This section is from the book "The Law Of Contracts", by William Herbert Page. Also available from Amazon: Commercial Contracts: A Practical Guide to Deals, Contracts, Agreements and Promises.
Amount $--------. Age ---------.
THE X. Y. INSURANCE COMPANY OF --------- [name of State]
In consideration of -------- dollars, receipt of which is hereby acknowledged, and of the payment of --------- [here insert amounts and times of payments of premiums] until --------- [insert "the death of the insured" in ordinary life, and
"--------- full years' premiums shall have been paid or until the prior death of the insured" in limited payment life].
[insert "his" or "her"] executors, administrators or assigns, with--------- [insert
"out" if so desired] right of revocation, if --------- [insert "he" or "she"] survives the insured, otherwise to the executors., administrators or assigns of the insured, the first instalment being payable immediately upon receipt of due proof of the death of the insured, and indebtedness to the company on this policy, together with the balance, if any, of the then current year's premium, being deducted from, the amounts first payable under this contract.
Should the beneficiary live to receive the twenty instalments payable to
--------- [insert "him" or "her"] as above provided, the company will pay ---------
[insert "him" or "her"] annually, during the remainder of --------- [insert "hie" or "her"] life, the sum of $--------, beginning one year after the date when the twentieth instalment payable hereunder shall fall due.
Change of Beneficiary. - When the right of revocation has been reserved, or in case of the death of any beneficiary under either a revocable or irrevocable designation, the insured, subject to any existing assignment of the policy, may designate a new beneficiary with or without reserving the right of revocation by filing written notice thereof at the home office of the company, accompanied by the policy for suitable endorsement thereon. If any beneficiary shall die before the insured and the insured shall not have designated a new beneficiary, the interest of such beneficiary shall be payable to the insured, --------- [insert
"his" or "her"] executors, administrators or assigns. If a new beneficiary shall be designated only twenty annual instalments will be payable under this policy, and further --------- [if necessary, insert "semi" or "quarter"] annual premiums will be reduced to --------- dollars each.
Upon return of this policy to the company, accompanied by evidence satisfactory to the company of the death of the beneficiary, the company will reduce the future --------- [here insert "annual," "semi-annual" or "quarterly" premiums to $---------each.
Except as herein provided the payment of a premium or instalment thereof shall not maintain the policy in force beyond the date when the next premium or instalment thereof is payable.
All premiums are payable in advance at said home office, or to an agent of the company upon delivery of a receipt signed by one or more of the following officers of the company--------- [insert titles of officers who may sign receipts], and countersigned by said agent.
A grace of one month subject to an interest charge at the rate of --------per centum per annum shall be granted for the payment of every premium after the first, during which month the insurance shall continue in force. If the insured shall die during the month of grace, the overdue premium will be deducted from any amount payable hereon in any settlement hereunder.
Conditions. - (The policy may here provide for restrictions of liability by reason of travel, occupation, change of residence and suicide. These restrictions, except such' as refer to military and naval service in time of war, must be applicable only to cases where the act of the insured provided against occurs within two years after the issuance of the policy.)
Incontestability. - This policy constitutes the entire contract between the parties and shall be incontestable from its date, except for non-payment of premiums and except as otherwise provided in this policy. All statements made by the insured shall, in the absence of fraud, be deemed representations and not warranties, and no such statement shall avoid this policy unless it is contained in a written application and a copy of such application shall be endorsed upon or attached to this policy when issued.
If the age of the insured has been understated, or if the age of the beneficiary has been overstated the amount payable hereunder shall be such as the premium paid would have purchased at the correct age.
Participation, - This policy shall participate in the surplus of the company and beginning not later than the end of the --------- [insert first, second or third] policy year the company will annually determine and account for the portion of divisible surplus accruing hereon.
Dividends. - Dividends at the option of the owner of this policy shall, on the --------- day of --------- of each year --------- [here may be inserted "after the first policy year" or "after the second policy year"] be either:
1. Paid in cash, or
2. Applied toward the payment of any premium or premiums, or
3. Applied to the purchase of paid-up additions to the policy, payable in twenty annual instalments at the same times as the original amount insured under this policy is payable. The payment of such twenty instalments shall discharge the company from all liability on account of such dividend additions, or
4. Left to accumulate to the credit of the policy with interest at ---------
There insert a rate not exceeding that used by the company in calculating its reserves] per centum per annum and payable at the maturity of the policy, but withdrawable on any anniversary of the policy.
Unless the owner of this policy shall elect otherwise, within three months after mailing by the company of a written notice requiring such election, the dividends shall be paid in cash.