"~I Ihul1 2'1,", 11"1' Y"III, 1111"1".1 Il1l1ddlll"lI I" 111111 SIIII"II IIIUY hllllulll or cl'lIdllud
rlllm 11"111101'11110 lllldllr IIIlY OlHlolI bUI only UIIII" "110 dlsu.llollllr III" C"l11pllny.
Wllhdraw,,1 VIII/l~ - Ul1lel5 lI,hel'wls" 11111"11 III ,hll "1"<111I1I or UII opllol1, Ih" pUY"1 .hllll lIuYII Iho I'IMI" III
reclllvu IlIe whlldrowul volulI ulldllr Ihlll oplloll,
For Orllolll ^ ul111 Il Ihe Wlllldl'llwul vulu" IlIull hll IIIIY UI11".ld hllllll1<e lIr PlO<lIl1dl plus lI<clued
III'erell.
1'111' Opllol1l1lhll wllhdrllwul YlIlu" shull hlllhe coll1l11u,"1I Ylllu" lIr 11111 1'"'1101111118 P"Yl11eIlIS, SUl;h Ylllue
will be cokulollld ol1lhll ,UI11I1 husls u. 1110 "I'IMlllul PIlY111111111,
For Opllol1 C III" wllhlll'lIwul YUIIlIl .hllll h" III" <OIl1I11UIIIII vulu~ lIr III" 1'"I11UIIlIIlI pUYl11ellls. Such value
will he <ukulullld 1111 Ihll .Ol\le 1",,1. 115 Ih" Ol'lgll1l1l pUY1II1I1I15, 'Ill IlIclIlye ,1115 vlllulI, III" PUY"" lnuSI
lubl1111 lIyld"II<" IIr IIISlIl'lIblllly, SII<h "yldllll<1I 11111" hll SlIllsrUCIOI'Y I" IlIe COIl1PUI1Y, O,hOl'wll", Ihe
wllhdl'owlIl YUIIlIl 511011 hll Ihe COlli 111 II 11I11 vululIlIl III1Y 1'11111111111111 gllUI'III11I1"d (lIIYI1I"/1l5, 1111111. oVllnlllle
p,uymOI1I5 will hll 1'011ll1111d IIllh. ""d or 11111 guof'UIII""d period I/Ihll (IllY"" .holllll bllllllve 1111 Iho, dUle.
rhe pUYll1el111 wllllhcl1 <Ol1IlnulI ror III" 111"1111I11 or Ihe pUY..'
Under UIIY 1I1 III"se "1HI""5. Ihll puye" .hulI III1VII Iho 1'11111 III I'"c~IYII Ihll whhdl'owul vulllo III pUrllul
111\10111115. HOWIIVIII', IIw (lurtlollllllOUI1I5 .hllIIIlOI hll 1051 Ihllll Ihll '1111111"1' "r Ihll whhdruwul vulue 01'
$100.
lHlllh III1'a)!tt - 1/ 11111 (lOY"1 dillS huflll'lIll1" pro<lIcds III" IIxhuu5llld or Ihll pl'"sCl'lhod pUYl11elllslI1udo. 0 IInlll
1I0yII111Jl1 will be l11ud" III OIlIlIUIII 10 III" IISlole IIr Ihe IU51 '1I1Ylvlllf.( puye", Thllllll1l1l1Jl1lo he (llIld will be
cukulol"1I us dllsCl'lb.d rill' Ihe oppllcuhle opllollll1lhll Wlllldrllwul VululIl'r"vlsllIl1,
Llmllolloll Oil IliRlus 'If I'orce all" ChI/illS "f Crtdllllr,i - Nllhh"1' Ih. 11111011111 r"llIll1ed IInd"r un opllon fllIrll"Y
pay,"e", lI1ulle lIf1der 011 01'111111 con h" 115s1MII"d 01' (lllIdgllll. To Ih" uXlllnl 1'111'1111111I11 by Iuw IlIch
a1l101l"15 or IllIYlI1enlllhull filii he slIbJ"CIIO c1011115 or cl'edllnll or 10101 pl'oCe55,
Form 1300
10
11300
NI':rn.I':~II':NT OI'TlONN
TAlll.l':!; 01' MONlIII.Y IN!i'I'r\I.I.I\ll':NTN UNlIElIOl'noN II OR c
M1mlhly In"alll1loml aro IhUWIl lul' ollch 51,OQO ul IW'l'l'ucco~llIl'l'lIo~. Thl! IIWcllhuwn IIrc IIwclllurUII blrthd.y
when Iho Ill'll l1Ionlhly 1l1l1l1lhncllllll'ayahlc,
fwnON II TAlll.l':
IN!iTAU.MENI'N Hilt ^ !iI'I':clI'llm I'I':RIOJ)
V..r. M'"l1h'y YUtl M""lhly \'ClH. ~hllllhly \'L'IUI Mlllllllly V,II.,. M'"l1l1ly Yo.r. 1II01l11lly
1IIIIIIImOllll 11111.11111.1111 '11I11I1I1IIL'1I11 IIIII.llm.II," 11111.1111101111 1I1.1.lhll.1111
I $84,n--'6" $14,'/) II 58.,,4 II'. ~Io.)O II $1118 In 54,)4
2 42.66 7 12.9S 12 N.lll 17 ",110 n 4.'10 17 4.21
) lB.79 8 11.47 1.1 7,4'1 '8 l.7J II 4.74 lB 4,11
4 21.H6 9 10,)2 14 7,111 1'1 1,4'1 H UII 19 4.02
S 17,70 III 9,39 '.\ 6.104 21) ,\,17 2.\ 40410 ]0 ],91
Multll'ly Ihl! l1Iomhly hllllllllllClll1 lIy II.H~ ful' III1I1UIII, hy 5.<J6 fur 1l!IIII'II11l1l1olul' hy 2,99 fur IluarlCl'ly hlllllllmenll,
fWI'ION (' TAlll.E
I.II'E INCOME
A.o of ,.~oo Uf. IlIe'"11" Willi AMI! 0' III~'I!L' Uf. IIIeOIllO Willi
"" m,11I .y fJlIJl'DlIlCeU I'erlud ,,"I1It1h oy lhHHDlllccd PerluLi
1'1"1'0.111.10 J.!J..b:w 20 V cau Ulu.~ NCllrrll l>lIh! IU VIHIII 2U \'Utl Lift! III&:ulI1.
ufflm 1I11'Iral
I'.ymolll 11I.10 1'011I.10 M.lo ...~IIIAIL' Mol. hmlltlc 1'0)1 IJIIW I Mol. h!lllllll' M.I. I'.m.lo M.lo '10m.'.
