Application for Life Insurance

This life insurance product is provided by Sun Life of Canada (Philippines), Inc., a member of the Sun Life Financial group of companies.
In this application, you and your mean persons whose information we are processing or disclosing. We, us, our and the Company refer to Sun
Life of Canada (Philippines), Inc.
What are you applying for? Variable Life Insurance Non-Participating Life Insurance
Participating Life Insurance Conversion with increase in coverage (Provide policy number/s of source
policy/ies to be converted)
PRINT clearly. Use BLACK ink. Indicate N/A if question is not applicable.
A Personal Information
Life to be Insured (Complete if Life to be Insured is also the Applicant)
Title Last First Middle Other Legal Name
1. Name
2. Gender 3. Birthdate 4. Age 5. Civil Status 6. Country/ies of Legal Residence
Male DAY MONTH YEAR Single Married Philippines USA
Female Widowed Separated Legally Others, specify
7. Birthplace (City/Province/State and Country) 8. Citizenship/s 9. Philippine TIN 10. SSS or GSIS No.

11. Home Phone (country code, area code & tel. no.) 12. Work Phone (country code, area code & tel. no.) 13. Mobile Phone No. (country code & mobile no.)

14. Permanent Residence Address No., Street, Village/Subdivision, Barangay (P.O. Box is not acceptable) City/Municipality Province/State Country Zip Code

15. Present Residence Address No., Street, Village/Subdivision, Barangay (P.O. Box is not acceptable) City/Municipality Province/State Country Zip Code

16. Primary Occupation/Position 17. Details of Duties 18. Total Years in Employment/Business

19. Annual Income 20. Employer or Name of Business 21. Nature of Business (Indicate product or service)

22. Business Address No., Street, Village/Subdivision, Barangay (P.O. Box is not acceptable) City/Municipality Province/State Country Zip Code

23. Other occupation 24. Previous Occupation and Name of Previous Employer (if presently unemployed or retired)

25. Have you ever held or are you currently holding an elected or appointed government position? Yes No
If “Yes,” provide details. Position: Date/s in the position:

Individual Applicant/Owner (Complete if Applicant is different from the Life to be Insured)

Title Last First Middle Other Legal Name
26. Name
27. Gender 28. Birthdate 29. Age 30. Civil Status 31. Country/ies of Legal Residence
Male DAY MONTH YEAR Single Married Philippines USA
Female Widowed Separated Legally Others, specify
32. Birthplace (City/Province/State and Country) 33. Citizenship/s 34. Relationship to the Life to be Insured 35. Philippine TIN 36. SSS or GSIS No.

37. Home Phone (country code, area code & tel. no.) 38. Work Phone (country code, area code & tel. no.) 39. Mobile Phone No. (country code & mobile no.)

40. Permanent Residence Address No., Street, Village/Subdivision, Barangay (P.O. Box is not acceptable) City/Municipality Province/State Country Zip Code

41. Present Residence Address No., Street, Village/Subdivision, Barangay (P.O. Box is not acceptable) City/Municipality Province/State Country Zip Code

42. Primary Occupation/Position 43. Details of Duties 44. Total Years in Employment/Business

45. Annual Income 46. Employer or Name of Business 47. Nature of Business (Indicate product or service)

48. Business Address No., Street, Village/Subdivision, Barangay (P.O. Box is not acceptable) City/Municipality Province/State Country Zip Code

49. Other occupation 50. Previous Occupation and Name of Previous Employer (if presently unemployed or retired)

51. Have you ever held or are you currently holding an elected or appointed government position? Yes No
If “Yes,” provide details. Position: Date/s in the position:

SSRA.02.18
*SSRA.02.18*
Sun Life of Canada (Philippines), Inc.
Page 1 Serial No. SR00000001
*SR00000001*
 A Personal Information (continuation)
Business Applicant (Complete if the Applicant/Owner is a sole proprietor, partnership, corporation, or other business entities)
52. Company/Business Name 53. Relationship to the Life to be Insured 54. Philippine TIN
Employer Others, specify
55. Type of Entity (e.g. corporation/partnership, etc.) 56. Nature of Business 57. Country of Incorporation 58. Date of Incorporation
Submit approved Request for Approval of Entity Documents (RAED) or Business Registration

59. Name of Contact Person (Last, First, Middle) 60. Designation 61. Business Phone No. 62. E-mail Address
(country code, area code & tel. no.)

63. Business Address No., Street, Village/Subdivision, Barangay (P.O. Box is not acceptable) City/Municipality Province/State Country Zip Code

64. Mailing Address and Contact Information

Applicant (Choose one) Permanent Residence Present Residence Business Address
65. Would you like to use the same mailing address for 66. Philippine Mobile Phone No. 67. E-mail Address
all your existing policies?
Yes No
68. How would you like to receive your billing statement and official receipt? Choose one. All your policies will be updated based on option selected.
SMS*+ Electronic Copy SMS*+ Printed Copy Printed Copy only *SMS billing is available to Philippine mobile numbers and individual accounts only.

