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Page 1: Ask the Proposed Insured today's date including the year, day of week, month and day ofthe month. Record his,'ller response. 17. Ask the Proposed Insured to recall the three objects
Page 2: Ask the Proposed Insured today's date including the year, day of week, month and day ofthe month. Record his,'ller response. 17. Ask the Proposed Insured to recall the three objects
Page 3: Ask the Proposed Insured today's date including the year, day of week, month and day ofthe month. Record his,'ller response. 17. Ask the Proposed Insured to recall the three objects
Page 4: Ask the Proposed Insured today's date including the year, day of week, month and day ofthe month. Record his,'ller response. 17. Ask the Proposed Insured to recall the three objects
Page 5: Ask the Proposed Insured today's date including the year, day of week, month and day ofthe month. Record his,'ller response. 17. Ask the Proposed Insured to recall the three objects
Page 6: Ask the Proposed Insured today's date including the year, day of week, month and day ofthe month. Record his,'ller response. 17. Ask the Proposed Insured to recall the three objects
Page 7: Ask the Proposed Insured today's date including the year, day of week, month and day ofthe month. Record his,'ller response. 17. Ask the Proposed Insured to recall the three objects

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