Allot Clause Samples
Allot. 16. Amount paid $ [ ] None (Must be "None" if either 14a or b is answered "Yes".) ----------------------------------------------------------------------------------------------------------------------------------- 17. Is a medical examination to be made on: Yes No a. the proposed Insured? ......................................................................................... [ ] [ ] b. spouse (if proposed for coverage)? ............................................................................ [ ] [ ] ----------------------------------------------------------------------------------------------------------------------------------- 18. If 17a or b is "Yes", is it agreed that no insurance will take effect on anyone proposed for coverage until Yes No the person(s) indicated in 17 have been examined, even if 16 shows that an amount has been paid? ...
Allot. Amount paid $468.00 [ ] None (Must be "None" if either 17a or 17b is answered "Yes".) - -----------------------------------------------------------------------------------------------------------------------------------
Allot. 19. Amount paid $208.00 [ ] None (Must be "None" if either 17a or 17b is answered "Yes".) ----------------------------------------------------------------------------------------------------------------------------------- 20. Is a medical examination to be made on Yes No a. the proposed Insured?.......................................................................................... [ ] [X] b. spouse (if proposed for coverage)? ............................................................................ [ ] [ ] ----------------------------------------------------------------------------------------------------------------------------------- 21. If 20a or 20b is "Yes", is it agreed that no insurance will take effect on anyone proposed for coverage until Yes No the person(s) indicated in 20 have been examined, even if 19 shows that an amount has been paid? ................. [ ] [ ] ----------------------------------------------------------------------------------------------------------------------------------- 22. Changes made by the Company ----------------------------------------------------------------------------------------------------------------------------------- ▇▇▇ ▇▇▇▇▇-▇▇ Page 1 (Continued on page 2)
Allot. 19. Amount paid $468.00 [ ] None (Must be "None" if either 17a or 17b is answered "Yes".) - ----------------------------------------------------------------------------------------------------------------------------------- 20. Is a medical examination to be made on a. the proposed Insured?............................................... Yes [ ] No [X] b. spouse (if proposed for coverage)? ...............................