Evening sentinel, Friday, January 9, 1914 · page 10

 

 

Householders
and Farmers

r

‘ Better Today Than Too Late

Figure Your ()Wn

Compensation
Premiums

 

 

 

F 111 Out Application Below, Cut Out and Mail to the AETNA LIFE, or Any of its Agents, and You Are

Protected from Date on Which Application is Received

 

 

 
 
 

4

According to Opinion Rendered by Attorney General Light

The Connecticut Workmen’s Compensation; Act

"Relating to Employees Injured in the Course of Their Employment“

APPLIES TO

Even Ii You Employ Only One Servant or Farm Worker

YOU

0

~ ' Part or Whole Time

The very full coverage given for $7.50 a year will be sufficient for most householders employing domestic servants.
it, is not enough in your case, you can easily figure. out the remainder of your premium.

It is just as eaSy for the farmer to tell what his insurance will cost him if he employs more help than is covered by the

$9.90 premium, or it he desires to protect himself also against accidents to the public on his property.

 

 
 
 

 

 

Application For Workmen’s Compensation For
1 Private Residence --Not Farm

,1\111111:11
I‘m-111111111
l11x111'1'1111 111'11111111111' 111111111'11151111111 1111
\. 1\'1-'g111.11'1\1)1)111\ 51'1\‘\ \\ 13 111111 111111'11111111111111)
....\1l 1 \Sll\1,111i1..1’ 15111111151111 1111s~111111111 11111111111111111111111111111
1111): 1111' 11111111111 11111'511. 1111'.)
1‘. ()111111;1r1~11111e 1111111111 5111111111 11111111441111 11111 111111‘1'1111111 21 1111111 «11 his
111'111'1'111111115111‘1133 1111- 1111111 111111 comes regularly 111 1111111111 111 111111'
11111111111 111‘ 1111- 12111111111191 111111 \1111'115~ 21 (1111' 111' 1111111 weeki

32357.50

.\111l:11\11
I), 1‘1'1111-1111111: 11111 :111'11i1151 _\11111‘ 11154111 1121111111} 1111' ,\1‘('|1)1-‘j.\"|‘.\' Ti 1 1111".
11111.1( 111 111111 111111111111111-111'111‘1115111.

.\'11111111-1'
1'11111111111'11

ADDITIONAL SERVANTS.

1\1l1liii1111;11 1111111111'5111'1'111115 (in excess of inn) 1.. . . .1.,.:1l 511.511 11:11'11 5‘1

“\11111111111111 1111114111111 1111111111 sei'vzuns (in excess 111' 1111111
11111111,; _\'1111 11111 11111111 1111111 211111111 111' their time ...... :11 11.511 each $
........ 111111111111' servant.» (such as 1t11111'11111e11. 5121111111111111. 1:211'111-11-1
111'.» :11111 1111111111111 ............ . ..................... :11 3.1111 1-111'11 .:
141..|’:11'1 111111-111111111111' servants (such :15 11111 1111111 who comes
111 :111111111 111 )11111' 1111111) .......................... :11 1111.11111111'11 iii
..1 11:1111111111's ........................................... :11 11111111 11111111 11"»
1111111 ,\111111:11 1’1'11111111111 ..................... 11';
Name 111. 15.11111111ye1' .............................................. . ...........................
11111111111151: ..‘, ...................... . .................... 1 .....................................
1\11111'1'1«s ......................................................................... .......
3111111 \11111-1l1111-11111- 111'111'11111111ily 1111111111 111'1111111'111111111 ........................... . . . ......... .
\1‘11 )'1111 111111111 111' 1111111111? ................................................... . ...... .
1M \‘1111 desire 111111111111111 1111‘ (‘11111111111111011 Residenei Policy 111 ~1'1'1111'1l 111111111'? ... . . . . . . ........

The Compensation insuranc e granted for this premium will be sold at an annual rate 01:54.50
\11 those holding or purchasing A ctna Combination Residence Policies covering Burglary. Glass

12231eakagc Water Damage Loss of Use and Public Liability Insurance. Write for further particu-
an;

 

Application For W orkmen’s Compensation For
Farm --Including Residence

\111111211

1‘1‘1'111111111
111511111111» 111'111'11111114‘ (“1111111111N1111111 1111'
1\. Regular 111111111151111~1 111111 11111111 1111111 1111111 _
‘ 1'1. \11 111‘1'11si1111211 1111111 11111111111111 11111'ing111e _\'11;11'1'11s11111;' 11111 111111'1' 1111111 $9.90
$3.15 in \\'.'11;'11~‘111‘ 111 \1':1j;1‘< (11111111111111, 1111111111. 11'1111'1115111-11, 111 1111 1';11--
‘ 111111111'11 :11 1111111111111 1':1~11 “111131141

\'1111111111‘
17.111111111111111 ADDITIONAL COVERAGE
._\111li111111:ll 1111;111:11'1111111, 11111 111111511 servants ............ :11 31.1111 1-;11'11 S
........ \11111111111111 regular l11111<11 servants ...................1.;11 $1.511 11:11'11 S
\\';1;1'1-~' [111111 11111111111111}; 1111:1111, 11 11111115111111) 1111' 111'1'11si1111111
1111111 111 excess 111 $335
112511111111111l.:11'$ ........................... :11 31.311111-1'5‘1111114‘1
........ (11:1111111'111's 11811101111111.1113;
Protection against accidents to 1111: public (anyone

111111'1'1111111your1111111105'1111s1 1111 1111111. 1111111111111: resi'
. I

 

 

 

 

1111111111. 111111111 :11111 1111 1111111111111111gs ......................... :11 513.1111 .
«\1111 live cents 11111' new 1111' :111 acreage in excess 111
live. .1\1'1'1's 111 live t‘t‘lllS ................. ' ................ ........... . .. .‘S
s
I
. V .-.
'I'1111'1l 1\111111‘:1l 1’1'11111111111 ..................... 31
“111111111 1C11111111y1'1' ................................. . ....................................... ..
.\11111'ess .................................................. . ............. ........... ..
T111111 .'\1'1'e;1g‘e 1‘ ........ 01111111311111 ........ 11111 cultivated) ..... . ............... . ..... . . .. .......
1’1'1111'1111111'1'1111 ........
l

[ETNA LIFE“ INSURANCE COMPAN 7
he Etna Accident and Liability Compan

IMPORTANT-—-~The COnne’cti‘cut' Compensation Act Effective Jan. «1, 1914. '

,1