Amendment of Applica
tion
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.):
1
New Business Application
Group Application
✔
Reinstatement, Policy Change, Conversion
Pre-Need
General Information
Life to be insured/Planholder (LastName, FirstName, MiddleName)
Client No.
DELA CRUZ, ARDEN ZACHARY, GALANO
Application Serial No.
Policy No. (for Individual Life)
Plan No. ( for Pre-Need)
0835102939
Advisor
New Business Office
Eucalyptus
Joy Marie B. Regalado
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.
Exact Height = 31 Inches
Exact Weight = 10 Kilogram
Exact Cause of Grandmother's Kidney Failure - Too much drinking of Carbonated drinks specifically
softdrinks
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 application 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)
GAMU, ISABELA
Signature of Life to be insured (if other than the applicant)
X
Printed Name
LUDY FATIMA G. DELA CRUZ
Signature of Applicant/Planholder
X
Printed Name
LUDY FATIMA G. DELA CRUZ
Signature of Witness
X
4
13/03/2022
Printed Name
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*