THE UNDERSIGNED, in consideration of having been admitted to membership in
the Knights of Columbus through
____________________________________________ Council No. ____________, located in
___________________________________, ____________________________
(City) (State)
does hereby covenant and agree with said Knights of Columbus and said Council
as follows:
a.
That my membership in the Knights of Columbus shall not commence until I
have been regularly initiated in the first degree of the Order and that I shall
have no rights as an insurance member. nor be considered as such, nor shall
any claim accrue in favor of my beneficiary unless and until
I
have
been elected to membership and initiated in the first degree, until my
insurance application has been approved by the Supreme Physician and
until the first payment of contributions on the certificate has been paid, and
then only in the event at the date when all said requirements shall have
been met my health and insurability remain the same as at the date of the
completion of Part 1 of my insurance application, or at the date of Part 2
thereof, whichever date is later.
b.
That the Charter, Constitution, By-Laws, Rules and Regulations of the Knights
of Columbus, and of any Council thereof of which I may at any time be a
member, which are now in force or which may at any time hereafter be duly made
or enacted, including any change in the manner, method or amount of ins
urance
contributions, shall be binding upon me and my beneficiary.
c.
That
I
will
abide
by
the
decision
of
the
Board
of
Directors
of
the
Knights
of
Columbus,
or
their
successors
in
office,
in
all
matters
of
difference
or
dispute
between
the said Knights of Columbus or any council or any officer
or member thereof and myself relative to membership or the obligations
of membership in the said Knights of Columbus.
d.
That I have read my application for membership in its entirety and am
fully acquainted with its contents and that I hereby warrant each and every
material statement by me
made therein and in my application for insurance
is true, and that all other statements therein are, in the absence of fraud,
deemed representations and not warranties and that they are the only
statements and answers upon which a benefit certificate may be issued to
me by the Knights of Columbus and I agree on behalf of myself and of
any person who may have any claim or interest on account of the Benefit
Certificate which may be issued to me, that said statements and answers
form part of the consideration for my acceptance aa a member of the
Knights of Columbus.
_____________________________ ______________________________
NAME SIGNATURE
__________________________
DATE
