Supplementary Questions concerning Use of Alcohol

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 questions 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?
State the offense and date.
3. Have you ever been advised to reduce your consumption of alcohol?
By whom, reason and amount previously consumed.
4. Have you stopped drinking alcohol?
When, why, and amount previously consumed.
5. Have you received treatment for alcohol abuse?
Where, when, and medication prescribed.
6. Have you ever been a member of A.A.?
a) For how long were you a member?
b) Are you now a member of A.A.?
c) Do you regularly attend A.A. meetings?
d) Do you have a sponsor?
Information:
3. Signatures

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

MonthDayYear
Date
Printed Name
Person being insured if age is 16 and over
Printed Name
Parent if proposed insured is below 18 years old
Should be Empty:

Supplementary Questions concerning Use of Alcohol

1. General Information

2. Questions

3. Signatures