TEMPERANCE PUN .. EVENFORLIFE! Here at last is a new kind o f hospitalization plan for non-drinkers and non-smokers only! The rates are fantastica lly low because "p oo r r isk ” 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 w ill ever call! Starting from the very first day you enter any hosp ita l...
SEND FOR YOUR POLICY NOW BEFORE IT'S TOO LATE! 233 APPLICATION TO PIONEER LIFE INSURANCE COMPANY, ROCKFORD, ILLINOIS F O I A T-3 00
IMDrtDTAIJT.CHECKTABLEBELOWANOINCLUDEYOUR im r u iii An i . first premiumwith application LOOK AT THESE AMERICAN TEMPERANCE LOW RATES Pay Monthly Pay Yearly Each child 18 and under pays $280 * 2 8
AMERICAN TEMPERANCE HOSPITALIZATION POLICY Name (PLEASE PRINT)_________________________________________________________ Street or RD § _________________________________________________________________
.Zone .
- County_
.State-
City____________ Age-----------------------
Date of Birth.
Day -W eigh t.
Occupation. Beneficiary—
_Height_
. Relationship.
I also apply for coverage for the members of my family listed below: NAME AGE HEIGHT
Each adult 19-64 pays Each adult 65-100 pays
BENEFICIARY
WEIGHT
* 3 “
* 3 8
$ 5 »
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 □ 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.
* 5 9
SAVETWO MONTHS PREMIUM BY PAYIN6 YEARLY! Mail this application with your first premium to AMERICAN TEMPERANCE ASSOCIATES Box 131, Llbertyville, 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, andlhat the policy is issued solely and entirely in reliance upon the written answers to the above questions. Date:________________________ Signed: X _____________________________________
25
JUN E, 1963
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