Sunday Gazette-Mail from Charleston, West Virginia on September 10, 1972 · Page 155
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Sunday Gazette-Mail from Charleston, West Virginia · Page 155

Charleston, West Virginia
Issue Date:
Sunday, September 10, 1972
Page 155
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$1 no-risk Money-Back Guarantee When you receive your policy, look it over at your convenience. If you wish, show it to a trusted advisor - even your own insurance man. And then, if you are not completely satisfied with your policy, return it to us w i t h i n 30 days and we will p r o m p t l y refund your money with no questions asked. Union Fidelity Life is licensed by the State of WEST VIRGINIA NO SALESMAN WILL CALL ACT NOW! THE EXPIRATION DATE OF MIDNIGHT Sept. 20,1972 WILL NOT BE EXTENDED. GET YOUR APPLICATION AND $1 IN THE MAIL TODAY. USE HANDY POSTAGE PAID ENVELOPE INSIDE. UNION FIDELITY LIFE INSURANCE COMPANY, a subsidiary of Union Fidelity Corporation Philadelphia, Pa. 19102. 1 FORGET: check which Plan you wish to have $1000.00 A MONJH 219 218 IWMOOOSO (Please Print) MR. Name MRS. MISS OFFICIAL APPLICATION FORM TO' UN , ON HDELITY LIFE INSURANCE COMPANY PHILADELPHIA, PENNSYLVANIA 41852 44853 44854 _ Firu Middle Initial L a s t (If you are a married woman - use your own f i r s t name). ADDRESS CITY S t r e e t or R D. No STATE ZIP A G E . _SEX Male D Female D DATE OF BIRTH . Month Day Y e a r List all dependents to be covered under this Plan: (DO NOT include name that appears above Use separate sheet if necessary.) NAME (Please Print) 1. 2. 3. 4. 5. RELATIONSHIP SEX DA MONTH TE OF Bl |_ DAY 3TH |_ YEAR AGE D Check here if you want Coverage for your Children. D Check here if you want Coverage for your Children and Maternity Benefits. I hereby apply for Union Fidelity's Hospital Plan and am enclosing the first month's premium to cover myself and all others listed above. I understand that this Policy will become effective when issued. SIGNATURE UFA 7101 3 DATE Sign - Do not print S c ' p t . 20, 1972 © 1972 Union Fidelity L i f e Insurance Company 184 1 12 WV

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