Supplementary Questions concerning Use of Alcohol

Please PRINT clearly. Use BLACK ink.

In this form, you and your refer to the person being insured, 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.
1. General Information
Name (Last, First, Middle)
Policy No.
Client No.
New Business Office
2. Questions

The person being insured must answer the following questions. Please indicate details for each question on the space provided.
1. Do you currently drink alcohol?
State amount and frequency. (state quantity as glasses, shots, bottles, etc
wine
whiskey
brandy
liquour
beer
gin
other types of alcoholic drinks
2. Has your driving license ever been suspended for an alcohol related offense?

Yes
3. Have you ever been advised to reduce your consumption of alcohol? By whom, reason and amount previously consumed.

Yes
4. Have you stopped drinking alcohol ?When, why and amount previously consumed.

Yes
5. Have you received treatment for alcoholabuse?Where, when and medication prescribed.

Yes
6. Have you ever been a member of A.A. ?

Yes
6a. For how long were you a member?

Yes
6b. Are you now a member of A.A. ?

Yes
6c. Do you regularly attend A.A. meetings?

Yes
6d. Do you have a sponsor?

Yes
3. Signatures

This section must be signed by the person being insured and, the parent, if applicable. You hereby agree that this form part of your application for insurance on your life.
Place of Signing
Date of Signing (day/month/year)

DayMonthYear
Date
Signature of person being insured if age is 16 and over
Printed Name
Signature of parent if proposed insured is below 18 years old
Printed Name
An Online Form by Jojo Porquez.
Should be Empty:

1. General Information

2. Questions

3. Signatures