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...
SEND FOR YOUR POLICY NOW BEFORE IT’S TOO LATE!
444 APPLICATION TO PIONEER LIFE INSURANCE COMPANY, ROCKFORD, ILLINOIS PO> AT-300 AMERICAN TEMPERANCE HOSPITALIZATION POLICY Name(PLEASEPRINT)_______________________________________________ StreetorRD#____________________ ________________________________
I M D n D T A M T . CHECK TABLE BELOW AND INCLUDE YOUR I I K r U H l « n I . first PREMIUM WITH APPLICATION LOOK AT THESE AMERICAN TEMPERANCE LOW RATES Pay Monthly Pay Yearly Each child 18 and under pays $ 2 8 0 * 2 8
C ity_______ Age__________
.State-
_Zone_
.C o un ty.
Dateof Birth.
. Relationship. Day
Occupation. Beneficiary.
.Height.
-Weight.
Ialsoapplyforcoverageforthemembersof myfamilylistedbelow: NAME AGE HEIGHT
Each adult 19-64 pays
* 3 « o
WEIGHT
BENEFICIARY
* 3 8
Each adult 65-100 pays
* 5 9 0
Tothe bestof your knowledgeandbelief, areyouandall memberslistedaboveingoodhealth andfreefromanyphysical impairment, ordisease? Yes Q No p To the besf of your knowledge, have youor any member above listedhadmedical advice or treatment, or haveyouortheybeenadvisedtohaveasurgical operationinthelastfiveyears? Yes □ No □ If so, please give details stating person affected, cause, date, name and addressof attendingphysician, andwhether fullyrecovered.
* 5 9
SAVE TWO MONTHS PREMIUM BY PAYIN6 YEARLY! Mail this application with your first premium to AMERICAN TEMPERANCE AS OCIATES Box 131, Libertyville, Illinois
Neither I noranyperson listedabove uses tobacco or alcoholic beverages, and I herebyapply for a policy based on the understanding that the policy does not cover conditions originating priorto itseffectivedate, andihat thepolicyis issuedsolelyand entirely inrelianceuponthe writtenanswerstotheabovequestions. Date:------------------------------ Signed: X____________________
JANUARY, 1964
29
Made with FlippingBook Online newsletter