69. Would you like to receive personalized communications, products, and service offers from the Company, Sun Life Asset Management Company,
Inc. (SLAMCI) and related parties that may help with your financial needs? Yes No
If other than applicant’s mailing address, answer questions 70-72.
Title Last First Middle 71. Relationship to the Life to be Insured
70. Name
72. Mailing Address No., Street, Village/Subdivision, Barangay (P.O. Box is not acceptable) City/Municipality Province/State Country Zip Code

B Source of Funds/Property of Applicant

73. Source of Funds/Property to pay premiums (Select all that apply)
Allowance Donation Rental Sale of Assets, specify
Business Inheritance Retirement Fund/Pension Savings/Placements/Investments/Interest
Commission/Professional Fee Regular Remittances Salaries/Bonus Others, specify

C Beneficiary Information
If beneficiaries are designated as irrevocable, their consent is required before any policy transaction will be processed (e.g. policy advance, surrender,
change of beneficiary, etc.). Beneficiary designation is subject to Secs. 11, 12 & 182 of the Insurance Code, as amended, and Art. 2012 of the Civil Code.
For additional beneficiary/ies, unequal sharing, creditor or corporate accounts, use Amendment of Application.
On Death - beneficiary for proceeds arising from the death of the life to be insured
74a. Primary Beneficiary (If designation is left blank it is considered revocable)
Name (Last, First, Middle) Relationship Citizenship Birthdate Designation
(to the life to be insured) DAY MONTH YEAR Revocable
Irrevocable
Name (Last, First, Middle) Relationship Citizenship Birthdate Designation
(to the life to be insured) DAY MONTH YEAR Revocable
Irrevocable
Name (Last, First, Middle) Relationship Citizenship Birthdate Designation
(to the life to be insured) DAY MONTH YEAR
Revocable
Irrevocable
74b. Contingent Beneficiary (In the event of death of all primary beneficiary/ies)
Name (Last, First, Middle) Relationship (to the life to be insured) Citizenship Birthdate
DAY MONTH YEAR

Name (Last, First, Middle) Relationship (to the life to be insured) Citizenship Birthdate
DAY MONTH YEAR

75. On Endowment for scheduled pay-outs - beneficiary for proceeds if the life to be insured is living on endowment date
Name (Last, First, Middle) Relationship (to the life to be insured) Citizenship Birthdate
DAY MONTH YEAR

76. On Maturity for Final Endowment or Variable Life Insurance Plan - beneficiary for proceeds if the life to be insured is living on maturity date
Name (Last, First, Middle) Relationship (to the life to be insured) Citizenship Birthdate
DAY MONTH YEAR

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Sun Life of Canada (Philippines), Inc.
 D Smoking Habit Information (To be completed if the Life to be Insured is 16 years old and above)
77. How many cigarettes, cigarillos, cigars, e-cigarettes, pipes, betel nut, chewing tobacco, nicotine gum or patches or any form of tobacco have you
consumed within the last 12 months? Less than 5 5 to 10 11 to 20 21 to 40 40+ None

E Insurance Policy Information (For VUL application, skip Question nos. 78-88)
78. Plan Name 79. Rate 80. Face Amount
Smoker Non-Smoker
81. Currency 82. Amount paid with the Application 83. Extra Rating: Indicate applicable extra rating
Philippine Peso US Dollar
84. Additional Benefits 85. Premium Payment Default Options (Not applicable to products without cash values)
Benefit Amount Check one. If no option is chosen, the default applicable to the product as indicated in the
Accidental Death (ADB) contract to be issued shall apply.
Critical Illness (CIB) Premium Advance Paid-up Insurance Paid-up Term Insurance
Hospital Income (HIB) per day 86. Dividend Options (Not applicable to term/non-participating insurance) Check one.
Female Benefit (FB) Cash Dividend Accumulation If no option is chosen, Paid-up
Paid-up Additions* Premium Reduction* Additions shall apply.
Female & Maternity (FMB)
If dividend accumulation option is chosen, the applicant authorizes the Company to apply any
5 Year Ren. & Conv. Term (5 YRCT) dividends to the Premium Default Option in effect and any interest on outstanding policy advance.
Accidental Death, Dismemberment *Not applicable to Sun Acceler8 and SUN Fit and Well or any other products with the same
features. For these products, if no option is chosen, Dividend Accumulation shall apply.
& Disablement (ADDD)
Waiver of Premium: 87. Endowment Benefit Payment Options (Applicable to products with anticipated
endowment benefits only) Check one.
Total Disability (Benefit) Receive amount in check Leave the amount on deposit with the Company
On Death of Initial Owner (WPD) If no option is chosen, amount to be left on deposit shall apply.
On Death & Disability of Initial 88. Special Paid-up Bonus Options (Applicable to Sun Acceler8 and SUN Fit and Well or
Owner (WPDD) any other products with this feature). Check one.
Cash Special Paid-up Bonus Accumulation
Others, specify
If no option is chosen, Special paid-up bonus accumulation shall apply.

