Common use of SUPPLEMENTARY BENEFITS Clause in Contracts

SUPPLEMENTARY BENEFITS. a. For proposed Insured b. For spouse, children, Applicant for AWP Type and duration of benefit Amount Type and duration of benefit Amount $ $ ___________________________________________________________________________________________________________________________________ $ $ ___________________________________________________________________________________________________________________________________ $ $ ___________________________________________________________________________________________________________________________________ [ ] Option to Purchase Additional Ins. $ [ ] Applicant's Waiver of Premium benefit ----------------------------------------------------------------------------------------------------------------------------------- 12. State any special request.

SUPPLEMENTARY BENEFITS. a. For proposed Insured b. For spouse, children, Applicant for AWP Type and duration of benefit Amount Type and duration of benefit Amount $ $ ___________________________________________________________________________________________________________________________________ $ $ ___________________________________________________________________________________________________________________________________ $ $ ___________________________________________________________________________________________________________________________________ [ ] Option to Purchase Additional Ins. $ [ ] Applicant's Waiver of Premium benefit ----------------------------------------------------------------------------------------------------------------------------------- 12. State any special request.- -----------------------------------------------------------------------------------------------------------------------------------