Diary of Sir Arthur Hirtzel, 1906 [‎3r] (10/294)

Date
190
^ ~ ^ ^ —_—•*~~'*a
£1,000 USTSUJR^NCE COUPON.
The Insertion of this Coupon implies no liability on the patt of the Publishers.
All Claims and Connespondence relative thereto must be sent to the Chief Office of •
THE
LAW FIDELITY & GENERAL INSURANCE CORPORATION,
59 - 62 , CHANCERY LANE, LONDON, WC.
£ 1,000 —The sum of ONE THOUSAND POUNDS will be paid under the
" following conditions by the above-named Corporation to the heirs,
executors, or administrators of any person over fourteen years of age killed by an accident
to the Railway Train while travelling in a passenger carriage of a passenger train, as an
ordinary ticket-bearing or paying passenger ; or £500 if killed by an accident to the Tram
way Car, Omnibus, or licensed Cab (plying for public hire) on the streets ; in which the
said person was travelling as an ordinary ticket-bearing or paying passenger, or who shall
have been fatally injured thereby should death result within three calendar months after such
accident. Should such injury not prove fatal, then the person injured shall be entitled to
receive for the loss of both arms or legs, or an arm and leg, by actual separation above the
wrist or ankle, or the irrecoverable loss of sight in both eyes, such loss in any case resulting
within twenty-eight days from the date of the accident, £250 ; or for the loss by such acci
dent, and within twenty-eight days, of one arm or leg, or one eye as aforesaid, £100 ; or
should such injury not result in the loss of limb or limbs or eye or eyes as before-mentioned,
but absolutely, solely, and continuously totally disable and confine the owner of the Coupon
to the house, then he or she will be paid £1 (ONE POUND) per week during such total
disablement, and confinement, but in no case for more than ten consecutive weeks for any
one accident.
PROVIDED that at the time of such accident the person so killed or injured was the
owner of this Insurance Coupon, that his or her usual signature and address has been
written in the space provided below, that such person had duly caused his or her name to
be registered at the Chief Office of the Corporation in London, and had paid the fee of
sixpence for such registration and acknowledgment, that notice of Claim is sent to the :
Registered Office of the Corporation at London within fourteen days of the occurrence of
the accident, that Medicaf Certificates and other information be furnished by the person
claiming upon the request for same by the Corporation, and that such Claim be made
■Within twelve months of the registration of the holder’s name.
This Coupon is not transferable, must be produced at the time the Claim is made, and
no person can claim in respect of more tha n one such Coupon
The Insurant. 2 is applicable only to persons whose place of residence is in Great Britain or
Ireland, Channel Islands or Isle of Man, but covers accidents occurring in any part of Europe.
This Insurance also covers Railway Servants and Post Office Employees travelling as
ordinary passengers.
♦Date 190
(*Fill in here date of acknowledgment when received )
Signature.
Address.
FORM OF REGISTRATION.
*!♦ To be detached at the dotted line and forwarded to
No. S
THE LAW FIDELITY & GENERAL INSURANCE CORPORATION, LTD.,
60-82, CHANCEEY LANE. LONDON, W.C.
‘ In accordance with the terms of the Coupon to which this was attached, f request you to
Ht register my name as below, for which purpose 1 send Postal Order for 6d., and desire that
;,; an acknowledgment be sent to me at the undernoted address.
Full Name . .
Full Address
Profession or Occupation Age.