F Insurance History and Declaration on the Proposed Replacement of Existing Policy/ies of the Life to be Insured
89. Do you have other life insurance policies in force or pending with the Company and other insurance companies? Yes No
If “Yes,” provide details in item 90.
90. Insurance Information on the Life to be Insured: If space is insufficient, use Amendment of Application.
Year Issued or Total Individual Total Critical Total Accidental Total Accidental Death,
Insurance Company Indicate if Pending Life Insurance Illness Death Benefit Dismemberment & Disability

91. Is this application intended to replace any existing life insurance policy/ies with the Company and with any other
life insurance company? Yes No
92. Will premiums for the insurance applied for be paid by a policy advance or surrender from an existing policy? Yes No
For any “Yes” answer to questions 91 and 92, complete and submit the Replacement Notification Form.
REMINDER FROM THE INSURANCE COMMISSION ON REPLACEMENT OF POLICIES: Replacement occurs when an existing life insurance policy
is used to pay for a new one through a policy advance or surrender. Replacing an existing policy with a new one is disadvantageous as you may be
required to pay a higher premium due to any change in your health or age. It may also result in the loss of financial benefits accumulated over the years.
93. Insurance Information on Working Spouse: Answer if life to be insured is not working and financially dependent on working spouse.
Total Amount of Individual Life Insurance Coverage Total Amount of Critical Illness Coverage Explain why there is no insurance coverage
on Working Spouse on Working Spouse on Working Spouse

94.Insurance Information on Parents and Siblings and Applicant/Owner if not the parent. Answer if life to be insured is below 25 years old and
financially dependent on parents. If space is insufficient, use Amendment of Application.
Total Individual Life Total Critical
Family Member Age Explain why there is no insurance coverage
Insurance Coverage Illness Coverage
Father
Mother
Brothers

Sisters

Applicant

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Sun Life of Canada (Philippines), Inc.
 G Health Information: Leave blank if a full medical examination is to be submitted or required based on published Company guidelines.
It is important that you provide complete and true information for us to assess your application. If you are not sure if some information is relevant, provide it
anyway. If you fail to provide all relevant information that you already know, future claims may be denied, the policy or rider may be declared void.
95. For child below age 5: Life to be Insured 96. For women: (To be answered by Applicant/Owner of WPD/WPDD or
a. Birth weight (indicate unit of measurement) Life to be Insured aged16 years old and above)
b. Was the child’s birth premature, or is there any indication a. Are you pregnant? Number of months? Yes No
of failure to thrive or gain weight? Yes No b. Have you had any complications of pregnancy? Yes No
c. Are there defects noted from birth, or has a doctor If “Yes,” provide details
or health practitioner advised that child’s height, weight c. Do you have or have you ever had any
or physical development was not meeting normal gynecological problem? If “Yes,” provide details Yes No
developmental milestones? Yes No
97. Family History: If space is insufficient, use Amendment of Application.
Life to be Insured Applicant/Owner of WPD/WPDD
Family Age Health Condition/ Age at Cause of Death Family Age Health Condition/ Age at Cause of Death
Member (if Alive) Medical Diagnosis Death Member (if Alive) Medical Diagnosis Death
Father Father
Mother Mother

Brothers Brothers

Sisters Sisters

Instructions: Underline conditions being referred to. Provide further details on the next page for any “Yes” answer. Life to be Insured Applicant/Owner
of WPD/WPDD
98. Has any of your parents, brothers or sisters, whether living or dead, been diagnosed with breast, colon,
ovarian, rectal, or other types of cancer, heart disease, cardiomyopathy, stroke, diabetes, muscular
dystrophy, Alzheimer’s disease, Parkinson’s disease, polycystic kidney disease, or any other hereditary
disorder before age 60? Indicate age at onset of illness Yes No Yes No
99. Are you currently taking any medication? Yes No Yes No
Name of medication
Doctor’s name and clinic address
100. Height and Weight Information Present height (indicate unit of measurement)
Present weight (indicate unit of measurement)

