Amendment of Application

Application
In this form, you and your refer to the person being insured and the applicant or the planholder who is named in the application as the buyer
of the pre-need plan, whichever is applicable, while we, us, our and the Company refer to Sun Life of Canada (Philippines), Inc. or Sun Life
Financial Plans, Inc. Both are members of the Sun Life Financial group of companies.
PRINT clearly. Use BLACK ink.

This is in connection with the application for (check appropriate box.): New Business Application Reinstatement, Policy Change, Conversion
Group Application Pre-Need

1 General Information
Life to be insured/Planholder (LastName, FirstName, MiddleName) Client No.

Application Serial No. Policy No. (for Individual Life) Plan No. ( for Pre-Need)

Advisor New Business Office

2 Amendments
The application for this policy/pre-need plan is hereby amended or corrected as indicated below. A copy of this Amendment of Application,
the original of which (signed if an Amendment) is to be retained by the Company, shall be attached to and shall apply to any policy/plan
issued thereon.
COVID-19 QUESTIONS (PRINT clearly. Read each question carefully. Indicate N/A if question is not applicable) Page 1 of 2

1. Are you or have you been in close contact with anyone who has been quarantined or who has been diagnosed with novel coronavirus (SARS-CoV-2/COVID-19)? YES [ ] NO [ ]
If YES, provide details: ____________________________________________________________________________________________________________

2. Have you ever been quarantined due to a possible exposure to novel coronavirus (SARS-CoV-2/COVID 19)? YES [ ] NO [ ]
If YES, provide duration of quarantine period: __________________________________________________________________________________________

3. Have you ever been advised to be tested to rule in, or rule out, a diagnosis of novel coronavirus (SARS-CoV-3. COVID-19)? Or, are you awaiting the result of a test which has already been submitted for the novel coronavirus
(SARS-CoV-2/COVID-19)? YES [ ] NO [ ]. If YES, provide copy of the test result.

4. Have you ever tested positive for the novel coronavirus (SARS-CoV-2/COVID-19)? YES [ ] NO [ ]
If YES to Question 4, answer Questions 5 (a to e). If NO, please proceed to answer Question 6.

5. On what date were you diagnosed with SARS-CoV-2/COVID-19? ________________________________________________

a. At any time did you require admission to hospital for observation, quarantine, or treatment of COVID-19? YES [ ] NO [ ]
If YES, please continue answering the ff questions:
- Was admission for observation or quarantine purposes only and at no time did you have symptoms and/or require treatment? YES [ ] NO [ ]
- Date of admission: (DD/MM/YYYY) _________________ Date of discharge: (DD/MM/YYYY) _____________________
- Did you require treatment in the intensive care unit (ICU)? YES [ ] NO [ ]
- Did you require a machine to help you breathe? YES [ ] NO [ ]
- Did you experience any complications such as lung (respiratory), kidney, liver, or heart problems related to the COVID-19 infection? YES [ ] NO [ ]
If YES, provide details: _____________________________________________________________________________________________________

3 Signatures
By signing below, you hereby declare that all declarations by the life to be insured or by the planholder and by the applicant, if the applica-
tion includes a waiver of premium benefit, made from the time the application for the life insurance coverage was completed to the date of
signing of this Amendment of Application form remain true and correct.
You hereby agree that this declaration as to your insurability and the above amendments will form part of the application.
Place of Signing Date of Signing (day/month/year)

Signature of Life to be insured (if other than the applicant) Printed Name
X
Signature of Applicant/Planholder Printed Name

X
Signature of Witness Printed Name
X
4 Corrections (for Company use only)
Acceptance of the policy/plan by the applicant/planholder, constitutes a ratification of these corrections which form part of the application.

0AOA.05.13
*0AOA.05.13*
Amendment of Application
Application
In this form, you and your refer to the person being insured and the applicant or the planholder who is named in the application as the buyer
of the pre-need plan, whichever is applicable, while we, us, our and the Company refer to Sun Life of Canada (Philippines), Inc. or Sun Life
Financial Plans, Inc. Both are members of the Sun Life Financial group of companies.
PRINT clearly. Use BLACK ink.

This is in connection with the application for (check appropriate box.): New Business Application Reinstatement, Policy Change, Conversion
Group Application Pre-Need

1 General Information
Life to be insured/Planholder (LastName, FirstName, MiddleName) Client No.

Application Serial No. Policy No. (for Individual Life) Plan No. ( for Pre-Need)

Advisor New Business Office

2 Amendments
The application for this policy/pre-need plan is hereby amended or corrected as indicated below. A copy of this Amendment of Application,
the original of which (signed if an Amendment) is to be retained by the Company, shall be attached to and shall apply to any policy/plan
issued thereon.
5. b. Are you still experiencing symptoms at the present time? YES [ ] NO [ ] Page 2 of 2
If YES, provide details: ______________________________________________________________________________________
c. Do you have any pending or recommended follow-up appointments or tests related to your COVID-19 diagnosis? YES [ ] NO [ ]
If YES, provide details: ______________________________________________________________________________________
d. Date of complete recovery: (DD/MM/YYYY) ______________________________________
e. If employed, have you been certified to return to work on an unrestricted and full-capacity basis? YES [ ] NO [ ]

6. Have you been vaccinated for SARS-CoV-2/COVID-19? YES [ ] NO [ ]

If YES, please provide complete details below and answer questions 7 and 8. If NO, please proceed to Question 8.
Vaccine Brand: _____________________________
a. Date of first vaccination: (DD/MM/YYYY) _______________ b. Date of second vaccination (if applicable): (DD/MM/YYYY) ________________
Have you received a booster dose for COVID-19? YES [ ] NO [ ]
If YES, please provide complete details including vaccine brand and date given: __________________

7. Other than the common side effects of the vaccine, are you experiencing any ongoing serious or adverse after-effects from the vaccination e.g. anaphylaxis (severe, potentially life-threatening
allergic reaction), thrombosis formation (blood clots) combined with thrombocytopenia (low platelet levels), difficulty of breathing, chest pain or chest heaviness, rapid or abnormal heart rhythms
(arrhythmias), pricking or pins and needles sensations in the hands and feet, coordination problems and unsteadiness, persistent ringing in the ear? YES [ ] NO [ ]
If YES, provide complete details: __________________________________________________________________________________________________________

8. Are you currently in good health, and able to work full time or carry out normal daily activities? YES [ ] NO [ ]

3 Signatures
By signing below, you hereby declare that all declarations by the life to be insured or by the planholder and by the applicant, if the applica-
tion includes a waiver of premium benefit, made from the time the application for the life insurance coverage was completed to the date of
signing of this Amendment of Application form remain true and correct.
You hereby agree that this declaration as to your insurability and the above amendments will form part of the application.
Place of Signing Date of Signing (day/month/year)

Signature of Life to be insured (if other than the applicant) Printed Name
X
Signature of Applicant/Planholder Printed Name

X
Signature of Witness Printed Name
X
4 Corrections (for Company use only)
Acceptance of the policy/plan by the applicant/planholder, constitutes a ratification of these corrections which form part of the application.

0AOA.05.13
*0AOA.05.13*