1111's ’1 11.131311 ,«
Compensation
Premiums
Fill Out Application Below, Cut Out and Mail t. the AETNA LIFE, Or Any of its Agents, and You Are ‘ - I l
~ l Protected from Date on Which Application is Received
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According to OpllllOIl Rendered by Attorney General Light '
The Go hecticut or? I ~* men’s Compensation Act
1 ~Belating to Employees Injured 1n the Course of Their Employment——
,4
Even If You Employ Only One Servant or Farm Worker
Part 01' Whole Time ~
~ The very full sewerage given for $7 .50 a. your will be sifffioletit for most householders employing domestic servants. IfI
‘ it is not enough 111 your one 9, you can easily figure out the remainder of your premium .
'. It 1s just as easy for the farmer to tell what his insuranoe Wiiiwcosnhlm if he employs more help than 18 covered by the
$9. 90 premium, or it he desires to protect himself also against acc dents to the public on his property
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II I II .:I II I . . II . 2. .1 le 1» A fit III -1 I‘III. “I‘ 1,1";11‘ :i Fin «I ,»I _ 1 g 1 11,. “1 ,
Apphcahon For Workmen 3 Compensation For i! i Amcafiofi F01 W01 kmen 8 Compensation F0?
‘ r 1 Private Residence --Not Farm ‘ ’ ‘ 1 ’ ' 1‘3““ nlncludmg Residence
in i. . ; 11- , I
V A 111111211. .
.Annnnl I , Premium
. llremmm . . . . . ,
lnsuhamc bxoviding‘ Compensation for ' ' y . I “‘SWRIWC providing (AN‘IPWSRU’N 1"“ ' ,
A Regular INDOOR SERVA Nils (not more than two) _. II ,. é . ii A. Regular 1- 11110) see (not more than two) , . ‘
l’ A1 LL (Eligidfirl‘edflfLP (2:1; 35 ““3 dmssmakor GONNA” “3 “0”" ”1 1h" [j 'i * ‘“ " All occasional help employed during the yo: 1r costing not slow than $9.90 ‘
((Jlieypart time indoor sei’vlnt giving you not more than a third at his $$7 5,9 I '1 ' $1325 111 names or in wages and board} hoard. if furnished. to ho: ral—
or her time (Mich as the nan who comes moan) to attend 10 Your ,' . tr. . . ‘ ‘ .culatcd “t ""Mhml “35h Wages)
lunmcc or the laundrcss who works aday or two a “recidI . 1 Number
And also . ' Employed ADDITIONAL COVERAGE
l) l’iotcctil you against your legal liability for AIL‘LlDl‘NiS 11‘“ ””5 z . . . ~ .
l’lll’l 1%- in and about your premises. ‘ . .. . . . . ..Atl’lllmnal rdvnlar help. not house servants ............ at $113.00 null 31
Number ’ ........ Additional regular house servants ‘ ..................... at $1.?“ earl: it;
limployctl ADDITIONAL SERVANTS. \A'nges paid (including hun‘d. if furnished) for occasional
. Additional indoor scrvan is (in excess of two). ....... at $1.50 rash :5 help in excess of $325
I > . ......... ‘Hlditioual partition: indoor servants (in excess of one) ‘ ' Estimmd at $ ........................ at $1.211 per $10.13
, giving you not more than a third of their time . ..... at 0.50 each 5 1 i not? . ‘ ‘1»
........ Outdoorscrvants(sucl1ascoachmco,slhiflememgsrden« _, _ ........l.1a m“'""""""""""""""”""'"matWommm‘
1 i ers and helpers"). ......................... . ..... at 3.01) each :5 ' . 1 1 Protection 3831““ “mam“ ‘0 the public (“PW 1
. ‘ ........ Patbtime mitdoor servants (Wk as the am who comes , , other than your employccsl on fmm. including reei I ‘
l (‘I t; attend to your lawn) ........ ..I. ...... , ......... at $1.00 each $ drum hams and all outbuildings ............... . ......... :11 $3.011
........ Jan curs at 101m cach$ Admifiycymtsperaen-forall acreageiiiexccssuf
A Total Annual Premium .......... . . . .. 5 first” Acres .311 “W cents ----- ' 1 1 ------- ’ -------------------------- . ------ 1‘5
I Name of Employer ............ . ..... ...... ........ . ......................................... i h $
. 1 “minor; .............. . ...... . . . ................. . ....................... 1 ................... i . , 1- .--.
- Address....m... ....... ........ ........................................ , . ‘ V .1
State whether one or two immly house or apartment ...... . . . ............ . ................... . 'l‘otnl Annual Premium IIIIII . IIIIIIIIIIIIII g,
Arvyouownorortmnt? ................ .. ...... .. ...... . . 1 ‘ . 1
on you desire quotation for Combination Residence l’olicy descrilxd heluwi. ..... Name of 15111910er ----- 1 ' - 1 ~ ------ - -----------------------------------------
if g “I*‘I‘heCompsmnonhuMIxxcgrmudhrtflsmthcfidumaodwmdum Address.. ............... ....1 .. ..... . ......................... 1
1' WM“: °" Wm mm W” Cm 31112187.“ Total Acres. 1:: (. . . . . .. .cultivated. . . . . .. .not initiated) ...... . ...........................
I1 first“: Water Damage Lou-oi Us. and FM: W111 111mm“. Wrist fir W particu- _ a] g 1 , ' '
.1 “1 Princip crop .......................
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. A IKPOBTAflTwFiil out and mail oneof the shove appliostions to
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Norwalk Chronicler