10 52.69 51.60 52.68 5U8 52.II'J 5Ud 46 4.0'1 3.M 3,90 l\4 4, IS 1.67
II 2,71 1.60 Un 2.S9 2,71 2,"1 47 4.17 3.70 J.'H !.l9 4,24 ],7)
12 2:/) 1.61 2.71 2,60 2,7,1 2.62 48 4,B 3.76 4.01 ).104 UJ ],79
I) 2,14 2.6) 1.73 2.61 2,7.\ 2.f1.\ 4'1 U.I ],H2 4,07 ll,9 4,42 ],B6
14 2,76 2,64 2,7S 2,6] 2,77 2.64 SO 4,42 U8 4,'2 314 UI ),9)
1\ 2,7B 2,66 2,77 2.6\ 2,79 2,611 SI UO l'H 4,18 ),79 4.f>l 4,00
16 2,81 2.67 2.79 1.66 2.81 2,68 52 4,611 4.l1l 4,24 lH4 02 4.0B
17 2,B) 2,69 2,81 2,68 2,8) 2,fJ') S3 ",,{)I) 4.07 4.J0 3.90 UJ 4,15
IB 2.85 2,71 2.64 2,7n 2,86 2.71 S4 4,7'1 4, I 3 4,)11 ].'Jl 4,95 ~.2"
19 2,8B 2,73 2,BI' 2,71 2.8B 2:13 B 4.'JO 4,1'1 4,41 4.01 S.ll7 0)
20 2.90 2,74 1,8B 2.73 2,91 2.7\ So 1,01 0.\ 4,47 4,07 5.20 U2
21 2,93 2.76 2,91 2.7\ 2.93 2.77 S7 1.12 01 UJ 4, I 3 U4 UI
22 2.95 2,7B 2m 2.77 2.96 2.7'1 58 5.13 4,411 4,S'J 4.21 S,~8 UI
2] 2,98 2,81 2,96 2,79 2,9'1 2,BI 59 1,J5 4.48 4,64 09 5,64 4.72
24 lOI 2,83 2,9'1 2,81 .1.112 2,8.1 1,0 S.4~ 4,5] 4.70 07 5,R0 U3
25 3,04 2.BS lOl 2,84 3.0S 2.86 61 5,61 ",()I) 4,75 4,44 1,97 4.95
26 J.08 2,88 3,OS 2,811 ].08 2,88 62 U4 4,8 , 4.80 02 6,/.\ 1,07
27 3, II 2,90 l08 2,BB 3,12 2.'/1 (,3 1.87 4.94 ~,81 4060 6,)4 1.20
2B 3.14 2,93 J, II 2.91 3.1'1 2.93 M 6,11I 5,118 4.'111 4,68 6,14 1,34
29 3,18 2,95 !.I 5 2.'1] J.I9 2.'H I,S 6, II, 5.1.1 4,94 4,75 6,75 5,48
30 3,22 2.98 !.I 8 2,IM 3.2.1 2.')9 116 6,30 U8 4,'IB 4.82 6,97 S,64
)( 3.26 lot 3.12 2,9'1 ],27 3.02 67 6.45 U.I S.1I2 4.8'1 7,21 I,BO
J2 3,JO l04 ],)5 3,01 3,JI !.III (,8 fl.lll) 1,7} S.us 4,96 7,46 1,97
J] J,)4 lOB 3.2'1 lOI J,]" l08 6'1 6,7f, 1,911 5,09 S,02 7.7J 6,17
34 J.J9 3,11 3,]J lOB ],41 3.1'2 70 11.'11 6.118 5.12 S.IIB B.02 6.41
H J,43 3,14 3,37 3.1'1 US 3.1'5 71 7.l17 6,27 5,14 5.13 B,J2 6.68
36 3,48 3.1'8 l41 3,1'\ UO 3."1 72 7,2] 6,47 1,17 5.17 8,64 6,96
J7 U3 ),22 3,45 ],18 U6 J,23 7J 7,J8 6.61, 5,1'1 5.19 8,98 7,27
38 3,19 1.26 UII 3.22 3,61 3.27 H U4 11.87 S,20 I.lll 9,J4 7,61
J9 3,64 J.I0 U4 J.15 U7 3,)( B 7.6'1 7,07 5.22 1.22 9,72 7,97
40 J,70 3.34 U9 3.29 3,7] 3.36 71, 7,84 7,17 5,2J 1.2! 10,1 J 8,36
41 J.76 J,)9 3,64 3,]J 3.7'1 3,4' 77 7.'18 7,48 5.24 1,24 10,17 8,78
41 J.B2 U3 3,69 :1.37 3,B6 l45 78 8.13 7,1>7 5.H US 11.03 9,2)
4) U8 3,4B 3.74 .\.41 J.93 UII 79 B,26 7,87 5.16 1.26 II.H 9,70
~4 J,9\ U3 3,7'1 J,41 4,llO U6 80 B.39 8,01 5.26 1.26 12,06 10,21
45 4.02 U9 3,U J,IO 4,08 J.61 or over
form 1)00
II
11300
MIlNUI\Il':N'I'M, I,JIIE IN!iUltANn: l'OI\Il'AN\'
WAlVI':ltlW MON'I'Ill.\'l'IIAllCiI':!i Ill' IN!iLJltANn: IUUUt
C08'1' 0I"IN8UH^NCli
The CUll uf Inlurance 1'01' Ihll rideI' ruI' a pulky IIIUlllh II (a) lIIulllplled hy Ilw I'elulu ur I(b) mini" (e)
plul (&1) I and dl vlded hy 1,000 whelel
(a) Illhe Mumhly CUll or hUUI'allce l{alU I'Ul' Ihll rider;
(h) II ,he Ilealh lIenefll 1'01' 11ll' hlllle pulky III' Ihe heKIII'111118 ul' IIw pulky lIIumh rur Ihe Ueolh lIenlnl
Olll'lun Ihen In erre~t divided hy I plul ,he UUllral1lood IIIWI'ell I'ale Ihuwn In Ihe Sp"clnc.llonl
Pogel
(c) II Ihe Calh Value or ,he policy III Iho heglnnlllK or Ihe pulley lIluluh; IIl1d
(d) Illhe lum or Ihe 1>ell,h Ilonufhl undol' any Addlllonal Inlu,edl{lderl,
MON'I'IILV CUS'" OI'INSUllANn: II An,:
'!'he MUlllhly couur IJIIUrllllCO Na'e II 11I15odun Ihe IlIluI'ed'.:
(a) Allalnod AglI; ond
(h) Prllmlum Cle.. onlhll HrOCllve Ulllo or Ihll rleler,
The Table or Monlhly COil or lmurllll.;e I{olel II allllchlld,
EF""CI'lVt: UA'I'E
'rhll Effllcllve 1>11111 or Ihll rider II Ihe Policy Dille, ulIllIII II IlIler dllle II Ihown on Ihe rider.