101. Has there been a weight change of more than 10 pounds (4.5 kilos) within the last 12 months? Yes No Yes No
If “Yes,” provide details. Life to be Insured: Reason: Gained lbs Lost lbs
Applicant/Owner of WPD/WPDD: Reason: Gained lbs Lost lbs
102. Many people during their lifetime will experience or be treated for medical conditions. Please let us
know which of the following you have had, or been told you had, or sought advice or treatment for:
a. high blood pressure, chest pain/discomfort, heart murmur, rheumatic fever, stroke, aneurysm,
circulatory or heart disorder? Yes No Yes No
b. diabetes, sugar in the urine, thyroid or other glandular (endocrine) disorder? Yes No Yes No
c. kidney, bladder, or urinary disorder/infection, sexually transmitted disease, reproductive organ or
prostate disorder? Yes No Yes No
d. disorders of the skin or pigmentation, enlarged glands or lymph nodes, nodules, polyps, cysts,
lumps, tumor, mass, abnormal growth, cancer, malignancy, or any related conditions? Yes No Yes No
e. asthma, chronic cough, pneumonia, tuberculosis, emphysema, or any other respiratory or lung disorder? Yes No Yes No
f. fainting spells, convulsion, developmental delay, epilepsy, seizure, tremor, loss of consciousness,
paralysis, severe headache(s) or migraine(s) or any other disorder of the brain or nervous system? Yes No Yes No
g. anxiety, depression, stress or any emotional/psychological, mental or psychiatric disorder? Yes No Yes No
h. ulcers, ulcerative colitis, intestinal bleeding, pancreatitis, hepatitis, cirrhosis, Crohn’s disease or other
disorders of the stomach, digestive organ or liver? Yes No Yes No
i. arthritis or systemic lupus erythematosus, gout, back or spinal disorder, joint pain, multiple sclerosis,
bone fracture, muscular weakness or muscle disorder? Yes No Yes No
j. anemia, bleeding or blood disorder? Yes No Yes No
k. AIDS or positive HIV test? Yes No Yes No
l. any other illness or surgery? Yes No Yes No
103. Do you have any health symptoms, recurring or persistent pains, or complaints for which a physician
has not been consulted or treatment has not been received? Yes No Yes No
104. Other than previously stated, have you, within the past 5 years:
a. consulted any doctor or other health practitioner? Yes No Yes No
b. submitted to blood tests, ecg, x-rays, treadmill, echocardiogram, scans, MRI, ultrasounds, mammography,
colonoscopy, biopsies or other tests? Yes No Yes No
c. attended or been admitted to any hospital or other medical facility? Yes No Yes No
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Sun Life of Canada (Philippines), Inc.
 G Health Information: Leave blank if a full medical examination is to be submitted or required based on published Company guidelines. (cont.)
105. Provide details for any “Yes” answer to Section G. If space is insufficient, use Amendment of Application.
Proposed Insured
Question Doctor’s name & complete address Dates Seen Reason for visit or Results of medical/laboratory tests, any advice
No. (month & year) diagnosis or treatment received and results of treatment

Applicant/Owner of WPD/WPDD
Question Doctor’s name & complete address Dates Seen Reason for visit or Results of medical/laboratory tests, any advice
No. (month & year) diagnosis or treatment received and results of treatment

H Travel, Aviation, Hobbies and Lifestyle Information on the Proposed Insured 16 years old and above or Applicant/Owner of WPD or WPDD
Provide details for any “Yes” answer. If space is insufficient, use Amendment of Application. Life to be Insured Applicant/Owner
of WPD/WPDD
106. Are you a Filipino citizen residing in the Philippines for less than 6 months, or are you a resident alien in
the Philippines without a valid immigration status and have resided in the Philippines for less than 5 years? Yes No Yes No
107. In the last 12 months, have you travelled outside the Philippines for a period of more than 3 months,
or do you intend to do so within the next 12 months? Yes No Yes No
Specify country Duration of Travel Reason for travel
For any “Yes” answer to Questions 106 and 107, complete a Residential Background Questionnaire.
108. In the last 2 years, have you flown as a pilot, student pilot, crew member or flight attendant in a non-
commercial flight or airline? If “Yes,” complete and attach an Aviation Questionnaire. Yes No Yes No
109. In the last 2 years, have you engaged in scuba diving, automobile or motorcycle racing, sky diving or
other aerial activities, rock mountain climbing or other hazardous sports, or do you intend to do so
in the next 12 months? If “Yes,” submit appropriate questionnaire. Yes No Yes No
110. Do you drink more than 4 drinks* in a single day, or drink before or during work, or drink to cope
with difficulties or depression, or combine alcohol with other drugs or with certain prescription
medications? If “Yes,” complete and attach an Alcohol Questionnaire. Yes No Yes No
*1 drink = 330ml/bottle of beer or 148 ml/glass of wine or 43 ml/shot of liquor
111. In the last 5 years, have you used marijuana, shabu, ecstacy, cocaine, LSD or other psychoactive drugs,
heroin or other narcotics? If “Yes,” complete and attach a Drug Usage Questionnaire. Yes No Yes No
112. Have you ever applied for or received a pension, payment, or benefit due to injury, sickness or disability? Yes No Yes No
If “Yes,” provide details
113. Do you have any physical or mental condition which prevents or has prevented continuous full-time
employment in your usual occupation? If “Yes,” provide details Yes No Yes No
114. In the last 10 years, have you declared or been petitioned for insolvency, or have been charged with
or convicted with any criminal offense? If “Yes,” provide details Yes No Yes No

