Figures for later years will be furnished upon request.

REINSTATEMENT.—In case of continued temporary insurance under the above provisions, this policy, upon evidence of insurability satisfactory to the company, may be reinstated within the first three years of the term for which the insurance is continued by payment of arrears of premiums with interest at (here insert not greater than six) per centum per annum.

OPTIONS AT MATURITY-The insured, by written notice to the company at its home office, and with written consent of the assignee and irrevocable beneficiary, if any, may elect to have the net sum payable under this policy paid either in cash or as follows:

(I) By the payment of interest thereon at . . . . . . . . . . per centum per annum payable annually, to the payee under this policy at the end of each year during the life of the payee and by the payment upon the death of the payee of the said net sum and accrued interest to the executors, administrators or assigns of the payee, unless otherwise directed in said notice. (2) By the payment of equal annual installments for a specified number of years, the first installment being payable immediately, in accordance with the following table for each $1,000 of said net sum. (3) By the payment of equal installments payable at the beginning of each year for a fixed period of twenty years and for so many years longer as the payee shall survive in accordance with the following table for each $1,000 of said net sum. Installments payable under options (2) or (3) which shall not have been paid prior to the death of the payee shall be paid, unless otherwise directed in said notice, to the executors, administrators or assigns of the payee.

If the insured shall not have directed otherwise the beneficiary may, after the death of the insured, by like written notice, and with the written consent of the assignee, if any, select either of the above options.

Unless otherwise specified by the insured the payee may on any interest date receive the amount yet due under option (I), and may at any time receive the commuted value of payments yet to be made, computed upon the same basis as option (2) in the following table, provided that no such commutation will be made under (3), except after the death of the payee occurring within the aforesaid twenty years.



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AGENTS ARE NOT AUTHORIZED to modify this policy or to extend the time for paying a premium.

IN WITNESS WHEREOF, The Company has caused

this Policy to be executed this. . . . . . . . . . day of . . . . . . . . . . OHIO STANDARD LIFE INSURANCE POLICY.

(Insert “Ordinary” or “Limited Payment” Life Fixed Survivorship Annuity.

- - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - -

- - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - -

Of (Name of State)

IN CONSIDERATION OF . . . . . . . . . . . . . . Dollars, receipt of which is hereby acknowledged, and of the payment of (here insert amounts and times of payments of premiums) until (insert “the death of the insured” in ordinary life, and “. . . . . . . . . . . . full years' premiums shall have been paid or until the prior death of the insured” in limited payment life),

PROMISES to pay at its home office in . . . . . . . . . . . . Dollars in Twenty equal annual Installments of $. . . . . . . . . to . . . . . . . . . . . . . . . . . . . . . (herein called the Beneficiary),

(insert “his” or “her”) executor, administrator or assigns, with (insert “out” if so desired) right of revocation, if (insert “he” or “she”) survives the Insured, otherwise to the executors, administrators or assigns of the Insured, the first Installment being payable immediately upon receipt of due proof of the death of the Insured, any indebtedness to the Company on this Policy together with the balance, if any, of the then current year's Premium being deducted from the amounts first payable under this contract.

Should the Beneficiary live to receive the Twenty Installments payable to (insert “him” or “her”) as above provided, the Company will pay (insert “him” or “her”) annually during the remainder of (insert “his” or “her”) life the sum of $... . . . . . . . . . . . beginning one year after the date when the Twentieth Installment payable hereunder shall fall due.

CHANGE OF BENEFICIARY-When the right of revocation has been reserved, or in case of the death of any beneficiary under either a revocable or irrevocable designation, the insured, subject to any existing assignment of the policy, may designate a new beneficiary with or without reserving right of revocation by filing written notice thereof at the home office of the company, accompanied by the policy for suitable endorsement thereon. If any beneficiary shall die before the insured and the insured shall not have designated a new beneficiary the interest of such beneficiary shall be payable to the insured, (insert “his” or “her”) executors, administrators or assigns. If a new beneficiary shall be designated only twenty annual installments will be payable under this policy, and future (if necessary, insert “semi” or “quarter”) annual premiums will be reduced to - - - - - - - - - - - - dollars each.

PAYMENT OF PREMIUMS.–The company will accept payment of premiums at other times than as stated above, as follows:

- - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - -

- - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - -

Upon return of this policy to the company accompanied by evidence satisfactory to the company of the death of the beneficiary the company will reduce the future (here insert “annual,” “semi-annual” or “quarterly”) premiums to

$. . . . . . . . . . . . each.