G1~N'~RAL
Thll rldllr II a plll'l or Ihll polley III which II II III1I1Chlld, iii hellllfllS lire IUbJecl 10 011 Ihe lerm5 of Ihll
rider alld Ihe policy, 'l'hll rider hal 110 Calh 01' L.OIln Vllloe.
WolveI' or Monthly Chorgei will 'WI reduce any II1110unl Ihal we would olherwlie poy. Any Monlhly
Charge Ihat II deducted olld lalel' wolved will he credlledlo Ihe Cllih Value.
UENEI'I'I'
We agree 10 waive Ihe MOlllhly Chllrge for Ihe policy afler we receive proof Ihol TOlal Dll8blllty of Ihe
Inluredl
(0) hus exllled conllnuouily for al lellll Ilx mOlllhi;
(h) began on or afler IlIlured'l flfteenlh bll'lhday; alld
(c) hegan while Ihll rider was In rorce, and herore ose 60.
We will wulve 1111 Momhly Churgu, rlllllng due while '1'0101 lllillhllllY cOllllnuel, NOlwllhllundlng Ihe
waiver or Monlhly Charsei Ihe Pulley 1lI0Y l1evOI'Il\l'Iel5 lel'llllllllle hy IlIp," wtwl1evcr 0 L.olln lIalanco
(lncludhlg occrued Imereu) e<(lIol, Ihe Cosh Vlllue, This COil he ovolded hy your POYIIIIIIll or 1'0llc)lloan
InlerUlI,
TOTA1.lllSAlllUTV
TOlal Uliahllll)l ,"CUllS contplelC InllbllllY, heclluse or budlly Injury or dlsclIsc. III ellgllge In IIn)l galnrul
occupallon. Occupallon II1l1l1nl Ihe lnsured'i rllgulor oc~upullon durlllg ,he flr'l six monlhl or TOIBI
Ullablllly. After Ihul 111ll1I uccupollon /IleUIlI OilY UCCUPlllloll for which Ihe Insured Is reasonably filled by
educallon, Irullllng or expcrlence, llelng 0 hO/llllmokcr or sludllnl Is Cllllsldcred ellgBglng In B llBlnrul
occupallon,
form 1300,112
,I,
II 13002
'1'.-\111.1': UI' MlIN'I'III.\' l'Wi'l' lit' IN!ilJIlt\NU'; "ATI':S
Tho IIlOlllhly wBlvur ~051 rUII 15 IJB5UI! Ulllhu OIlIlII1UII OMu ol1d ,"I1I1M dillS OIl Ihu huul'ud. ^lIulnud 'MU
IIllunl UMO lul blnhdoy ul1lhu prl<lr pulley 1Ill1llvul'iBry.
WI' WI' WI'
Allulllud ('''II Allul"ud C"I' AlIulllud C"I\
All Rulu AMu Ihll ^Mu Rull
-
15 ,01 30 .Q2 45 ,04
16 .01 31 ,02 46 .05
17 ,01 32 .02 47 .06
18 ,01 33 .02 48 .Q7
19 .01 34 ,02 49 ,08
20 .01 35 .Q2 50 .09
21 ,01 36 .02 51 ,II
22 .01 37 .02 52 .12
23 ,01 38 ,02 53 .14
24 .01 39 ,02 54 ,17
25 ,01 40 .02 55 ,19
26 ,01 41 .03 56' .22
27 .01 42 .03 57' .24
28 .Q2 43 .03 58' .27
29 ,02 44 .04 59' ,29
'R,n,w.' only
...~, , .
form 1300.IU
.3,
R 11003
MONuMENTAL LIFE INSURANCE COMPANY \ I'.l/II~V Nl" .....-... \
,1/lSl <:11/11'/ SJllIIllI/ll.IIMlll1I Mil ~I!"~ ~{"- '1 6
(lI/H- I, ,).1';,.):-1
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M 111111111 1 lllbl NIIIIIU I II II II WI' \ c L+-'MIII
'1 "I 111111 t. ' I 11111 h 1(, .; "" [J fllI.I..I.
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2 ~ illd~I" 611.ul ~ NIII. CIIY, SI,'h'. 11111.111111 t.A j. ~ A I IAII' UllillllIlI,3..PII,1I1
\~ Pl.'}.. 'I~'l- f(fIo,p-.I'j 'oJ' 7:J~(' III Allllllllllllllllblllllllllllu 1'II'lIl1ll1l1bl'IIYIIIIIII \0 "11 ~,II ""'~'I
'3 U UIIIII IIi Olllh I II All' I lllbl OlllllllllY 101-1 t: I'h~IU III 1\11 Ih Ii I AIIIIIIIII I I UIIIII,,,11 LJ MAll
./~ h 'I~ I "'It I NUUlllbllllllllllllY II: loJ $ .:(';,'; ,':' \1 I 6111111AIIIIIIIII I I 5111111 V SIIVIIIUI []Mollullllllc
4 , Octllll"IlIlIlI,"I11 b,'II~h, dllllllbl I
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d 011,11111I ,ddllbl 611..1 " Nil CIIV ~IIIIII 1111 Cmlll II 1\tIi1l11l11l1l11'11I11II.IiIlIl-AIIIIIIIIII $ VilIS -.--.......
~',1r"1f SI (,II.~jlt. ,.'tl ~_, ~ UMUlllIlIlIlIl'llIllIllillll-11I11I1I1 AIIIIIIIIII , .... VIIIL--..--.