I Temporary Life Insurance Questions: If you answer “Yes” to any questions below, do NOT make any payment.
Life to be Insured
115. Have you ever applied for life or health insurance and been refused coverage? If “Yes,” provide details, Yes No

116. Within the last 2 years, have you consulted a doctor for chest pain, stroke, heart attack, any other disease of the heart or Yes No
cancer? If “Yes,” provide details
117. Within the last 60 days, have you been admitted or advised to be admitted as an in-patient in a hospital or clinic (except
for pregnancy, child birth or routine health check-up), or have you been advised to have any test or to undergo surgery? If Yes No
“Yes,” provide details

J Corrections and Amendments

118. For Company Use Only

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Sun Life of Canada (Philippines), Inc.
 K Third Party/Beneficial Owner Determination
A third party/beneficial owner is a person or institution who funds, owns or controls the account other than the individual and/or business applicant on whose
behalf a transaction or activity is being conducted or has ultimate effective control over a legal person or arrangement.
119. Is there any Third Party/Beneficial Owner, other than the owner and/or business applicant, who:
a) funds any of the payment? Yes No
b) has access, use or any kind of financial interest in the account? Yes No
c) on whose behalf the transaction or activity is being conducted? Yes No

If the Third Party/Beneficial Owner is an individual, answer questions 120-125. If an entity, answer questions 120-122 and 126-129.
120. Name (Last, First, MI) / Business Name 121. Relationship to the Individual Applicant/Owner

122.IfThird
“Yes,”Party/Beneficial Owner
provide details below. Permanent Address No., Street, Municipality/City, Province, Country, Zip Code (P.O. Box is not acceptable)
If “Yes,” provide details below.
Birthdate
123. If “Yes,” provide details below. 124. Birthplace (City/Province/State and Country) 125. Occupation
DAY MONTH YEAR

126. Type of Entity (e.g. corporation/partnership, etc.) 127. Nature of Business 128. Date of Incorporation 129. Country of Incorporation

L Signatures
**IMPORTANT** All payments made through our advisors must be covered by a BIR-approved Provisional Receipt issued by the Company.
By signing, you acknowledge/agree that:
A. Declaration
• you were present during the completion of this application and that the answers and statements made on this application and in any other document forming part of
this application (hereinafter collectively called this “Application”) are true, complete and have been given with your full consent and will be the basis of any contract
that may arise;
• the funds where the premiums are sourced from were not generated from any of the unlawful activities listed in the Anti-Money Laundering Act;
• any advisor, paramedic or medical examiner is not authorized to make or modify a life insurance policy, or decide whether anyone proposed for insurance is an acceptable
risk, or waive any of the Company’s rights or requirements;
• in case of apparent errors or omissions in this application, or if the Company is unwilling to issue a policy applied for, the Company may amend this Application by noting
the change in the space entitled “Corrections and Amendments” and issue a policy based on such amended Application;
• except as provided in the Proof of Temporary Life Insurance, if issued, bearing the same number of this application, the Company will not incur any liability until the
Company approves the issue of a policy and only if the first premium is fully paid and the answers and statements made on this Application would be full and true asif
they had been given at, and where applicable to the time of payment of the premium;
• concealment, misrepresentation and false declaration covering this application will cause the insurance to be void;
• Article 1250 of the Civil Code of the Philippines (on extraordinary inflation or deflation) shall not apply to any of the payment and guaranteed benefits under any policy
to be issued;
• if you transact with the Company by electronic means, you assume full responsibility for all transactions that use your electronic identification;
• you will accept said policy when issued; provided that for variable life insurance, such acceptance shall be subject to the applicable “cooling-off” period provision.

