Reserve (or Estimated Net Liability) required according to the Valuation for 
Sick Benefit of per Week (a) 
throughout Life. 
Sum of £ 
(6) payable at death. 
Sickness Benefit of per \ 
Week ceasing - - f . . ( . 
Deferred Annuity of l at A ° e W 
per Week commencing -) 
Sum of £ payable at Death. 
Member’s Age 
at Entry. 
Yearly Contri 
bution for 
Benefit. 
Valuation Age 
1 year older. 
Valuation Age 
3 years older. 
Valuation Age 
5 years older. 
Valuation Age 
10 years older. 
Yearly Contri 
bution for 
Benefit. 
Valuation Age 
1 year older. 
Valuation Age 
3 years older. 
Valuation Age 
5 years older. 
Valuation Age 
j 10 years older. 
Yearly Contri 
bution for 
benefit. 
Valuation Age 
1 year older. 
Valuation Age 
3 years older. 
Valuation Age 
5 years older, j 
Valuation Age! 
10 years older 
20 
25 
30 
35 
Note.—This part of the schedule 
is only required to be filled in when 
contributions for the various benefits 
are not kept separate. 
40 
45 
(a) The amount of sickness benefit per week should be the maximum per member assurable by the society, and when the society 
does not grant such benefit throughout life the age at which such benefit ceases must be stated. 
(b) The amount payable at death should be the maximum per member assurable by the society. 
(c) State at what age sickness benefit ceases and the annuity begins. The amount of sickness'benefit, deferred annuity, and sum 
payable at death, shall be the maximum amounts assurable per member by the society. 
Signature of Valuer 
Address 
Calling or Profession 
Date- — — . 
298 VALUATION.