6. UIIII PIIIIIIIUdllllllllldllllW halll III. 1I1b1l1ll1'" III Ihll III allY IIlhlll
Clllllllallvll110, Ulve lilllllwllIlI delllll, U CIIIIIIIIIIIIII limllollllily'.lIlIlOlIlIl $
^mlllllll ul I ) AI\thlllllllll Insutl!ll 1U~l!t S
M!HIIIIII~llt" It,~ \ MI)IIIIHI~III111 (] FIIIIIlI\l UlJlIU!lt "~' y"--
Ill! /Ill Pul Nu' '
/Ill tlllt I
I)VI~JJ"'S) IICllllu,"II'1 TIIIIII ,...___ftt
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I] Olh"
.. .._.' . COMPLETE fOR FAMILY COVERAGE lOR ADDITIONAL INSUREDI
II, Foil 11011I11 III 1II1IIullIIld,"11 111011111011 1111 (11'111011" I'luobo 1111111 Illlllilllo," BIIIIIIIIII", AlII'- S.. 1I01llhl ~~~uli; - -
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If . \
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III 10llvull011111l 0111111 III "duCB 'mllollt, IIlellllllm, III pellod
01 '"VUIOII', IIIduIIllIlIlllllelldor IIpliOllll1l Ih. PlllPOlOd
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wllhlll Iha put Ih". yu",. Ilock COI, '11111111111, .nlo, III 1II111111<yd,
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14. a.
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Vulllcll vlolo}11I1I wilhlll Ihl pul IW. 0 yuo,,"
o VII Q.o1'lo II VOl, IIIVI dul"ls
-'6. HaiallY 11"'"11 III lIu ,0VUIIlt' BI" 1I0WIIIII 1111.,111111 IIy IS a M,IIIOIV
01 Clllhallllilol 01 mBlllllul III I Cluwl
o VII [,)oofQo It YI'1i nllllplullJ 1I1\11111hllll AVldl1IJ1' SllllphlllHlnl
'a.OIlBS .ny plllllll III II. covel ad have ollpll"lIollS 1111 1110 InllllallCO
lIalldlng III allV IIlhel ClllllpalllBSl If.
II la, ,lat. 10101 amllollt $
II Accldenlal Oealll U8IlIllt, 118 IlIcllld.d, II,to olllollnl $
Trlllsiny'pIlson--11I '1IICOVllifliol' IIppllad IlIllila III'Accldollt A
HOllin In'"III1" willlllllt lecelvlnll Iha omOllllt alld 111011 applied 101
alld at Ihl elalldeld plomlullll II VBI Cl1i'1 II ye" IIlva dUIIIIII,
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22. Cnllo,1I01l1 alld IIlIllndmenle IItome OlllcI UII onlvl
(Chanll' oslo alllnollt, claulllcallon, plan olln'OI.nCI, IUI or benlUI
1011111111I wllllell endQ/l8l1l11l1 01 Ippllclnt-Folm 60b,1
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1
NON,MEDICAL
PART 2 - Non-Mltdlunl
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cl WhlllllUlllIllIl WII UIVIIIIII 1II1111cIIIIIIII IlIlIlI/lhl"I'/
2. Itll 1111 plllllll plllplllU~ Itll 111I1111111" IIVIII 111111
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Dr pmlllllll ~IICIIIIIIIIIIIII .-
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,hllllll.11c "VIII, clIlIlI 1'111111,
cl D1Ullllvl 5111111111111111haUIII, 111I/IIIICIl, 11I111I11111.
IIVII, Ullt blu~tllI, 11'III"h Dllllelll, 1'11/1111111. 1'1I1i1'I,
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ho,o\.l/ldor, nil fHOVllihlllli of 11Iw fOlhllldlll1l llllY pllYMCllIl1 01 othm 1)II'tiIJlI. Whllllllli i1lllllldt1d Uf tl~llIlHlllltlllll.J, IIr whl) Illoy hQlouftur atteno UI
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Any III1VInI!IlI11otllppllod hy tho Cllfll!lilllV II~ n IlItHlHI II 11 shull I)!! ItllWldptl
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I
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Thll Ippllclliofl. 10 Ih. bill nllll~ klll\'WI.dUIt "ruIIJllliel, lII\'ul\'1!5 ( J Ihlti& IIUI
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19 '//
Sllou.e/Addltlolllllln.ured
Allllllenllt/Owne, II Dill., Ihnll P,opOI.d Inlu,ed
"1111
MONUMENTAL LIFE INSURANCE COMPANY
~ E~Br ClIME BTAH r U~~ rlMOn~ MO mOl
UMrLllllN INK
, PART 2 . MectlCBI t" ....0/). ./.. .- 'T
I NalllQ end eddrQBB .0.1. youI Pjljs?n~l. "hY~I~IJ'I. r: 4)J.. 'J.I..l./L.A_. Ih'~t f'l' 1./( J..~ .I'~'/~--'--'r;~"
III nono, $0 slalo) N. , tl.i.Lw 7: "-.\ '.-{t'Lt J ~~'.lll.c...~IIl,;~ 11<' ,,-,~ L !'!~I..JL"', 0Jli::
b DIll Ind IUlon fur"c'onsullod? :J /'J t. b, L 'J ..:/~L.[;. J. rr ". . .. """J; ).,.-/---1' 7!:.'cl-'-/. "
c Whltll8llmlnl wu given 01 medl<:allon plosulbed'l 1'),,1., J,J, "/ L'~.X IL' .. 'J(~~::-C!~!fl.~~:':.i~-~7J.j.rld,tii?c
2 Hu ptfson plOposod fOl InsUlanco ovor hnll symploms 01 DETAilS 01 "\os" answors (IDENTIFY OUESTIl1N NUMBER,
been diagnosed os flovlng dlsOlduI, dlsuaso 01 pO/slslonl CIf1ClE APPLlCMLE IT EMS: Include diagnoses. dalu, dllllllon
dlscomlorl 01 - Vu No snd nalnos ond addllsses of all allpnd1ng phYllellns Ind medlell
II Ree~helor~ Syslemllungs, bl()llchl, \rodlna, elc) such lacIJIII~SI~ \ I' (! ,\.<,W./..../ f' I,
U I I b IIII? I', .J. \ Lj "l\.I.l\ i.!\.(\(\'U'/" l.JI.'l4-