B. Participating Life Insurance (if applicable)

You understand that in a participating life insurance policy, the owner is eligible to receive dividends and special paid-up bonus subject to the following limitations/conditions:
• the Company in its sole discretion determines the amount of dividends and special paid-up bonus, if any;
• dividend rates and special paid-up bonus will typically vary based on the performance of a number of factors, including mortality experience, taxes, inflation, policy
owner termination experience, and policy expenses, with the investment return of the Company being the main determinant of dividend and special paid-up bonus
performance; and
• considering the variability of dividend performance and special paid-up bonus, it is not guaranteed that there will be a dividend and special paid-up bonus accumulation
sufficient to offset any future premiums or the policy will become self-liquidating or able to pay its own premiums in the future.
C. Variable Life Insurance (if applicable)
• a variable life insurance product involves risks and the value of units in Investment Funds may rise and fall;
• the benefits payable under such product are linked to the performance of the Investment Funds according to your Fund Allocation Instruction;
• your Fund Allocation Instruction is based on your judgment and you have not relied on any advice provided by the advisor;
• while the policy is in effect, any premiums received by the Company, after deducting the relevant Premium Charges, are used to create units in Investment Funds for
allocation to the policy and such units will be created based on the unit price of the Investment Fund on the Valuation Date immediately following our receipt of such
premiums in cleared funds;
• premiums and all charges may be changed by the Company with the prior approval of the Insurance Commission;
• you have the right to cancel the new policy and obtain a refund equal to the value of your units plus the initial charges by sending a signed written notice to and received
by us at the Company’s office within 15 days from receipt of the policy.
D. Data Privacy and Authorization
Medical Information Database
In accordance with the Insurance Commission’s Circular Letter No. 2016-54, your medical information will be uploaded to a Medical Information Database accessible to
life insurance companies for the purpose of enhancing risk assessment and preventing fraud. Once uploaded, all life insurance companies will only have limited access to
your information in order to protect your right to privacy in accordance with law.
A copy of Circular Letter No. 2016-54 may be accessed at the Insurance Commission’s website at www.insurance.gov.ph.

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Sun Life of Canada (Philippines), Inc.
 L Signatures (continuation)
Authorization to Process your Personal Data
You understand and acknowledge that the Company, its employees, duly authorized representatives, related companies, third party service providers and vendors, shall use,
process and share your information, including sensitive personal information, with any person or organization to (i) administer and service this insurance or investment account;
(ii) process claims and enforce/fulfill contractual rights/obligations; or (iii) for other reasonable purposes related to the provision of products and services (including but not
limited to improvement/upgrade in systems and business processes, data analytics, automated processing, etc.).
The Company may further process your information for purposes of complying with its legal obligations, laws and regulations (including but not limited to the Anti-Money
Laundering Act and Credit Information Systems Act); pursue its legitimate and lawful rights and interests; and other purposes allowed under privacy laws and regulations.
Your personal data shall be retained throughout the duration of your coverage under your plan or existence of your account(s) and/or until expiration of the retention limit
set by laws and regulations from account closure and the period set for destruction or disposal of records. You certify that you have read, understood and agree with the
declarations and authorizations above, including Sun Life’s privacy policy found in https://apps.sunlife.com.ph/privacy.

Authorization to Obtain Information

1. You authorize any physician, hospital, clinic, insurance company or other organization, institution, or person that has any personal record of you and/or the life to be insured
to give to the Company any and all information about you and/or the life to be insured including but not limited to personal data and other information with reference to your
and/or the life to be insured’s health and medical history and any hospitalization, advice, diagnosis, treatment, disease or ailment. This information is required for, and may be
sought during underwriting evaluation of the risk associated with your and/or life to be insured’s application for life insurance, administration and continuing service of your
and/or the life to be insured’s insurance policy, assessment and payment of insurance claims for living and death benefits, and providing you and/or the life to be insured with
products that cater to your and/or the life to be insured’s needs at any given point in time; 2. You also authorize the Company to have your and/or the life to be insured’s
blood and urine samples analyzed for the purpose of underwriting your application for your insurance coverage and or that of the life to be insured. The analysis of the blood
and urine sample may include, but is not limited to, tests where allowed by law, for diabetes, liver function, kidney disorders, cholesterol and related blood lipids, presence of
immune disorder or the presence of medication, drugs or nicotine; and 3. You also consent to a personal investigation on you and/or the life to be insured, and copy of the
authorization granted in this document shall be as valid as the original.
Place of
130.Please Signing
tick 131. Date
here if you opt not to receive marketing of Signingfrom
information Sun Life Financial. 132. Signature of Life to be Insured
(day/month/year)
X
133. Place of Signing 134. Date of Signing (day/month/year) 135. Signature of Applicant
X
136. I.D. Presented (Government-Issued and Photo-Bearing I.D.) 137. I.D. No. 138. I.D. Expiry Date (day/month/year)

139. Place of Signing 140. Date of Signing (day/month/year) 141. Signature of Parent (required if life to be insured is below 18 years old or if the applicant is not the child’s parent)
X
142. Printed Name of Parent 143. Printed Name of Child

144. Place of Signing 145. Date of Signing (day/month/year) 146. Signature of Authorized Signatory (required if applicant is a business entity)
X
147. Printed Name of Authorized Signatory (required if applicant is a business entity) 148. Designation

149. Place of Signing 150. Date of Signing (day/month/year) 151. Printed Name and Signature of Advisor who conducted the interview and verified the signatures

