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  Contribution ­
  for
Benefit.

Valuation  Age
1  year  older.

Valuation  Age
3  years  older.

Valuation  Age
5  years  older.

Valuation  Age
10  years  older.

Yearly  Contribution ­
  for
Benefit.

Valuation  Age
1  year  older.

Valuation  Age
3  years  older.

Valuation  Age
5  years  older.

Valuation  Age
j  10  years  older.

Yearly  Contribution ­
  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.