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bl Cheolllorv SYslelll (heell, blood, allnllos, veins, elc) (,L')' 'j I' Jlil''-f'l.. ,d'- ~ .' J
such n high blood pressulo, hUll altock, murmUI, I 9 _,... ,",
rheomaltc lever, chut polm, , . . , .. .....,....,.,. j+- liL" / of-
, "J/Hi'1 )1
c) Dlgeellva syslemlesophagus, SIOIllOr,II, IlIleslllle, I, 'I' .l.",I.,....1 .,/1 "I
liver, gall blldder, elcl such as uker, clrrllODls, collllB, ~ '- 7 ,..Jr
hemorrhoids, bleodlng?" " , ,. ....,..., "..,. I! 4- 1/ J Iv /1 ,
dl Nervous Syslem (bralrl, /Ierves, elcl Sllcll os ~sIalysls, I Or
~~'nll~g, ~Pllepsy, cOllvulslons, 1I101llal 01 lIervous I! -t}- C/..,v. /~dJ. r~ ). \ '\
el M~~~U~:~ on'.j ~'kel~;~'S~S;~';IS' ;r;lueclee, bOlles, . ":--. . 1:;,"
101n19, eplne, elcleuch os neck or bock ploblems, "I..t" )'.' '",1"" " "~*1
laclure, allhlllls? , , . ., , , . , "b" ::j ',:," I! , 1(.' 1....',' . J I ,~~
II Oonllo'lIr,"olY sYelem \kldIlOY, Sui or, roprOullcl vo ,',
olgons. elelsucll as In ecllon, bloedlllg, 1I10le or '~. ('I' . /_1> 'Or
I I dl .. $? I J ," . 'I' I,) ", ,
eme e eOluol .",..",.,.,.."....",.."".., . ,,'
g) Olandulor Syelem (1IIYlold, pallcreos, 00/01101, IYll1ph
r~~~~'~n~t~) S~.C.h a~. ~1.o~~I,O,5: .or sbll~rrnOI,gro~"~ .~', I J n"' '~
hI Ble881 dlsolder or menslroal Irregulollty?... , . . . , .. 1 J
I) Ever had Impolrod slghl 01 hearlllg, callcer 0/ glowlh,
venoreol d~.ej50, 1wnlJ!~1 skin dlsoasa?, , , , . , , , , ,. II
II Hod anl""eulglcol o~olollF'nol revealod 111 plevlolls
Queslloill', orgm1e 0 a ospllal. cllnlc, dlspellBory 01
sanelorlum fOl obsolyallon, e~omlllalloll 01 IIoalll1ell1 "
nol reyoaled In preYlous Quesllone? , , , . , , , , . . . , , " IfI-... U
. 3) ~~a~~r,~ ~~,o~e~~e~_~.'~~I,n ~~~.~aBI. year? ,II ,y,D,S,' ,1~d~~~I,O. f (J
41 Used norcollcs, barbllUlol05, omphelamlnos, peychedollc .,1....
dlugs, 01 beon trealed fOl dlug IIsage or alcohollem?, ., I J F'I
~) Ever boen diagnosed or tlealed lor AIDS lelaled complo~
~:e~~eej, iesled 'poslilve' ;01' AIOS ilnliboiJloslfiil.V,ill)? : : -If
6) Age II Living Couso 01 Death Ago 01 Dealh
f..a!.h~!.~____.,,____.llL\'ILil" -.--'-fl.:r"--
3 ~~i~~rrs-aii~~i.5j~!ib~~)!~1~\~(.~ ~., ._--~~-----_.
... I acknowledge aildag~~lhOl ~r~ 'i~re;J~i7~~'o~:we'~ ~ere given by me i~ ille Q"esltons slaiecJ above:thiiilhe\-a;i!iU',i;;(j correciTo
Iho besl 01 my knowledge alld belief, 0110 tholthey shall be pOlloi my appllcollon, which shall conml 01 Perls I ond Il laken togelh8/,
and thallho foregoing oneW8/S will bn rrlloo IIpOIl hy tho Company In Iseolng Ihe policy ond shalf become 0 rnrl or Ihe Dollcy
I e~ple$sly wolve, 10 Ihe e~lenl pnrrnllled by slofuln, on behall of '\lysell ond 01 ony pe.,son who shall ha,~ or cl.1'm an, ,nlereslln any
policy heroundEI, all provlelons of law lorblddlng ony physician or olher person, who has ollend~d 01 e~amlned me or who may heruller
allend or e~amlne 11I0, from disclosing Any ~nowledQe or Inforlllallon which he IhelOby acquired
Slgnld II. nC.lL' h, ", I,; . :At!...!.:.... L !r.' /;...../.7.:/ ___ ._ __
. .. Clly Slale . Propoud Inaulld
:::;..:~~'~y - th ~',""a':;:~ i.~ \. "\r- '~L ';;.:.,
M'~CII Eumlner' L ... AppllcentlOwnlr it oihlr iilln Propriliciin,iiiiii'
"'l"lillrd,..1i ( \ /I ,I ,\. c., " I II" ' II I,
I ~/,;JC I
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I~). (/l.l.~ . J
IN THE COURT OF COMMON PLEAS
of CUMBERt.AND COUNTY, PENNSYLVANIA
LINDA BECHTEL, I NO. 94M459B civil Tel:m
I
Plllintiff I CIVIL AC'l'ION M LAW
I
v. I
I
MONUMENTAL LIFE INSURANCE I
COMPANY, I
I
Defendants I
DIFflNDMT' S ANIlUlILAliIL Nfl" MATTIIR
AND NOW, this 27th day of. October, 1994, com9S the Defendant,
Monumentlll Life Insurance company, (hereinafter "Monumental") by
IInd through its attorney, Patricia carey ZUcker, Esquire, of
Balaban IInd Balaban, pursuant to Pa, R.C.P. 1029 and 1030, to file
the following Answer and New Matter to Plaintiff'S Complllintr
Mmfll.B
1. ADMITTED.
2. ADMITTED.
3. DENIED as stated. It is ADMITTED that Monumental issued
Osoar P. Bechtel a Universal Life II Policy (UL2A Policy) in the
initial face amount of $25,000, with a policy date of September 9,
1991. It is DENIED that the Policy Number is 00165526, rather the
Policy Number is 0016552~6 (omphasis added). It is ADMITTED that
the copy of the policy attached to Plaintiff's complaint as Exhibit
"A" is a duplicate policy of the one originally issued to Osoar
Bechte 1, the orig illa 1 policy hav inlJ boon lost and IS requost for IS
dupliQate having been made by Oscar Beohtel to Monumental, By way
of further answer, Defendant I.ncorporates by reference its New
Matter and makus it a part hereof.
