Sunday Gazette-Mail from Charleston, West Virginia on July 16, 1972 · Page 163
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Sunday Gazette-Mail from Charleston, West Virginia · Page 163

Charleston, West Virginia
Issue Date:
Sunday, July 16, 1972
Page 163
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( R A M K l I N L I F E OFFICIAL ENROLLMENT FORM ·^···^··^················^··M APPLICATION TO NATIONAL-BEN FRANKLIN LIFE INSURANCE CORPORATION, CHICAGO, ILLINOIS ENROU W E N T ENDS MIDNIGHT JULV 19 1972 Please Print YOUR NAME. First Middle Initial Last .DATE OF BIRTH. ADDRESS. CITY (mo./day/yr.) .SOCIAL SECURITY NO.. _AGE. _STATE_ .ZIP CODE. List all dependents to be covered. Use separate sheet for additional children. NAME (PLEASE PRINT) DATE OF BIRTH (mo./day/yr.) NAME (PLEASE PRINT) DATE OF BIRTH (nWday/yr.) Child. Child. Child. Child. Child. 1 represent that neither I nor my spouse, if listed above, has been hospitalized due to sickness for a total of more than seven days in the last two years. 1 agree that il both husband and wife arc covered, the husband will be the Insured. I understand that coverage will take effect when the policy is issued. DATE. .SIGNATURE. 4801 NBL Please make check or money order payable to NBF Life. 40S8 This Policy Seri«» 5099 is available in all states where approved by the insurance deparUmm MIHyiBJflfflfrflj^Baja^^MB^FrtMBA^BBiB^^^MMKMMSBS^^MiMSjiii^M ·Florida r»«ld«nt« ptoax mall ·nrollnxm form to E. E. Htxra, Hgtnt. P.O. Bon 2475, Pm«acol». Flerida33054| 5 ? ^^!S5"5!H!!' x ^!S?^^^P^5!^~ s ^!!^5^5P^^Sg5K!!5B^ DETACH AND KEEP WITH YOUR RECORDS YOUR-*1-BACK NO-RISK GUARANTEE Fill Out and Mail No-Risk Enrollment by July 19th with only *1°° to NATIONAL-BEN FRANKLIN LIFE Otpt 4058 360 West Jackson Blvd. Chicago, III. 60606 " ©cic If after reading your CASH/PLUS POLICY and showing it to a family advisor you feel it does not fit your needs for any rea- son-return the policy within 10 days of receipt and your $1 will be refunded promptly. There is no further obligation. National-Ben Franklin tif e Insurance Corporation IS A MEMBEB OF The Continental Corporation Established 1852

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