IMG 5717 (2)
Image details
| Image format | |
|---|---|
| Year | |
| Original Source Organisation | |
| Original Source URL | |
| Article title | |
| Date | |
| Resolution | |
| Transcription |
Polic) Commencins District 18 Sept No. 12065 No. 9/2 Monday No. Weekiy Table Sum Pavable 1C Ipremium No. OOeath Dth ASUPEAS 23. 5 Res. Nos. of other First entry or additional F. E Assurances TUMSTALL AND DISTRICT ASSURANCE COLLECTING SOCIETV, STATION CHAMBERS, TUNSTALL. Proposal for Assurance on the Life of Another. (Over age 16). The Propaser is alone respansible for all the following information. 1. Name (in full) of Lite Proposed George Lowe 2. AOOTESSIM HII 41 St Kidsgrove Heatheole 3. Occupation Married or Single Married Miner Name (in tull of Proposer, if temale Surah Jane Lowe Mrs state whether Mrs. or Miss Address in Full as Above Relationship to lite proposed. Wife Are you under and oblisation to contribute to the Ct Tuneral Expenses (a) funeral expenses of the Life proposed to the extent of the sum to be assured or (6) what is the nature of your insurable interest in the Lite PPADOSEAI The Lite proposed 923 MONI RSCRCR Talke was bornat on 26 Birthday Juve 1897 Has any near relative of the Life proposed suffered from or died of consumption or any hereditary No A180as0] 1130. SIve Hll particulars. Proposal No. 4. 31 Foli0 in Collector's Book. 1/139 For use by Society Sonus Additions up to 31st Dec., 19 £ Oate of Enter 19 Sept 192 Date of Exit 24 Aug 1931 Cause of Exit Secession Cause of Oeath Vear of Maturity ACtvarial 1896 |
