CONSENT TO OBTAIN INFORMATION FROM CLIENT

I consent to Sun Life and its partner medical examiner conducting medical examination on me via video-
conferencing tool. I understand that the process will involve two-way audit and video, patient video and
still images, medical images, patient’s medical records and other information pertinent to the
examination. I agree not to record in video or audio format the online examination that will be performed.

I understand that I may be asked to provide my vital signs, medical history, laboratory tests, imaging
results, lifestyle and other relevant medical information. I acknowledge that I may also be asked to show
certain body parts as part of the examination. This is in view of the fact that the medical examiner will not
be in the same room as I am and would not be able to conduct the necessary physical examination on me.

I recognize and accept the risks in using this technology, which may include, but not limited to technical
difficulties, interruption, poor transmission on images which may lead to wrong conclusion in the
examination, delays and deficiencies due to malfunction of electronic equipment and software, and
unauthorized access leading to breach of data privacy and confidentiality. The examination is considered
confidential but given the nature of technology, I understand that despite the reasonable measures
employed, Sun Life and its partner medical examiner cannot guarantee absolute protection of my personal
data from hacking. Therefore, I cannot hold Sun Life and its partner medical examiner accountable for any
data that may be lost or breached despite reasonable measures in place.

With the above, I agree to Sun Life and its partner medical examiner processing my information. I certify
that I 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

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Printed Name and Signature of Client

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Date Signed