Having chosen the insurance office or com- pany which best suits his purpose, the proposer applies to its nearest agent and makes known his desire to insure his life. A form containing printed queries somewhat like the following (though offices differ somewhat in details) will be placed before him and the blank spaces filled in either by the agent or himself. --------------------------------------------------------------------------------------------------------------------------------- | PROPOSAL FOR LIFE ASSURANCE | |-------------------------------------------------------------------------------------------------------------------------------| | | Full Name _____________________________________________________ | | | Profession or Occupation ______________________________________ | | 1. Life proposed to be Assured | Business Address ______________________________________________ | | | Residence _____________________________________________________ | | | Married or Single _____________________________________________ | | ------------------------------------------------------------------------------------------------------------------| | 2. Age next Birthday ________ years. Born at _________________________________________________________ | | on the ___________________________ day of _______________ in the year 18_________ | | (Evidence to be produced.) | | ------------------------------------------------------------------------------------------------------------------| | 3. Has he resided out of Europe? | | | If so, where, and for what period? | | | ------------------------------------------------------------------------------------------------------------------| | 4. Is he, and has he always been, of sober and | | | temperate habits? | | | ------------------------------------------------------------------------------------------------------------------| | 5. Has he had any serious illness or disease | |