4, ADMI1"l'ED and DENIED. It is DENU;;o that Plaintiff'lJ
application for insurance was complotod on May 8, 1991, rather it
is averred that Oscar Bechtel initially tailed to complete his
appl ication for insurance by retus inlJ to respond to Monumental's
requests to schedule a medical examination of Mr. Bechtel. On
August 10, 1991, Oscar Bechtel did submit to a medical examination
performed by a designated medical examinor by Monumental. It is
ADMITTED that on May 8, 19!Jl, Oscar Bechtel paid One Hundred
($100,00) Dollars in premium to Howard G. Bock, the Monumental
sales agent who sold the UL2A Pol icy to Mr. Bechtel. By way of
further answer, Defendant incorporatos its New Matter by reference,
and makes ita part hereof.
5, ADMITTED,
6. ADMITTED and DENIED AS B'rATED. It is ADMITTED, upon
information and belief and not within any perBonal knowledge of
Defendant, that Plaintiff, Linda Bechtel, is the widow of Oscar P.
Bechtel. By way of further answer, it is ADMITTED only that the
Plaintiff, Linda 1<. Bechtel is listed on Oscar p, Bechtel's
Application for the UL2A Policy as the "Primary Beneficiary" and
"Wife".
7, ADMITTED. By way of further answer, Defendant
incorporates its New Matter by roference, and makes it a part
2
hereof.
8. ADMITTED. By way of furt:her answer, Defendant:
incorporates it:. New Mat:ter by reference and makes it a part
hereof.
WHEREFORE, Defendant: respectfull y request:s this Honorable
Court to dismiss Plaintiff's Complaint and enter judgment in favor
of Defendant.
NIlW MATTER
9. Defendant's Answers to paragraphs 1 through B, inclusive,
of Plaint:iff's Complaint are incorporated by reference as if fully
set forth herein.
10. On May B, 1991, Oscar p, Bechtel filled out an
Application t:o obtain a Monumental UL2A Policy in the face amount
of $25,000.00 and paid a premium of $100,00 to Monumental agent,
Howard G. Bock with this Application,
11, Part 2 of the Application (a copy of which is attached to
Plaintiff's complaint as Exhibit "A" and made a part of the UL2A
Policy) , request:ed whether Mr, Bechtel had, ".,. [E) ver had symptoms
or been diagnoaed aa having disorder, diaease or persistent
discomfort of - Respiratory systems", circulatory syatem...
Digeative System,. .", to which questions Oscar Bechtel marked "no"
in tho box next to each said question.
12. In Part 2 of the Application, Oscar Bechtel also checked
"no", the question about whether he had undergone,".,. [A) ny
surgical operat:ion not revealed in previous questions, or gone t:~
3
a hospital, olinio, dispensary or sllnatl.lrium foJ:' observetion,
eHaminlltion or trelltment not revealod in previous questions?H.
13. When asked in Part 2 of the Applioation whether he had,
HSmoked oigarettes within the pllSt yeur? It yes, indirJIlte quantity
per dllyHI Mr. Bechtel stated HI PK per Day.H
14. Above the signature line, the Applioation, Ln pertinent
part, states the followLngl "I acknOWledge and agree that the
forego Lng answers were g ivel' by me to the quellltions stated above,
that they are trulI and oorrect to the best of my knowledge. and
belief, and that they shall be pllrt of my aPPliolltion, which ahall
consist of Pllrts 1 IInd 11 taken togother, and that the foregoing
answers will be relied upon by the Company in issuing the policy
and shllll become part of the pOlicy.H
15. Mr. Bechtel's Application for the UL2A Policy was delayed
in prooess ing by Monumental as a result of Hr. Beohtel' B refusal to
submit to a medical examinatLon.
16. On August 10, 1991 Oscar Bechtel submitted to thE)
required medioal exam.
17. On May 8, 1991,
this UL2A Policy, Osoar P.
in force with Monumental.
18. On MIlY 8, 1991,
at the time of making Application for
Bechtel had $45,000.00 of life insurllnce
upon signing the Application and making
the premium payment of $100.00, Oscar P. Bechtel Was given a
Conditional Receipt by Monumentlll agent Howard G. Bock, a blllnk
copy of which is attached hereto as Exhibit HAH and made a part
hereOf.
4
19. The conditional ReoeLpt sets fOJ:'th Ln I.' ".:'Ir bold print,
the following oeveatr HIHPOR'l'AN'l'l 'rlml CONDI'l'IONAL RECEIPT DOES
NOT PROVIOE ANV INSURANCE UN'l'I L Al,L CONDl'l'IONS ARE ME'I'. H
20. The oonditions requLred to be met in order for insuranoe
to beoome effective, were definod in the conditionlll Reoeipt, in
pertinent part, as followsr
...[Ilt is understood and agreed thatl
(1) if all the followLng canditions are met, Lnsuranoe
applied for shall become effective alii of the dllte of th.Ls
reoeipt or the latest required medical eXllmination,
whiohever is later, SUbject to the terms and oonditLons
of the policy applied for. Tho condLtions arer
(a) payment of an amount equal to the
first full premium for the benefits applied
for to the Agent at time of signLng the
application,
(b) complet ion of the application,
provided, however, that if the company makes
any changes liS to amount, Classification, plan
of insurance, age, benefit, or adds any
restrLctive rider, the applicant's written
acoeptance of such change is necessary before
any insurance becomes effective.
(c) all required medical examinations
have been completad.
(d) and the Company is satLsfied that on
the date of the appliclltion each person to be
insured is a risk insurable IInd acceptanoe
under its rUles, limits and standards for the
plan and amount appl ied for al: its standard
rate of premium.
21. This conditional Receipt clearly notified oscar P.
Bechtel that the l1L2A Policy fot" which he had applied in the amount
of $25,000.00, could not be effectivo until after all conditions
listed in the Conditional Receipt had beon satiSfied, inclUding the
completion of a medical examination, Which did not take place until
5
Auguat 10, 1991, some three months after the APpliQstion had been
.H.cut~d by Hr. Beohtel.
22. When submitting to the required medical e~am on August
10, 1991, Osoar P. Bechtel represented to the medioal e~aminer thet
in Hay, 1991 he had been treated for bronchitis whioh resolved
itself after 10 days of antibiotics with, "No problems."
