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TEMPERANCE PLAN .. EVEN FOR LIFE! 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...
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SEND FOR YOUR POLICY NOW BEFORE IT'S TOO LATE!
IMDftDTAMT.CHECK TABLE BELOWAND INCLUDEYOUR i m r u n i A n i . first premium with application LOOK AT THESE AMERICAN TEMPERANCE LOW RATES P a y M o n th ly P a y Y e a rly
1017 APPLICATION TO PIONEER LIFE INSURANCE COMPANY, ROCKFORD, ILLINOIS f o b 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___________________________________ » Relationship___________________ I also apply for coverage for the members of my family listed below: NAME AGE HEIGHT WEIGHT BENEFICIARY J._____________________________ ________________________________ 2 . J .______________________________________________________________________ 4, ________________ ____________________________________ _________________ ‘ 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 Q No □ To the best 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.
Each c hild 18 a n d u n d e r p a ys
$ 2 8 0
* 2 8
Each a d u lt 19-64 p a ys
* 3 “
* 3 8
Each a d u lt 6 5 -1 0 0 p a ys
$ 5 9 0
* 5 9
SAVE TWO MONTHS PREMIUM BY PAYIN6 YEARLY! Mail this application with your first premium to
AMERICAN TEMPERANCE ASSOCIATES
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, amPthat the policy is issued solely and entirely in reliance upon the written answers to the above questions. Date:________________________ Signed: X _____ _______________ AT1AT
Box 131, Libertyville, Illinois
31
MARCH, 1964
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