8/3/2019 Change of Benificiary Non Financial Amedment Form

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In this form, you and yourrefer to the policyowner/planholder while we, us, ourand the Companyrefer toSun Life of Canada (Phils), Inc. and/or Sun Life Financial Plans, Inc., both are members of the Sun LifeFinancial group of companies.

You hereby request the Company to effect the change/s indicated below.

Please PRINT clearly.

Use BLACK ink.

General InformationGeneral InformationGeneral InformationGeneral InformationGeneral Information

Detail s of Change(s) Request edDetail s of Change(s) Request edDetail s of Change(s) Request edDetail s of Change(s) Request edDetail s of Change(s) Request ed

00NFA.2.09

Policyowner/ Planholder Name (Last Name, First Name, M.I.)/ Company Name (applicable for group pension plan)

Policy/ Plan Number/ Group Contract No.

This portion is applicableonly if Payor is not thePlanholder of the pensionor educational plan.

PayorPayorPayorPayorPayor

Original Name (Last Name, First Name, Middle Name)

New Last Name New Middle Name

Mailing Address (no., street, municipality)

New First Name

City Telephone No.Zip codeCountry

Please indicate whether request is for:Change Appointment

Please attach the original ora certified true copy of thesupporting legal document.Original copy will bereturned after processing.

Name ChangeName ChangeName ChangeName ChangeName ChangeName Change for Policyowner/ PlanholderLife Insured Company ScholarBeneficiary Others, specify:

New Last Name

Reason

New Middle Name

Original Name (Last Name, First Name, Middle Name) as shown on the Company records

New First NameNew Other Legal Name(s)

Marriage Legal Separat ion For Correction Others, specify:

ScholarScholarScholarScholarScholar

This portion is applicable forEducation plan only.

Original Name (Last Name, First Name, Middle Name)

New Last Name New First Name

Please indicate whether request is for:

Address of Scholar (no., street, municipaliity)

City Country Zip Code Telephone No.

ReasonBirthdate (day/ month/ year) Age (last birthday)

New Middle Name

Male FemaleRelationship to PlanholderSex

Change Appointment

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*00NFA.2.09*

Non-Financial Amendment FNon-Financial Amendment FNon-Financial Amendment FNon-Financial Amendment FNon-Financial Amendment Formormormormorm

8/3/2019 Change of Benificiary Non Financial Amedment Form

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Detail s of Change(s) Request edDetail s of Change(s) Request edDetail s of Change(s) Request edDetail s of Change(s) Request edDetail s of Change(s) Request ed

Unless specified as irrevocable, beneficiaries may be changed.

Beneficiary ChangeBeneficiary ChangeBeneficiary ChangeBeneficiary ChangeBeneficiary Change

Contingent Beneficiary/ ies (Last Name, First Name, M.I.)in the event of death of all primary beneficiary/ ies

Relationship to t he Life Insured/Planholder/ Scholar/ Member

Date of Birth(day/ month/ year)

Fill-out this portion forany other changes that arenon-financial in nature.

Ot her Changes Aff ecti ng Benefi ciaryOt her Changes Aff ecti ng Benefi ciaryOt her Changes Aff ecti ng Benefi ciaryOt her Changes Aff ecti ng Benefi ciaryOt her Changes Aff ecti ng Benefi ciary

Reminders:

Payment of insuranceproceeds/pre-need planbenefits to any designated

beneficiary who is aminor at the time ofpayout will be subject tothe provisions of Article225 of the Family Code ofthe Philippines.

The consent of adesignated irrevocablebeneficiary(ies), whetherhe/she is a minor or oflegal age (i.e. 18 years oldand over), is required forany policy transactions/certain plan transactions.Hence, minors designatedas irrevocable beneficiaries

will be subject to the

provisions of Article 225of the Family Code ofthe Philippines.

Ot her Changes, please speci f yOt her Changes, please speci fyOt her Changes, please speci f yOt her Changes, please speci fyOt her Changes, please speci fy

Signat uresSignat uresSignat uresSignat uresSignat ures

This section must be signedby the policyowner/planholder. For any requestof change of beneficiary, ifthe present beneficiary/ies is/are irrevocable, his/theirsignature/s is/are also needed

to signify consent.

Place of Signing

Signature of Witness

X

Date of Signing (day/ month/ year)

Printed Name

Signature of Irrevocable Beneficiary, if any

XPrinted Name

Signature of Irrevocable Beneficiary, if any

XPrinted Name

Signature of Irrevocable Beneficiary, if any

XPrinted Name

Signature of Policyowner/ Planholder

XPrinted Name

Address of Wit ness (no., street, municipality, city/ province, country, zip code)

You request that the beneficiary/ies presently nominated to receive the proceeds due on death of the life insured/planholder/scholar/member be changed to:

Primary Beneficiary/ ies (Last Name, First Name, M.I.)Relationship to the Life Insured/Planholder/ Scholar/ MemberRevocable/ Irrevocable

Date of Birt h(day/ month/ year)

Please check appropriatebox.

Change is for:

Individual Insurance Pre-Need Plan Optional insurance riders attached to pre-need plan:

GYRT PAP FAP SAP Others, specify:

For Company Use OnlyFor Company Use OnlyFor Company Use OnlyFor Company Use OnlyFor Company Use Only

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Irrevocable Beneficiary/ies - Ifany beneficiary/ies is desig-nated as irrevocable, yourexercise of any right providedby the policy, except any rightprovided by the DividendsProvision, will be subject to theconsent of any beneficiariesdesignated as irrevocablebeneficiaries while they exist.

00NFA.2.09 Page 2 of 2