Beneficiary Change Request

In this form you and your refer to the policy owner, while we, us, our, and the Company refer to Sun Life of Canada (Philippines), Inc., a member of the
Sun Life Financial group of companies.

Purpose of the form:

This form is used to change the designated beneficiaries who will receive the benefits in the event of the insured’s death.

IMPORTANT NOTES:
You must accomplish and submit the completed form and a copy of your valid ID through any of our Client Service Centers or email to [email protected].

Please write legibly using capital letters. Write N/A if question is not applicable. Mark the box(es) with an “X” to indicate your choice(s) then sign the form
only when completely filled out.

This form is used only after the policy has been issued.

A General Information

1. Policy Number(s)
For Individual Policy Owner

Last Name

First Name M.I.

For Company/Business Policy Owner

Company or
Business Name

B Beneficiary Change Details

Reminders:
• Revocable Beneficiary(-ies) can be changed by the owner of the policy(-ies) without the consent of the beneficiary.
• Irrevocable Beneficiary(-ies) are those who, while they exist or are living, must give their written consent to:
a. Their removal
b. Their replacement
c. The assignment of the policy as collateral security
d. The transfer of ownership of the policy
e. Financial transactions affecting this/these policy(-ies) (e.g. policy advance, policy surrender, or fund withdrawal)
• A beneficiary who is a minor will be subject to all the laws protecting minors. This includes the representation by a guardian as provided by law.
• If you specify percentage sharing, the share of a beneficiary who dies while the insured is alive will be equally distributed among the surviving
co-beneficiaries.

Add Beneficiary(-ies) Remove Beneficiary(-ies) Change of Beneficiary Information

Proceed to items 2 to 17, then complete Proceed to items 18 to 19, then Proceed to item 20, then complete items
items 21 and onwards complete items 21 and onwards 21 and onwards

B.1 Add Beneficiary(-ies)

Kindly complete the needed information below to add beneficiary(-ies) to your policy.

Beneficiary #1
2. Name (Last Name, First Name, M.I.)/Company or Business Name

3. Birthdate/Date of Incorporation or Business Registration Day Month Year 4. Designation

(e.g. 08-AUG-2008)
Revocable Irrevocable

5. Country of Birth/Incorporation or Business Registration 6. Citizenship(s)/Nationality(-ies)

7. Relationship to the life insured 8. Beneficiary Type
Primary
Father Mother Employer Others, specify Contingent [in the event of death of all primary beneficiary(-ies)]

9. Address [No., Street, Village/Subdivision, Barangay, City/Municipality, Province/State, Country (P.O. Box is not acceptable)]

BCR.01.19
*BCR.01.19* Page 1 of 4
 B.1 Add Beneficiary(-ies) (continuation)
Beneficiary #2
10. Name (Last Name, First Name, M.I.)/Company or Business Name

11. Birthdate/Date of Incorporation or Business Registration Day Month Year 12. Designation
(e.g. 08-AUG-2008)
Revocable Irrevocable

13. Country of Birth/Incorporation or Business Registration 14. Citizenship(s)/Nationality(-ies)

15. Relationship to the life insured 16. Beneficiary Type

Primary
Father Mother Employer Others, specify Contingent [in the event of death of all primary beneficiary(-ies)]

17. Address [No., Street, Village/Subdivision, Barangay, City/Municipality, Province/State, Country (P.O. Box is not acceptable)]

B.2 Remove Beneficiary(-ies)

Kindly complete the information below to remove existing beneficiary(-ies).

18. Name (Last Name, First Name, M.I.)/Company or Business Name

19. Name (Last Name, First Name, M.I.)/Company or Business Name

B.3 Change of Beneficiary Information

Kindly complete the information below to update or correct any existing beneficiary information.

20. Original Beneficiary Name (Last Name, First Name, M.I.)/Company or Business Name (as it appears in the policy contract)


Kindly select information to update.

For Individual Policy Owner

Last Name, First Name, M.I.
Name

M.I.

New Other Legal Name(s)

Day Month Year

Birthdate (e.g. 08-AUG-2008)

Designation Revocable Irrevocable

Country of Birth


Citizenship(s)/Nationality(-ies)

Relationship to the life insured Father Mother Others, specify

Beneficiary Type Primary Contingent [in the event of death of all primary beneficiary(-ies)]

[No., Street, Village/Subdivision, Barangay, City/Municipality, Province/State, Country (P.O. Box is not acceptable)]

Address

BCR.01.19 Page 2 of 4
 B.3 Change of Beneficiary Information (continuation)

For Company/Business Policy Owner

Company or Business Name

Relationship to the life insured Employer Others, specify

Country of Incorporation or Business Registration

Designation Revocable Irrevocable

Day Month Year

Date of Incorporation or Business Registration
(e.g. 08-AUG-2008)

[No., Street, Village/Subdivision, Barangay, City/Municipality, Province/State, Country (P.O. Box is not acceptable)]

Business Address

C Compliance with Regulatory Requirements

The following information is collected for regulatory compliance.

