Prohibited Risks: Citizens of Chicago, members of the theatrical profession, students of co-educational colleges, naval heroes, and summer girls are not eligible to membership, and their applications will not be considered by this company.
Applicants must answer truthfully and without evasion the following questions:
State name, including all nicknames or pet names used during the love to be insured.
How long have you been in love?
Was it love at first sight?
Are you (1) handsome, (2) good-looking, or (3) plain?
Are you susceptible to flattery?
Are you of a jealous disposition?
Have you ever had Heart-disease? Palpitation? Melancholia? Lover-complaint? Blues? Heart-failure?
What is your occupation? (Specify this definitely. If a business man, state if lady typewriters are employed, and if so, how many and of what appearance. Append photographs if possible.)