This Policy Witnesseth that Pursuant to the
The Government of Canada hereby insures the life of (hereinafter called the insured) subject to the following terms, provisions and conditions:
Plan — Life — Premiums payable
Amount of Insurance
Upon receipt of satisfactory proof of death of the insured and discharge of this contract.
How and to whom payable
(a) Payable at deathDollars as follows:
Toof the insured,
Toof the insured,
(b) Remainder ofDollars as follows:
Toof the insured,
Dollars to be applied to purchase an annuity
Toof the insured,
Dollars to be applied to purchase an annuity
An interim premium ofDollars andcents may be payable on or before the date of this policy. Monthly premiums ofDollars andcents each shall be due and payable on the first day of each month in every year during the continuance of this contract until the premiums forpolicy years shall have been paid, after which no further premiums shall be required. The policy years and policy anniversaries shall be computed from the first day of19while this policy is in force.
This policy is issued in consideration of the application herefor and of the payment of the premiums as provided herein and is subject to the provisions and conditions hereinafter set forth including the endorsements hereon or attached hereto and to the provisions of the said Act and any amendments thereto and regulations made thereunder, as fully as if the same were written above the signatures hereto set.
Signed at the City of Ottawa, in the Province of Ontario, thisday of19
Provisions and Conditions
This policy is subject to the provisions of the Veterans Insurance Act, including any amendments thereto and regulations made thereunder, and, together with the application herefor and any endorsements hereon or attached hereto, constitutes the contract between the parties hereto.
2 Payment of premiums
All premiums are payable on or before their due dates to the Receiver General and may be sent to the Chief Treasury Officer of the Department of Veterans Affairs, Ottawa, Canada. Premiums may be paid monthly, quarterly, semi-annually or annually in advance but to effect a change in the frequency of premium payment, written request therefor must be made to the Superintendent of Veterans Insurance, Ottawa. Except as expressly provided herein, the payment of a premium shall not maintain the policy in force beyond the due date of the next premium.
A grace period of one month shall be allowed for the payment of any premium after the first, without interest charge, during which period the policy shall continue in force, but, if the insured dies during such period, the premium, if then unpaid, shall be deducted from the insurance money payable hereunder, provided, however, that the grace period shall not apply when the only premium that has been paid is an interim premium for a period of less than one month.
For the purpose of determining the premium payable hereunder, the age of the insured shall be taken at the birthday of the insured nearest to the date of this policy. Proof of age satisfactory to the Minister shall be furnished before any payment of insurance money is made hereunder. If the age of the insured has been understated, the amount of insurance and every benefit provided hereunder shall be such as the premium paid would have purchased at the correct age. If the age has been overstated, the excess premiums paid shall be refunded.
The statements made by the insured in the application for this policy shall, except in the case of fraud or error of age, be accepted as true and incontestable after the policy has been in force, during the lifetime of the insured, for a period of one year from the date hereof. All statements made in the said application shall, in the absence of fraud, be deemed representations and not warranties.
6 Residence, travel and occupation
This policy is free of all restrictions as to residence, travel and occupation, including military, naval and air service.
7 Change of (a) beneficiary, (b) apportionment and (c) mode of payment of insurance money
The insured may at any time change the beneficiary or beneficiaries, or the contingent beneficiary or contingent beneficiaries, theretofore designated, or the apportionment of the insurance money among them, or the mode of payment of the insurance money, all in conformity with the provisions of the Veterans Insurance Act in that behalf.
Any change as aforesaid shall be made by declaration of the insured in duplicate on forms to be supplied by the Superintendent of Veterans Insurance on request. (Both copies of the declaration shall be returned to the said Superintendent, together with this policy of endorsement, after which the policy will be returned to the insured). Provided, however, that after the death of the insured the Minister may accept any instrument, writing or document appearing to him to be a bona fide expression of intention of the insured to effect a change as aforesaid, in which event payment in accordance therewith shall be in full and final settlement of all liability under this policy.
In the event of the self-destruction of the insured, whether sane or insane, within one year after the date hereof, this policy shall be void and no part of the amount of insurance shall be paid but there shall nevertheless be returned to the beneficiary or beneficiaries, in proportion to their interests hereunder, the premiums actually paid, without interest.
If, before attaining the age of 60 years and before default in the payment of any premium hereunder (or, in the event of default, not later than the end of the period of grace), the insured becomes totally and permanently disabled so that he is thereby rendered incapable of pursuing any substantially gainful occupation, and if such disability is not deemed to be attributable to his service to such an extent as to entitle him to pension on the grounds of total disability under the Pension Act, the premiums thereafter falling due under this policy, during the continuance of such disability, shall be waived; provided, however, that premiums shall not be waived where such disability commenced prior to the date of the policy, and provided further that the insured shall be deemed to be totally and permanently disabled where his total disability has existed continuously for at least one year. The insurance money payable under any settlement of this policy shall not be reduced because of any premiums waived under this provision.
10 Proof of disability
Proof of disability shall be furnished to the satisfaction of the Minister before any premium will be waived hereunder. If the insured makes application for the disability benefit, he shall be examined by such physician as may be named for that purpose by the Minister. (The fee of the physician shall be paid by the insured). If the physician is satisfied that the insured is totally disabled and incapable of pursuing continuously any substantially gainful occupation, and that it is unlikely that he will at any time recover in whole or in part from such disability and incapacity, he shall so certify. Notwithstanding such certification, however, the Minister may submit the report for review to the Director of Medical Services of the Department of Veterans Affairs or to such other medical adviser as may be named by the Minister for that purpose, and he may require the insured to be examined by another physician; and in determining whether proof of disability as aforesaid has been established, the Minister shall take into account not only the said report or reports, but all other information available to him.
