Other formats

    Adobe Portable Document Format file (facsimile images)   TEI XML file   ePub eBook file  


    mail icontwitter iconBlogspot iconrss icon

The Pamphlet Collection of Sir Robert Stout: Volume 20


page 19


Form of Declaration to be indorsed on Contract for Life Assurance, where same is effected for the Benefit of the Wife, or of the Wife and Children, or of the Children or any Child of the Assured, under Section 8 of the Act of 1870.

Know all men by these presents that the within contract of Assurance has been effected by me for the benefit of [*Here insert words designating the person or persons to take benefit].

In case the Assured intends to apportion the amount of Insurance money, add as follows:—

And I hereby declare that the amount insured by the said contract shall be apportioned as follows [Here insert proposed mode of apportionment].

As witness my hand and seal, this day of one thousand eight hundred and Signed, sealed and delivered by the above-named in the presence of


, The officer issuing the within contract.

* "My wife," or "my wife and children," or "my children by my present wife," or "my child a.b." [naming it], or otherwise as the case may require.