Except as herein provided the payment of a premium or installment thereof shall not maintain the policy in force beyond the date when the next premium or installment thereof is payable.

All premiums are payable in advance at said home of. fice, or to an agent of the company upon delivery of a re

Standard forms.

Standard forms,

ceipt signed by one or more of the following officers of the
company (insert titles of officers who may sign receipts),
and countersigned by said agent. -
A grace of one month subject to an interest charge at
the rate of . . . . . . . . . . . . per centum per annum shall be
granted for the payment of every premium after the first,
during which month the insurance shall continue in force.
If the insured shall die during the month of grace the over-
due premium will be deducted from any amount payable
hereon in any settlement hereunder.

CONDITIONS.—(The policy may here provide for restrictions of liability by reason of travel, occupation, change of residence and suicide. These restrictions except such as refer to military and naval service in time of war, must be applicable only to cases where the act of the insured provided against occurs within two years after the issuance of the policy.) INCONTESTABILITY-This policy and the application therefor, a copy of which is endorsed hereon, constitute the entire contract between the parties and shall be incontestable from its date, except for non-payment of premiums and except as otherwise provided in this policy. All statements made by the insured in said application shall, in the absence of fraud, be deemed representations and not warranties. If the age of the insured has been misstated, or if the age of the beneficiary has been misstated, the amount payable hereunder shall be such as the premium paid would have purchased at the correct age. PARTICIPATION.—This policy shall participate in the surplus of the company and beginning not later than the end of the (insert first, second or third) policy year the company will annually determine and account for the portion of the divisible surplus accruing hereon. DIVIDENDS.—Dividends at the option of the owner of this policy will on the . . . . . . . . . . . . day of . . . . . . . . . . . . of each year (here may be inserted “after the first policy year” or “after second policy year”) be either— (1) Paid in cash, or (2) Applied toward the payment of any premium or premiums, or (3) Applied to the purchase of paid up additions to the policy, payable in twenty annual installments at the same times as the original amount insured under this policy is payable. The payment of such twenty installments shall discharge the company from all liability on account of such dividend additions; or (4) Left to accumulate to the credit of the policy with interest at (here insert a rate not exceeding that used by the company in calculating its reserves) per centum per annum and payable at the maturity of the policy, but withdrawable on any anniversary of the policy. Unless the owner of this policy shall elect otherwise

within three months after the mailing by the company of a jo"
written notice requiring such election, the dividends shall
be applied to the purchase of paid up additions.

LOANS.—After three full years' premiums have been paid, the company at any time, while this policy is in force, will advance, on the proper assignment of the policy and on the sole security thereof, at a rate of interest not greater than . . . . . . . . . . . . per centum per annum, which interest if not paid annually shall be added to the princpial and bear the same rate of interest, a sum equal to, or, at the option of the owner of the policy, less than, the reserve at the end of the current policy year required to provide for the twenty installments payable under this policy and for any dividend additions thereto, and no more, computed according to the (designate mortality table adopted by the company for computing reserves) mortality table and interest at the rate of (designate rate of interest adopted by the company for computing reserves) per centum per annum, less (here may be inserted not more than two and one-half) per centum of the amount insured by this policy and of any dividend additions thereto. The company, however, will deduct from such loan value any existing indebtedness to the company on the policy and any unpaid balance of the premium for the current policy year, and may collect interest in advance on the loan to the end of the current policy year. Such loan may be deferred by the company for not exceeding six months after the application, therefor is made. Failure to repay any such advance or to pay interest shall not avoid this policy unless the total indebtedness hereon to the company shall equal or exceed such loan value at the time of such failure and until one month after notice shall have been mailed by the company to the last known address of the insured and of the assignee, if any. No condition other than as herein provided shall be exacted as a prerequisite to any such advance.

ASSIGNMENT.-No assignment of this policy shall be binding upon the company until it be filed with the company at its said home office. The company assumes no responsibility as to the validity of any assignment.

OPTIONS ON SURRENDER OR LAPSE. After this policy shall have been in force three full years the owner. within one month after any default may elect

(a) To accept the value of this policy in cash, or

(b) To have the insurance continued in force from: date of default without future participation and without the right to loans, for its face amount, including any outstanding dividend additions, less any indebtedness to the company hereon, or

(c) To purchase non-participating paid-up insurance, payable, except as hereinafter provided, at the same times and on the same conditions as this policy. The cash value will be the reserve at the date of default required to pro

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