AFFORDABLE SICK AND ACCIDENT COVERAG
• PAYS when you are injured
IN ANY ACCIDENT
up to 18 mos. total disability.
$l,OOO per month
total up to
$lB,OOO
• PAYS when you are
SICK
$l,OOO per month up to 12 mo.
total up to
$12,000
* PAYS medical benefits for injury
at home or doctors office
up to $lOO
• PAYS for ACCIDENTAL DEATH
$lO,OOO to your beneficiary
THIS POLICY PAYS YOU REGARDLESS OF WHAT YOU
COLLECT FROM ANYOTHER INSURANCE,
WORKMANS COMPENSATION OR MEDICARE PLAN!
Your policy contains these exclusions: (1) in any part of the world except the United States of America, the District of Columbia,
Alaska, Hawaii, Mexico or the Dominion of Canada; (2) while engaged in military or naval service of any country, or resulting
from war or any act of war; (3) as the result of any mental or functional nervous disorders; (4) as the result of suicide or any
attempt thereat; (5) Normal Pregnancy, Childbirth or Miscarriage; (6) Any loss resulting from hernia shall be considered as a
sickness within the meaning of this policy; (7) as the result of an accident occurring in consequence of riding as a passenger or
otherwise in any vehicle or device for aerial navigation, except as a fare paying passenger; (8) any premium paid to the
Company for any period wherein it is terminated by reason of the Insured’s entering the military or naval service of any country
will be returned pro rata to the Insured upon request.
The policy may be renewed, from term to term, by the payment of an annual, semi-annual, quarterly or monthly premium
as shown by the premium receipt, upon the consent of the Company evidenced by its acceptance of the premium.
Benefits are payable after the policy date.
This is an outline - Not a contract.
FOR MORE INFORMATION CALL TOLL FREE: 800-777-0490 or FAX 410-420-9339
Application Request Form
The Information you provide will be kept in strict confidence.
Name
Address
City
Date of Birth
AMOUNT OF MONTHLY BENEFIT DESIRED? $5OO $7OO $lOOO
Work Phone
Home Phone
Beneficiary Age
The best time to call is: O Morning O Afternoon O Evening (O Work o Home)
I wish to pay my premiums: O Annually O Semi-Annually O Monthly Bank Draft
Please send additional application for:
Name
Date of Birtl
Amount of Insurance Desired
FARMERS, SPOUSES AND EMPLOYEES
Residing in PA & DE
State
O Male
FOR
ADDITIONAL IMPORTANT FEATURES
OF THIS UNIQUE ACCIDENT POLICY!
No Waiting Period For Accidents!
Only A 7 Day Waiting Period For Illness!
Full 24 Hour Coverage - On Or Off The
Job
Pays Regardless Of Other Insurance,
Workmans Compensation, Or Medicare
Plan
Prompt, Courteous, Claim Service.
Zip
O Female
UNDERWRITTEN BY:
NATIONAL SAFETY LIFE
INSURANCE COMPANY
A Member of the Philanthropic
Insurance Companies
170 W. Germantown Pike
Suite C-1
Norristown, PA 19401
For Additional Information On These
Please Check
Almost Guarantee Issue Life
Ist Day All Accident Disability
Affordable Cancer Coverage
Affordable Hospital Indemnity
E