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�CKL e/t
_ PREMIUM NOTE SYSTEM.
THE LONDON
i
'Cutaal �iye �innrigr� o.
OF CANADA. i
va Ralthia of ove. v:: you mw�
no.&m ,v VaY :^utiw o:6z:voMint o:o 1 n: Yrs
a m vem .hese 4 uwy oe nr
inei; �o
cunnmo.sovo.,.:�:o E SECRETlJY,
rv.o. Cl Con.,..,
wo
pmg expiresaf.. .z88,?
P�
Gam. Com. NI,
an dl ev:wNxa th. µlryy in mb,... and, If, loan be Me1pllaWna sfwLj b, nwI-I n hu of fe avu baby in �ahh III A
.nfarab,
.1 �llrnY �Y an '"[ped im&ewtlnin olmumnnnnne y be ep binllY ...sweat Igyho BI Of])I... nn bm
egWmi, 11, be by ^pplyine m me sartNry.
gni ®mus $senCvwl, hereby transfer, assign, and set over aceto
_.... _.. and...... assigns all .......... ..............
right, title and interest in fls Policy of I sarance, and all bear and advantage to he derived
fans the same being en consideration of" ._... _. ......._
-....hand, thw I _._.day of _..___r83
D'Wofll 1111 o n. n n m1i
n eui rot 11 11111 to me ymbplo-n a o" inn, neem to rte "ammo ...b" aye Mn pms, bm than
siclag I In pon. V any I
tion an no
¢ia110 fllrymnu fee wwE bn nv111bd witonMe b,,rr,
file ZOudon Mutual giro jnsuraneq fmpant/ of panda hereby consent that
IG,, interest of — __. __. _.__ian the imilhin Polity,be
assoped to _... .__ — _subject, neoerlhedess, to all the conditions
thercin contained,
Secretmry.
lbs SURRENDER.
1fy0_ 40 IlioIredare a� thogndonulnnitrg 'neurnngp,omwmg ^flmndu,
1, P4 Having alienated died sold cud all -- ---right, Lille and weerast, in and m tilt
insur d by the tudhat Polwy tc I 1,.,..11 1
`T h rebs smander Ike same, ane? request that the Policy be cancelled
Given undo .__hand, taus _..... ........day qI .....188
tery d ytee of dbe aboveI ,alga be be .. .... .....
correag actoding 10 lay L,am(Mge
r11 t;
NUMBERRod �11
--
{{nuLures
y _ -
�'GG
Esrneusaea INr6s9 noe Over Damwrov Mance. OF CANADA.
IPR MIUM NOTE SYSTEM.
$}� 11c10 33clic j ;F)K671y[Iftee�ndn consideration J a D „M,; c� .-_ �in.U_.. �'. na��aR>.pp"byys�ara Cautious) ,ate;.de,
DO INSORt.
I rxd ro`.,,Yhip 1/ ��- 20 � :n ria� canary, / uv _and Province Of
.J�r..Iv�u.Rr / Dollars, on tlfe jollouling Proyerty, to Full:
agn,nse loss or dsann ��1
22),, fue or ]7;: lg to rLe aveonnt of Vw��
�� —
Y L N/n(L�._ '✓✓swPlt. r' n _.. 'd
Ysithond
�i'. /✓ T �(N..r ,y yj, I.,aaPeo:. a r Wt hT.
mtewo N- of Campbell. Ivnng they lu�ofY ElasY
.the 2y a pea / isx 3 1 I»
ked
W 1 tN �- Y•"+ B Y bn Ad I T yn ll lne d M m
og
bel—
ad the stirl ai y nJ 'I - m m I u P 1 1 Tn al t an
in III. W 9 1 OF o"IfF. of 1 Wl aPY^ to wa 91111a WF Nmn/u lam" P Id pw w Nu ereto hu[.a
la le ¢[®Wrennlin6 ke 1 ' npe ) 1 m+::e aha➢ oind OFF ad IN P d ntne afln FOR le Pule the on v,dm RE h a of tMvmdtann nPMulN h
OF doxyl I.Y. diva 11 LI Idl do Tapperm
3t is Agreed, 11 U P a p.l nl a.to, rVNR lq the � PhnaYmntaidd e:wnMq awlbthe PmvW f dd mnFwxwoNdtoth In'Ul mlady Afvtaa
AsaanoeeAmwMadG 1 vena '4 CI a.:mmCmW4lwnl.n the 9letSadlhe.'ngnaf 11 6hP+tY• ^ mow Nd to the vanaYommmwlltlaati
ppa90. of the icu of thv Paau P^^'d d
prin - nlM oth IM n.. 1 1 Irm+rtea ettnl h 6 d v�aAomWtha On mnd Na m lthe oIX vehern
2 flatness 8��h f Tne�;m� f can Y is lYti her.>n.ln r�As melw,.sevl we rvnewlaaiavl memtpnte.ml fheNo. It on, a. >a.a:m. inw.Pmm.amoan.'a. on,
— —'.: STATUTORY CONDITIONS.
�l�o
, IINFROO m,nxma._
At I do,
IF _ 1��_ n �....Ii .e., m...,.. h a id;2= on N Fly Nowi,a....awaa ..,..ph.. on _tt..
w I
4'
®.:
In to, 1416
I. I Opond OR IF rb .1 ad I. IF Wind low I IF key F,N Cynd nown OF Fred I
1
. Win IF OR IF den OF, OFF FOR d! and Food andow do
1.beyond
known .14
do by, ownew by IN
v�X�
_,.,....� IF
R Yys r+m. �
wh
n.
don
!fit n m..,. o J
ow. I Fly(do
....c .v m� Y "I
� e� ..
:e Ink 44
NI non he doppoodyallyd y. ......m
1.. bybad LOR
Mbibioneb
Nowdedy
;OFF
,IF1 FNo
�1
x•Mv.n
'
h
I.
aimn�
; 1.11,01111.e in.
So .s
veI.mv
..
{ Iwi^glcvi..'.j
OR FOR I®
OR .r
e.t.a, w...�......,.n.r..t.:..m
.y:
„e....,.'IF �_.Y M.pai now-FA.e P,:l..a ...°e. nd4l a W.,. w
�... �.
VARTATION3 IN (bONDITIONS.
This Policy issued on the above Statutory Conditions, with the following variations and additions. - Z
Thesevariation and addition , by virtue athe Ontario Statute in that behalf, in force so far as by the Court or Judo before whom a question is tried
relating thereto, they shall be held to "Depth and reasonable totbe exacted by the Company.
neaVot, ins, wo .11 towns -1 W ool�ot oi '111� a no ration so"notr "it" " "' "' Aw
xr lot so conot,.nu,mu..o L Wt. c. be anToni)....Init v a o.em v woora to soRia and m.nm