23. Hospital records obtained after Hr. Bechtel's death from
Carlisle Hospital and Harrisburg Hospital, reveal that on or around
Hay 20, 1991, Osoar P. Bechtel went to the Emergency Room of
carlisle HospLta1 where he was treated for chest pain, aortic
stenosis and tobacco and ~lcohol abuse. These records reveal that
Hr. Bechtel was transferred to Harrisburg Hospital on or around May
23, 1991 to be treated for "critical aortic stenosis and chest
pain."
24. Hospital retJords obtained from Carlisle Hospital IIlso
reflect that on or around July 12, 1987, and July 14, 1987, Oscar
P. Bechtel was admitted to that Hospital for treatment of chest
pain, aortic stenosis, hiatal hernia, ulcer disease and a possible
urinary tract infection. These records also reveal that Osoar
Bechtel smoked four packs of cigarettes a day for many years.
25. In his Application for tho UL2A Policy, Oscar P. Bechtel
knowingly misrepresented his medical and health conditions to
Honumental, which medical information was material to Monumental's
decision to issue said Policy.
26. Monumental materially and justifiably relied upon
Bechtel's misreprosentations for purposes of issuing Policy Number
6
001655226, to its detriment.
27. The UL2A Policy contains an Inconte.cability provision
whioh reads, in pertinent part, as followsr "This Policy will be
incontestable, elloept for non~paymlll1t of premiums I aft~r it has
been in force durLng the lifetime of the insured for two years from
it. PolLcy Date.H The Policy Date of the UL2A Policy is September
9, 1991.
28. 'l'he UL2A Policy issued tc Oscar P. Bechtel was not in
force during the lLfetime of Oscar P. Bechtel for two years from
its Policy Date of September 9, 1991, and is therefore contestable
under the policy language.
29. Policy Number 001655226 WAS frlludulontly obtained by
Oscar P. Bechtel and is void as a matter of law.
30. Plaintiff has failed to state a cause of aotion for whioh
relief may be granted.
WHEREFORE, Defendant respecUull y requests this Honorable
Court to dismiss Plaintiff's Complail,t and enter judgment in favor
of Defendant.
Respectfully submitted,
~Bl\N l\ND B()Bl\N
( atr ida Carey
I.D. 837334
Governors' Row
27 N. Front Bt
P.O. Box 1284
Harrisburg, PA 17108-1284
(717) 234-3282
Date, October 27, 1994
7
'-'-'-1 ,.. ,...,.,
MONUMENTAL LIFt; INSURANOE COMPANY
BalIlIllO/u, Mal11nnd 21102
,... _ _. __ _ _ _ ...~ _._ _~ _ ~ ____.,_. _~H"" _ 0- _.. to- ..... ......_..___...__ .__u_ -_....-- -.- -..-..-----..-...--...-....-..----............---...--.
CONDITIONAL RECEIPT MONUMENTAL LIFE INSURANOE COMPANY
H0ll18 011":0. lJallllllolO, Md 21202
IMPORTANT1 THIS CONDITIONAL RECEIPT DOES NOT PROVIDE ANV INSURANCE UNTIL ALL CONDITIONS ARE MET.
RECEIVED FROM,. . . .. Iho 6Ulll 01 . .. .. Dollalo, ao 0 dopooll on accoonl
01 application 101 Inoolancelllado Ihl6 <lalo 10 Iho MonulIlonlal lifo Inoulanco COlllpany on Iho life ol......H ..m..'U__' If 10 ondal'
olood and agreed Ihal:
(1) II all Ihe lollowlng condlllon6 010 11101. In6111al1CO appllud lor aha II bocolllo ollodlva 00 01 Iho dala ollhlo lecelpl OIlhQ lalool
lOQolred 1Il0dlcale,amlnallon, whlcl\ovo, lolnlo" ol/blnell.' lI\elolmo /Ind col1lllllono 011110 policy npp'lod lor. Tho condlllono alo:
lal paymanl 01 an amounl oqllallo 1110 Ilrollull plomlllnllol II," bOl1ollla appl"'<1 101 10 1110 Auonl alllmo 01 algnlng Ilia appllcallon,
(b) complallon 01 Il1e appllcallon, plovldod, 110WOVOI, 1110111 1110 Company lIlakoo /Iny cl1ango DO 10 amounl. ctaRolllcallon, plan
ollnoulanco, ago, benolll, 01 addo any laolllcllvo Ildol, 1110 oppllcanl'o wllllon accoplonco 01 ouch chengo 10 noceooary bololo
any Inoulanco bocomoo ollocllvo,
Icl all lOQulrod modlcal o,ollllnnllonn l1avo boon complolod,
(dl and Ihe Compan11n oolllllod Ihol on 1111) dole ollha oppllcnllon ooeh pOlnon 10 bo InOUlod 10 0 link Inoulable Ind acceplable
ondel III lulen, IImllo and olondoldo 101 Iho plan and omounl appllnd 101 at IIn olandald lale 01 plemlom,
(2111 wllhln 45 davo 110m Ihe dolo hOlOol a policy hoo nol beonloouod 10 Iho oppllconl, Ihon the appllcallon ahall bo doemad to
hava been declined by tl10 Company and any depooll paid will be lelundod.
(3) No agonl has Iho authollly 10 wolvo 0 complote anowe/ 10 any Quoollonln Iho appllcollon, paon on Inourablllly, lIlake or Bller
Ihe appllcollon 01 Ihlo locolpl, 01 walvo any 01 1110 compony'o olhor rlohlo or reQullemonlo.
(41 In no ovenl wllllho omounl ollila Inolllanco which may bocomo ollocllvo undor Ihlo locolpl o,cood $150,000 101 NoWlol Dealh
Bonolll and $45,000 lor Accldolllol Dealh Bono III.
ALL ~lIlMIUM CHECKS MUST BE MAUE PAYAULE TO THE COMPANY: 00 NOT MAKE CHECKSPAVABLE TO AOENT OR LEAVE PAVEE BLANK
Date.. . PLEASE READ CAREFULLV .... __-'__ ._.___..______.. Agont
~--~-..~-----..-_.._----_.._...._------~------_..__..-----_.._-_..__..-...------..----_.._---_.._-~---------_..._---.
