TEMPERANCE PLAN .. EVEN FORLIFE!
Here at last is a new kind of hospitalization plan for non-drinkers and non-smokers only! The rates are fantastically low because "poor risk” drinkers and smokers are excluded. And because your health is superior...there is absolutely no age limit, no physical examination, no waiting period. Only you can cancel your policy... and no salesman will ever call! Starting from the very first day you enter any hospital...
S E N D F O R Y O U R P O L I C Y N O W B E F O R E I T ’S T O O L A T E ! | 442 APPLICATION TO I PIONEER LIFE INSURANCE COMPANY , ROCKFORD, ILLINOIS I M P A D T A M T . check ta ile ie lo w m INCLUDE YOUR i m r v n i A n i . first p r em iu m w ith application 1 FOR AT-300 ¡AMERICAN TEMPERANCE HOSPITALIZATION POLICY 1 Name (PLEASE PRINT) LOOK AT THESE AMERICAN TEMPERANCE LOW RATES J Street or RD # Pay Monthly Pay Yearly 1 City 7nn» Cnnnty State 1 Age Date of Birth Each child 18 and under pays $ 2 «o *28 | Month Day Yaar j Occupation Height Weight 1 Beneficiary__________________________________~ Relationship___________ 1 1 also apply for coverage for the members of my fanfily listed below: n a m e a g e h eig h t w eig h t b e n e f ic ia r y
*3“
*38
Each adult 19-64 pays
1 1 . 1 2. 1 3.
Each adult 65-100 pays
1 4. J To the best of your knowledge and belief, are you and all members listed above in good health J and free from any physical impairment, or disease? Yes □ No Q 1 To the best of your knowledge, have you or any member above listed had medical advice or 1 treatment, of have you or they been advised to have a surgical operation in the last five years? 1 Yes □ No □ If so, please give details stating person affected, cause, date, name and 1 address of attending physician, and whether fully recovered. 1 Neither 1 nor any person listed above uses tobacco or alcoholic beverages, and 1 hereby apply 1 for a policy based on the understanding that the policy does not cover conditions originating l prior to its effective date, andthat the policy is issued solely and entirely in reliance upon the a written answers to the above questions. ■ Date' Signed: X 1 AT-1AT
» 5 9 0
* 5 9
SAVE TWO MONTHS PREMIUM BY PAYIN6 YEARLY! Mail this application with your first premium to AMERICAN TEMPERANCE ASSOCIATES Box 131, Libertyville, Illinois
L.
OCTOBER, 1963
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