21. Has there been any change in your citizenship(s)/nationality(-ies) or country of legal residence?
Yes, I am a citizen/national and a legal resident of (specify country).
Yes, I am a citizen/national of (specify country) but I legally reside in (specify country).
None

D Signatures

By signing, you confirm your understanding and agreement to the following:

a. You will inform us within 30 calendar days of any change in your circumstances, including but not limited to citizenship(s)/nationality(-ies), and
submit the applicable documents accordingly.
b. You acknowledge the Company’s statutory responsibility to provide your information, including but not limited to local or foreign tax status, to the
appropriate authority.
c. You acknowledge that the Company, its employees, duly authorized representatives, related companies, third party service providers, and vendors shall
process and share your and the insured’s information, with any person or organization to (i) service this account, (ii) process transactions and enforce
the contract, and (iii) pursue its legitimate and lawful rights and interests and other purposes allowed under laws and regulations, including, but not
limited to, those relating to data privacy and anti-money laundering.
d. Your personal data shall be retained throughout the existence of your account(s) and/or until expiration of the retention limit set by laws and
regulations from account closure and the period set for destruction or disposal of records. You certify that you have read, understood, and agreed with
the declarations and authorizations above, including Sun Life’s privacy policy found in https://apps.sunlife.com.ph/privacy.
e. If the creditor is the beneficiary, the death benefit will be paid to him/her or his/her designated successors. Benefits in excess of what is due to the
creditor will be paid to the other beneficiaries.
f. You agree to indemnify and hold free and harmless the Company, its affiliates, directors, employees, legal representatives, and assignees against loss
and damage from any claims and/or actions made by any third person including the parties to this policy or their representatives in relation to the
processing of this request.

If the policy owner or assignee is not an individual (e.g. company/business), the signature and title of the authorized signatory is required.

For Policy Owner/Authorized Signatory

22. Signature of Policy Owner 23. Printed Name

24. Signature of Authorized Signatory #1 (For Company/Business Policy Owner) 25. Printed Name and Job Title

26. Signature of Authorized Signatory #2 (For Company/Business Policy Owner) 27. Printed Name and Job Title

28. Signature of Witness 29. Printed Name

30. Place of Signing 31. Date of Signing Day Month Year

(e.g. 08-AUG-2008)

BCR.01.19 Page 3 of 4
 D Signatures (continuation)
For Irrevocable Beneficiary, if any
32. Signature of Irrevocable Beneficiary #1 33. Printed Name

34. Signature of Witness 35. Printed Name

36. Place of Signing 37. Date of Signing Day Month Year

(e.g. 08-AUG-2008)

38. Signature of Irrevocable Beneficiary #2 39. Printed Name

40. Signature of Witness 41. Printed Name

42. Place of Signing 43. Date of Signing Day Month Year

(e.g. 08-AUG-2008)

For Assignee, if any

44. Signature of Assignee 45. Printed Name

46. Signature of Authorized Signatory #1 (For Lender Institution) 47. Printed Name and Job Title

48. Signature of Authorized Signatory #2 (For Lender Institution) 49. Printed Name and Job Title

50. Place of Signing 51. Date of Signing Day Month Year

(e.g. 08-AUG-2008)

Let us serve you better!

Should there be any change in your information, kindly complete the section below.

52. Mailing Address (P.O. Box is not acceptable) Permanent Home Address Present Home Address Work Address
53. Address [No., Street, Village/Subdivision, Barangay, City/Municipality, Province/State, Country (P.O. Box is not acceptable)] 54. Zip Code

55. Work Phone (country code, area code, & tel. no., e.g. +63285558888) 56. Home Phone (country code, area code, & tel. no., e.g. +63285558888)

+ +
57. Mobile Phone (country code, mobile no., e.g. +639123456789)

+
58. Email Address

59. Do you want us to update the information on all your existing Life Insurance Policies and Pre-need Plans? (Considered NO if unanswered)
Yes No [Only policy(-ies) specified in this form will be changed]

60. Would you like to receive personalized communication and product offers from Sun Life of Canada (Philippines), Inc. (SLOCPI); Sun Life Financial
Plans, Inc. (SLFPI); Sun Life Asset Management Company, Inc. (SLAMCI); and other members of the Sun Life Financial group that may help with
your financial needs? Yes No

For Office Use Only

BCR.01.19 Page 4 of 4