AUTHORIZATION TO OBTAIN INFORMATION
I AUTHORIZE any pllyole/an, modlcnl plocllllonol, hoopllal, clII1IC, olhol modlcal or medically lololod laclllly, InoolBnco 01 ,olno'/flng
company, Ihe Medlcollnlolmalloll BUIl'OU, Inc., conoomol leporllng aooncy 01 omployoI, having Inlolmallon avallablo on 10 dlagnoolo,
tlealmol1l and plognoolo wllh loopocllo any ph10lcol or monlol condition alldlol IIoalmol1l 01 mo or my mlnol chlldron and any olhel
non,modlcal Inlo/mallon 01 mo 01 1111 minor chlldlo" 10 Olvo 10 1110 Monumonlallllo Inourance Company 01 110 logal roprooenlallvo.
Bny and all ouch Inlolmallon.
I UNDERSTAND Iho InlOlmallon ohlolnod b1 U50 ollho Aulhollzallo'l will bo used by Iho Monumonlal L1felnoolanco Company 10
delelmlno ellglblllly lor Inouranco and ellglblllly lor bonolllo onder on e,lollno policy. Any Inlolmallon oblolnod will nol bo lolonoed
by Iho Monomonlal Lifo Inourance Company 10 any pOloon 01 olganllollon EXCEPT 10 loln5ullng companloo, Iho Mod'cal'nlolmallon
BUleau, Inc., 01 olhol peroon5 or oloanlzallono porlOlmlno huoln050 or legal OOr/IC05 In connecllon wllh my oppllcallon, claim. or 00
may be olhorwloo lawfully leQulred 01 05 I may lurthol aulhollzo.
I KNOW Iholl may rOQoenllo locolvo 0 copy ollhlo Aulhollzollon.
1 AGREE Ihal 0 pholoOlophlc cOP1 01lhl5 Aulhollzallon oholl bo 00 valid 05 Il1e ollglnal
I ACKNOWLEOGE loc'olpl ollho Nollco 01 016Cl051110 ollnlormallon and Nollco 10 rulsono Applying 101lnoulonco.
I AGREE Ihallhlo Aulhollzallon 5hnll bo valid 101 11'10 and ono hall yoa,s 110m Iho dale ohown bolow.
Dale
Slgnolule 0; P;opoood Insu;od-----
. Noma 01 Minor Child SI0I18IU10 01 AddlllonallnslIred----- ..... --
(THIS AUTHORIZATION MUST ACCOMPANY THE COMPLETED APPLICATION)
Alnoo
155110 Dnlo
MONUMENTAL LIFE INSURANCE COMPANY
~ FASl UI^SF. STlII.f LIlALTlMOIlL MIJ ~ 1 ~m
PolicV No.
SnCli11 Snnl/llv No
FIISI Nom.'
2 Resld,n"
r M 11111101
51".1 & No
APPLICATION FOil LIFE INSURANCE - PART I
l051 No",,,
Ii
III'''Jhl
PhOllft No
Is lJ Mol.
0> [J f'lIl~lo
I 1.1 NlIn.Slnokol
IAn. O",,'ion , 3 P~IIUI
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II A""".I 1.1 01101 I,fly LI MACI
II S'HlIlAlllllJol [J SolIJlY SovlIlU' [] MOllllm.IIC
WclUhl
Cllv
5101"
bIlC,""
Pial' ullnsUflll1rP.
J 0 Uat. 01 B,n" I II AU" IlO" nlllh,lilV
N""'",I Ulllh",lV
4 0 lJCClJllOllll1I (,'011' 5110,,11( lilllrP.II
[I I (
II
II AlIIlJl/lIl ullnSUlllIlU!
PlilU! III nltlh
s
Ii By whom ""'IIIIIV.1i
( N.J'''''' 01 Bu~ulllss
10 CllI!ck SlIl1l1h!IIII!lIlnlV Ullllehls '" Rhlurs desilcd
II Afflf"'"lall1",lh $ II PI"mllllll POY'" B,",hl
II O"ol"hIV IWmv", "I Proll""'") U MlJllipl, Cove, aD,
IN THE COURT OF COMMON PLEAS
OF CUMBERLAND COUNTY, PENNSVLVANIA
LINDo\ BECHTEL, I NO. 94-4698 civil Term
I
Plaint i tt I CIVIL ACTION - LAW
I
v. I
I
MONUMENTAL LIFE INSURANCE I
COMPANV, I
I
Defendants I
O!RTJrIOATB or SERVICE
AND NOW, this 27th day of October, 1994, I, Lori llruno,
Seoretary to Patricia CII~ey ZUcker, Esquire, hereby cortify that I
servod a true and correct copy of the foregoing "DEFENDANT'S ANSWER
AND NEW MATTER" upon the following individual by placing this
dooument in the United States Mail, first-class postage prepaid in
Harrisburg, Pennsylvania, addressed as folloWSI
H. Anthony Adams, Esquire
128 East King Street, Ste. A
Shippensburg, PA 17257
c4'Ai
/ i t. ~'tMiJ
L Bruno, Seoretary
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IN TH!!: COUR'I' of COMHON 1'1,EAS
OF PENNSYLVANIA ~ CUMBERLAND COUN'rY
LINDA BECHTEL,
PLAINTIFF
VB.
NO. 94~4598
CIVIL AC'I'ION - LAW
JURY TRIAL DEMAND!!:D
MONUMENTAL LIFE INSURANCE
COMPANY,
DEFENDANT
DEFENDANT'S ANSWER TO NEW MATTER
10.
Adn'itted.
11.
Adnlitted.
1;l.
Admitted.
13.
Admitted.
14.
Admitted.
15.
Denied, any delay in the processing at Monumental, was a
result of internal operation and not ocoasioned by Oscar Bechtel.
16.
Admitted.
17.
It is believed that at the time of the application, Oscar
Bechtel had $25,000.00 in insurance.
18.
Admitted.
Iii 'I'liE COUR'I' Of' COMHON PLEAS
OF PEIiNSYLVANIA - CUMBERLAND COUNTY
[,INOA BJlCKTI!:L, I
PIJAINTIFF I NO, 94-4598
I
VS. I
I CIVIL ACTION - U~W
MONUMENTAL LIFE INBURANCl!: I
COMPANY, I
DEFI!lNDANT I
PRAECIPI!:
TO THE P~OTliONOTARYr
PleBse dismiss the above oaptioned matter.
Datel~
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H. Ant ony Adama~ Esquire
Attorney for Plaintiff
128 E. King street, suite A
Bhippensburg, PA 17257
(717)-532-3270
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