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 ITS TOO LATE!
I M D n D T A M T . CHECK TABLE BELOW AND INCLUDE YOUR i m r u n i a n i . oust premium w ith application LOOK AT THESE AMERICAN TEMPERANCE LOW RATES Pay Monthly Pay Yearly
443 APPLICATION TO PIONEER LIFE INSURANCE COMPANY, ROCKFORD, ILLINOIS FOB AT-300 AMERICAN TEMPERANCE HOSPITALIZATION POLICY Name (PLEASE PRINT)___________________________________________________________ Street or RD #___________________________________________________________________ City________________________________Zone_______ County_______ State______________ Age__________________ Date of Birth_______________________________________________ Month Day Yaar Occupation_____________________________________ Height_________ Weight____________ Beneficiary__________________________________ f ______ Relationship__________________ I also apply for coverage for the members of my fanfily listed below" NAME AGE HEIGHT WEIGHT BENEFICIARY T. 2 . — J.______________________________________________________________ To the best of your knowledge and belief, are you and all members listed above in good health and free from any physical impairment, or disease? Yes □ No Q To the besf of your knowledge, have you or any member above listed had medical advice or treatment, or have you or they been advised to have a surgical operation in the last five years? Yes □ No □ If so, please give details stating person affected, cause, date, name and address of attending physician, and whether fully recovered.
$280
Each child 18 and under pays
* 2 8
* 3 »
Each adult 19-64 pays
* 5 » * 5 9
Each adult 65-100 pays
SAVE TWOMONTHS PREMIUMBY PAYIN6YEARLY! Mail this application with your first premium to AMERICAN TEMPERANCE ASSOCIATES Box 131, Libertyville, Illinois
Neither I nor any person listed above uses tobacco or alcoholic beverages, and I hereby apply for a policy based on the understanding that the policy does not cover conditions originating prior to its effective date, andihat the policy is issued solely and entirely in reliance upon the written answers to the above questions. Date:_________________________ Signed: X_____________________ AT-1AT
29
NOVEMBER, 1963
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