M Foreign Account Tax Compliance Act (FATCA) Questions

152. Are you a U.S. Citizen? Yes No

153. Are you a tax resident of the U.S. because you hold a green card (permanent resident card)? Yes No
154. Are you a tax resident of the U.S. under the substantial presence test?* Yes No
*To meet this test, you must be physically present in the United States (U.S.) for at least: 1) 31 days during the current year, and 2) 183 days during the 3-year period that includes the current
year and the 2 years immediately before that, counting: a) All the days you were present in the current year, b) 1/3 of the days you were present in the first year before the current year, and
c) 1/6 of the days you were present in the second year before the current year.
155. U.S. TIN (SSN/ITIN): Foreign TIN (other than US and PHL):

If you answer “Yes” to any of the above questions but do not have a U.S. TIN, please indicate one of the following reasons:
156a. Reason A – You have applied for a TIN or equivalent number and you agree to provide Sun Life with the TIN or equivalent number within 15 days of receiving
it from the US IRS.
156b. Reason B – You have not applied for a TIN or equivalent number or you were unable to obtain a TIN or equivalent number. If you select Reason B, please indicate
your explanation in this box.

DECLARATION AND SIGNATURE:

You hereby certify that all statements relevant for purposes of FATCA made in Parts A and M of this Application are, to the best of your knowledge and belief, correct
and complete. You agree that you will submit a new individual Self-Certification form within 30 days if any information on this form becomes incorrect. You also agree to
advise the Company promptly of any change in circumstances which causes the information contained herein to become incorrect and to provide the Company with an
updated individual Self-Certification form within 30 days of such change in circumstances.
By signing below, you understand and agree that the Company may share information that you provided on this Application, including other information in its possession
relevant to the tax qualification claimed on this Application, with relevant tax authorities in order to meet its local and foreign tax reporting obligations.
You certify that you are the Applicant or that you are authorized to sign for the Applicant in respect of the account(s) to which this Application relates. You agree to
provide proof of authority upon request.
157. Printed Name and Signature of the Applicant 158. Signature and Authority of Authorized Signatory 159. Date of Signing (day/month/year)

SSRA.02.18 Page 7 Serial No. SR00000001

Sun Life of Canada (Philippines), Inc.
 Advisor’s Report
For any explanation, provide further details on Item No. 17 Remarks or Additional Comments or use additional page.
A. About the Life to be Insured/Applicant
1. Did you personally see the life to be insured and/or applicant for this Application? Yes No Note: Face-to-face interview is required.
2. Upon reasonable research and inquiry, has the Applicant or any of his/her immediate relative/s (living or deceased) ever held any position/s office/s in
or on behalf of the government of the Philippines or of a country other than the Philippines? Note: Immediate relative refers to Applicant’s parents, spouse or
common-law partner, children, siblings and in-laws. Yes No If “Yes”, provide details below.
2a. Name 2b. Position 2c. Relationship to Applicant

3. How did you come to know about the life to be insured? Through Business Personal Family
4. For how long have you known life to be insured? Life time Years Just met
5. Who/What is your Source of Sale? (Check one)
Friend/acquaintance Orphan policy owner Relative of Advisor Upselling Campaign, specify
Cold Call Maturity Recapture Existing Client Others, specify
Walk-in (complete an Advisor’s Confidential Report) Referred Lead No.
B. Payment Information
6. Form of Payment 7. Mode of Payment 8. Due Date for First Regular Premium
Bank Transfer Cash Check Single Pay Yearly Traditional Plan VUL Plan
Credit Card (For Traditional products only) Settlement Date Settlement Date
Half-Yearly Quarterly
Validated Deposit Slip - if cash deposit 1 day before birthday subject 1 day before birthday
of over Php 100,000.00, declare source Monthly for Salary to backdating guidelines
Deduction/Worksite subject to backdating
of cash Application sign date or guidelines
9. Provisional Receipt (P.R.) No. 10. P.R. Date (day/month/year) 11. Amount Paid date of Medical Examination
whichever is later
12. Is the payment included in the application? Yes No If there is no payment, Proof of Temporary Life Insurance will not be issued.
13. Source of Payment from Sun Life Products
Maturity proceeds from Policy/Plan No. Redemption from SLAMCI Account No.
(Submit appropriate form to SLAMCI)
Change over bonus on Policy No. Fund withdrawal from Policy No.
(Submit appropriate form to Policy and Plan Change Section)
Dividend/Endowment payout from Policy No. Others, specify
14. What is the purpose of this application?
Income protection Retirement Estate tax funding Personal health & Retirement (employer-paid)
(Individual) accident protection
Creditor protection Education Savings/investment Key person insurance Others, specify
15. Special Payment Arrangement - if applicable to this product (Submit appropriate forms)
Advance Payment Option Auto-Charge Arrangement Auto-Debit Arrangement Salary Savings
(not available for VUL) (for premiums only; not available for VUL) (applicable for premiums only)
Employee Marketing (see GISSDAF) Salary Deduction/Worksite (see GISSDAF) Staff Assurance
16. Is the life to be insured an Advisor? family member of the Advisor? Indicate relationship to Advisor
a Staff? family member of the Staff? Indicate relationship to Staff
Others, specify
17. Remarks or Additional Comments:

