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? ...
Appears in 3 contracts
Sources: Life Insurance Application (Pruco Life Variable Insurance Account), Life Insurance Application (Pruco Life of New Jersey Variable Insurance Account), Life Insurance Application (Prudential Variable Appreciable Account)
Allot. 16. Amount paid $ [ ] None (Must be "None" if either 14a 17a or b 17b is answered "Yes".) ----------------------------------------------------------------------------------------------------------------------------------- 1720. Is a medical examination to be made on: on Yes No a. the proposed Insured? ......................................................................................... [ ] [ ] b. spouse (if proposed for coverage)? ............................................................................ [ ] [ ] ----------------------------------------------------------------------------------------------------------------------------------- 1821. If 17a 20a or b 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 17 20 have been examined, even if 16 19 shows that an amount has been paid? .............
Appears in 1 contract
Sources: Application for Life Insurance (Pruco Life Variable Insurance Account)
Allot. 16. Amount paid $ [ ] None (Must be "None" if either 14a 17a or b 17b is answered "Yes".) ----------------------------------------------------------------------------------------------------------------------------------- 1720. Is a medical examination to be made on: on Yes No a. the proposed Insured? ......................................................................................... .................................................. [ ] [ ] b. spouse (if proposed for coverage)? ............................................................................ ..................................... [ ] [ ] ----------------------------------------------------------------------------------------------------------------------------------- 1821. If 17a 20a or b 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 17 20 have been examined, even if 16 19 shows that an amount has been paid? ...
Appears in 1 contract
Sources: Application for Life Insurance (Pruco Life Variable Insurance Account)