I, of (address) the undersigned, being the parent, or personal representative of the parent or the guardian of the above-named Child hereby declare that the said child is now in good health and is not, to my knowledge, suffering from or or subject to any disease or complaint which may tend to shorten his/her life. I, on behalf of the child, hereby agree to confirm to and abide by the rules of the Juvenile Section of the Lodge and all amendments thereto, duly registered. I further agree that this declaration shall be the basis of the contract between the said child and the Lodge. Should it at any time be proved to be false in any respect, I agree that the said child shall forfeit all claims upon the Lodge. I further declare that I do not have any other Tax-Exempt Plans (excluding ISA’s) with this or any other Friendly Society and that by taking out this plan, my maximum entitlement of £25 per month or £270 per annum to Tax Exempt Savings Plans is not exceeded. Furthermore, I declare that the total of my contributions to this plan and other taxable qualifying policies does not exceed £3600 per annum.