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DISMEMBERMENT BENEFITS <br />American Banners We Assurance Company <br />BENEFITS <br />Principal <br />Class Employee Classification Sum <br />01 ®11 Employees $5,000 <br />' G <br />If an employee suffers an accidental loss as specified below, the amount payable is as <br />follows: <br />_ <br />For the loss of <br />. " <br />Life .......................................... .principal sum <br />Both hands or both feet'or sight of both eyes ......................principal sum <br />One hand and one foot ............. ........... . . .........principal sum <br />One hand and sight of one eye .............. .................principal sum <br />One foot and sight of one eye ........ ..... .... .... .principal sum <br />i <br />Sight of one eye ............................... one half of the principal sum j <br />One hand or one foot .> . , .... .. ... , . ... one half of the principal sum <br />1 <br />The above amounts'are payable, in addition to any other benefits, for death or bodily injury <br />caused solely by accidental, violent and external means except those resulting directly or <br />indirectly from self destruction, insurrection, war or act of war, air travel other than as a <br />fare paying passenger, military service, commission of assault or felony, drugs or poisons or <br />inhaling of gas whether voluntary or otherwise, bodily or mental infirmity or disease in any <br />form, sunstroke, ptomaines or bacterial infection other than in. consequence of an injury <br />. <br />caused by violent and accidental means: <br />i <br />All <br />A472 (AO&D•A8u Rev. 11/70 <br />'-T <br />AUG 181976 <br />- .a 5 <br />