18. Advisor Information

Name of Advisor (Last, First, MI) Code Share NBO/ISO Sunny Level Up Passer
% Yes No
19. Is commission being shared? Yes (Provide details. Share must be a minimum of 10%) No
Name of Advisor (Last, First, MI) Code
Code Share NBO/ISONBO Sunny Level Up Passer
% % Yes No
Name of Advisor (Last, First, MI) Code Share NBO/ISO Sunny Level Up Passer
% Yes No

20. Advisor Declaration

I declare and confirm that:
• I have performed the appropriate know-your-client process in accordance with the anti-money laundering laws and policies of the Company. Should there be any adverse
change in my opinion regarding the integrity or reputation of the life to be insured/applicant, I shall inform the Company’s Money Laundering Reporting Officer immediately;
• I have explained to the life to be insured/applicant the benefits being applied for in this Application in accordance with the provisions of the insurance contract that
will be subsequently issued, if approved by the Company;
• I have asked the life to be insured/applicant if the product to be purchased in this Application is intended to change or replace any existing life insurance policy/ies and
have fully explained to the life to be insured/applicant the disadvantages of changing or replacing any existing life insurance policy/ies;
• I have asked the questions contained in this Application to the life to be insured/applicant or parent and the answers were correctly recorded;
• This Application, report and any accompanying information are complete and true to the best of my personal knowledge and belief.
21. Signature of Advisor who conducted the interview and verified the signatures 22. NBO/ISO 23. Date of Signing (day/month/year)
X

SRAR.02.18 *SRAR.02.18*
Sun Life of Canada (Philippines), Inc.
Page 8 Serial No. SR00000001
Proof of
Temporary Life Insurance

Sun Life of Canada (Philippines), Inc., (the “Company”) agrees to provide temporary life insurance on the life to be insured beginning on the date of the
Application bearing the same serial number as this Proof of Temporary Life Insurance (the “Proof”) if:

1. the first premium has been paid with the Application for which a Provisional Receipt is issued;
2. the temporary life insurance questions in the Application have been truthfully answered “No”; and
3. all other required questions of the Application have been answered completely and truthfully.

Limitation on Amount of Insurance

The amount of insurance money payable on the death of the life to be insured pursuant to this Proof is the amount which the Company would have
paid had the policy applied for been issued. In no event will the Company pay more than:

• Php2,000,000 in total, if all policies applied for are peso-denominated; or

• the equivalent of Php2,000,000 in US Dollars, if all policies applied for are US dollar-denominated; or
• the equivalent of Php2,000,000 in a combination of Philippine pesos and US dollars, if both peso and US dollar policies are applied for

including any accidental death benefit, under all Proofs of Temporary Life Insurance in force in respect of the deceased insured. The applicable exchange
rate at the date of payment shall be used to determine the Company’s liability in US dollars, if any. The insurance money will be prorated among all
Proofs of Temporary Life Insurance in force on the deceased insured. Any amount paid for the amount of insurance in excess of the Company’s liability
under this Proof will be refunded.

Termination of Coverage on the Life to be Insured will be the earliest of the following:
a. the date a termination notice has been sent by the Company to the applicant;
b. the date a policy issued as a result of the Application takes effect;
c. the date termination is requested by the applicant; or
d. the date of death of the life to be insured.

Beneficiary
The beneficiary for temporary life insurance is the person or persons named as primary death beneficiary/ies in the policy being applied for.

Exclusion
If the life to be insured dies by suicide, the pertinent provisions of the Insurance Code shall apply. Where no insurance money is payable, the amount
paid with the Application will be refunded.

No Advisor has the authority to modify the terms of this Proof.

Important Notice
The Insurance Commission, with offices in Manila, Cebu, and Davao, is the government office in charge of the enforcement of all laws related to
insurance and has supervision over insurance companies. It is ready at all times to assist the general public in matters pertaining to insurance. For any
inquiries or complaints, please contact the Public Assistance and Mediation Division (PAMD) of the Insurance Commission at 1071 United Nations
Avenue, Manila with telephone numbers +632-5238461 to 70 and email address at [email protected]. The official website of the
Insurance Commission is www.insurance.gov.ph.

Issued by Sun Life of Canada (Philippines), Inc., a member of the Sun Life Financial group of companies
2nd Floor Sun Life Centre, 5th Ave., cor. Rizal Drive, Bonifacio Global City, Taguig City
TIN 204-962-522-000

Serial No. SR00000001