Notwithstanding that proof of total and permanent disability may have been accepted by the Minister, he may at any time require proof of the continuance of such disability to be established, and if such proof is not furnished to the satisfaction of the Minister, all premiums thereafter falling due shall be payable by the insured.
11 Cash surrender value
There shall be payable to the insured, where the Superintendent is satisfied as to the circumstances of the case, a cash surrender value based on the policy reserve on the British Offices Life Tables, Om (5), with interest at 3 1/2 per cent per annum, where
(a) the policy has been in force at least two years and premiums have been paid for at least two years;
(b) a written application therefor is made to the Superintendent by the insured and by the beneficiary or beneficiaries, unless the whereabouts of such beneficiary or beneficiaries are unknown to, or cannot, after a search satisfactory to the Superintendent, be ascertained by the insured; and
(c) the policy is returned to the Superintendent for cancellation and retention.
The cash surrender value payable within three months after the due date of the first premium in default, if any, shall be the reserve on the policy at the said date and at all other times shall be the reserve as at the date of surrender. Payment of the said cash value shall be in full and final settlement of all liability hereunder. Specimen cash values in accordance with this provision are shown in the table of guaranteed values below.
12 Reduced paid-up insurance
At any time after this policy has been in force for two years (premiums having been paid for at least two full years) but not later than three months after the due date of the first premium in default, if any, the insured may, upon written application and upon return of this policy for endorsement be granted paid-up insurance for a reduced amount, which amount shall be such as the reserve on the policy as at the end of the period for which premiums have been paid will provide when applied as a net single premium at the then attained age of the insured. Specimen paid-up insurance values in accordance with this provision are shown in the table below.
13 Automatic extended term insurance
If, after this policy has been in force for two years (premiums having been paid for at least two full years), any premium due hereunder is not paid within the period of grace, the full amount of insurance shall, unless the cash surrender value or reduced paid-up insurance has been applied for under Provision 11 or 12, be automatically continued for such a period (disregarding fractional parts of a month) as the reserve on the policy as at the date on which the said premium fell due will provide when applied as a net single premium at the then attained age of the insured. Subject to Provision 14 hereof, all rights and liabilities under the policy shall terminate upon the expiration of the period herein provided for. Specimen periods of extended term insurance in accordance with this provision are shown in the table below.
In Accordance with Provisions 11, 12 and 13
PLAN AGE Number of full years in force VALUES AVAILABLE AT END OF YEAR Cash Value Paid-up Insurance Extended Term Insurance Years Months
The values shown in the above table are mathematically equivalent to the full net premium reserves on the bases of the British Offices Life Tables, Om (5), and interest at the rate of 3 1/2 per cent per annum.
The cash values and paid-up insurance values in the table are for an amount of insurance of $1,000 and apply pro rata to the amount of insurance stated on the first page hereof; the periods of extended term insurance remain the same for all amounts of insurance.
The values shown are those available at the end of the policy years indicated: values available during a policy year or for subsequent years will be computed on the same bases and will be furnished on request.
If any premium due hereunder is not paid within the period of grace, and if the cash surrender value or reduced paid-up insurance has not been granted, the insured may, with the consent of the Minister and subject to such evidence of insurability as the Minister may require, reinstate the policy in full force at any time within five years from the due date of the first premium in default by payment of the arrears of premiums with interest at the rate of five per cent per annum compounded annually.
15 Policy unassignable
The insurance money payable under this policy shall be unassignable and shall not be subject to the claims of creditors of the insured or of the beneficiary. Any attempted dealing with such money by pledge, assignment or otherwise will be disregarded as null and void.
16 Payment of insurance money
The amount of insurance provided hereunder shall become payable in the manner stated on the first page hereof upon receipt of the satisfactory proof of the death of the insured and upon discharge of this contract. The total payments to be made at death under this policy and all other policies, if any, issued to the insured and in force under the Veterans Insurance Act shall not exceed the total amount of insurance stated therein, or $2,000, whichever is the lesser. The remainder, if any, of the insurance money, or the portion thereof to which any beneficiary is entitled, shall be payable in instalments as an annuity; provided, however, that where the insurance money remaining to be paid as an annuity to any beneficiary is $1,000 or less, the Minister may, upon the request of the said beneficiary, direct that such money shall be paid in such manner and in such amounts, including payment in a lump sum, as the Minister may consider appropriate.
The mode of payment of the insurance money stated on the first page hereof is that elected by the insured in his application but may be varied by declaration of the insured in the manner set out in Provision 7 hereof, or may after the death of the insured be varied by the beneficiary with the consent of the Minister. Alternative modes of payment of insurance money as an annuity are shown in Tables A and B below. Annuities may be made payable quarterly, semi-annually or annually, commencing 3, 6 or 12 months after the date of death of the insured. Annuities payable annually are shown in Table B but the corresponding annuities payable quarterly or semi-annually will be computed according to the same bases and principles and will be furnished on request to the Superintendent of Veterans Insurance.
Payment to beneficiary which $1,000 of insurance money will purchase as an annuity certain for the terms shown below. Payments for an amount of insurance money greater or smaller than $1,000 will be proportionate.
|Frequency of Payment||Term|
|5 years||10 years||15 years||20 years|
Annual payment to beneficiary which $1,000 of insurance money will purchase as a life annuity or as a life annuity guaranteed for the terms shown below and as long thereafter as the beneficiary may live. Payments for an amount of insurance money greater or smaller than $1,000 will be proportionate.
|Age of beneficiary as at birthday nearest to date of death of insured||Annual payment as an annuity for life||Annual payment as an annuity for life, guaranteed for|
|Male||Female||5 years||10 years||15 years||20 years|
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