Amendment of Application

In this form, your 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 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: Group ApplicationRe-Need

Reinstatement, Policy Change. Conversion

tifetobeinaured Ranholder (LastName ArstName MiddleName)

Client No.

Applicat on SerialNo.

Policy No. for individualtife)

RanNo. (for to Need)

Advisor

Now BusinessOffice

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.

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.

Race of Signing

Date of Signing (day month year)

Date

Sgnature of Ufe to be insured # other than the applicant)

RintedName

Sonatureof Applicant/ Ranholder

Printed Name

Pinted 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.