SunLife – Beneficiary Designation

SunLife – Beneficiary Designation
Name*

First NameLast Name
Middle Initial
SSN*
Beneficiary designation

For primary beneficiaries, indicate who should receive the group life or AD&D insurance proceeds in the event of your death. For secondary, (also known as contingent) beneficiaries, indicate who should receive the group life insurance proceeds in the event that ALL of your primary beneficiaries are not living at the time of your death. Please make your beneficiary designation(s) below. If you need more space, attach another sheet to this form.You may designate more than one Primary or Secondary Beneficiary. If you do, make sure to indicate the percentage share each should receive. The total within each class (Primary and Secondary) must equal 100%. If you do not specify percentages, surviving beneficiaries within the class will share proceeds equally.

*must equal 100%
Primary Beneficiary 1 Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Primary Beneficiary 2 Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Primary Beneficiary 3 Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Primary Beneficiary 4 Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Secondary Beneficiary Designation

On the lines below, list the individual(s) who should receive the proceeds ONLY IF ALL of the individuals listed above are not living at the time of your death. This is your secondary (or contingent) beneficiary. The Secondary beneficiary is not paid if a primary beneficiary is alive at the time of your death. Attach additional pages if necessary.

*must equal 100%
Secondary Beneficiary 1 Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Secondary Beneficiary 2 Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Secondary Beneficiary 3 Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Secondary Beneficiary 4 Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Please Note: You cannot name your Employer as a beneficiary for Group Life Insurance proceeds under the Group Policy. Unless you specifically instruct otherwise, your beneficiary designation will be revocable.

Dependent Life Insurance benefits are payable to the Employee. If the Employee does not survive the Dependent,

Dependent Life Insurance benefits will be paid to the Employee's estate.

Sun Life Assurance Company of Canada is not a tax or legal advisor and the above information is provided as general information only. Before making beneficiary designations, you may want to consult with your tax or legal advisor.
Employee Signature*

Clear
Date*

MonthDayYear
Date
CEI Human Resources will retain a paper copy of your beneficiary form and will send a copy to your CEI email address; please print for your records.
Should be Empty:

Beneficiary designation