SUN LIFE FINANCIAL - PHILIPPINES INFORMATION SHEET (Pls. attach xerox of any valid I.D) [APt CICANT | OWNER. DATE FAMILY NAME GIVEN NAME MIDDLE NAME BIRTHDATE BIRTHPLACE AGE (LAST BDAY) HEIGHT WEIGHT. bs, “SMOKERT NON-SMOKER CIVIL STATUS Mr Mrs (Miss C) RELIGION TIN sss Gsis ‘OCCUPATION NATURE OF BUSINESS EMPLOYER BUSS ADDRESS BUS TELNO TELIFAX EMAIL HOME NO MOBILE Est. Annual income ‘Ave: Nonthiy Expense HOME ADDRESS MAILING ADDRESS. 's tee any intention to reside outside the Philppines? Yes _ No __if"Yes', spect coutry and purpose De —————————————————— FAMILY NAME GIVEN NAME MIDDLE NAME BIRTHDATE: BIRTHPLACE [AGE (LAST 8.04Y) HEIGHT WEIGHT PHYSICIAN ‘OCCUPATION EMPLOYER: NATURE OF BUSINESS BUS TEL NO "ANNUAL INCOME [FAMILY HISTORY (INSURED) AGE [BIRTHDATE [STATE OF HEALTH | AGE ATDEATH | CAUSE OF DEATH [FATHER [MOTHER [BROTHERS = [SISTERS [PRIMARY SENEFICIARY. SIRTHDATE| RELATIONSHIP [CONTINGENT BENEFICIARY AGE SRTHDATE] RELATIONSHIP ENDOWMENT BENEFICIARY RELATIONSHI [PRIMARY [CONTINGENT FAMILY NAME GIVEN NAME MIDDLE NAME BIRTHDATE. BIRTHPLACE AGE (LAST B-DAY)’ HEIGHT WEIGHT RELIGION civit status WO We WO RELIGION TIN sss Gsis OCCUPATION NATURE OF BUSINESS EMPLOYER BUSS ADDRESS BUS TEL NO. TELFAX ENA HOME NO MOBILE Est Annual income HOME ADDRESS IF CHILD UNDER AGE 5 (INDICATE) PHYSICIAN / ADDRESS WEIGHT AT BIRTH HEIGHT AT BIRTH ‘SIGNATURE OVER PRINTED NAME / DATE