Complete Name*

Prefix First Name Middle Name Last Name Suffix

Birth Date

Month Day Year

Birthplace*

Age*

Civil Status*

Gender at Birth*

Present Address*

No., Street, Subdivision, Barangay

City

Province

Postal / Zip Code

Active E-mail Address*

example@example.com

Mobile Number*

Country Code Mobile Number

TIN*

SSS or GSIS Number*

Current Work*

Total Years of Employment*

Name of Company / Business*

Nature of Business / Company*

Company / Business Address*

No., Street, Subdivision, Barangay

City

Province

Postal / Zip Code

Annual Income*

Beneficiary Name (1)*

Prefix First Name Middle Name Last Name Suffix

Birth Date

Month Day Year

Birthplace*

Mobile Number*

Current Address*

Relationship to the Beneficiary*

Beneficiary Name (2)*

Prefix First Name Middle Name Last Name Suffix

Birth Date

Month Day Year

Birthplace*

Mobile Number*

Current Address*

Relationship to the Beneficiary*

Beneficiary Name (3)*

Prefix First Name Middle Name Last Name Suffix

Birth Date

Month Day Year

Birthplace*

Current Address*

Relationship to the Beneficiary*

Height*

Weight*

Name of Clinic / Hospital you went for the past 5 years*

Location of the Clinic / Hospital*

Date of Medical Check-up / Exam*

Medical Exam / Check-Up Purpose and Result*

Age of Father if still alive, any medical condition? Age of death, and cause if applicable*

Age of Mother if still alive, any medical condition? Age of death, and cause if applicable*

Age of Sister(s) if still alive, any medical condition? Age of death, and cause if applicable*

Age of Brother(s) if still alive, any medical condition? Age of death, and cause if applicable*

Do you have any immediate relatives working in government?

For women, do you have any gynecological problem?

For women, did you have any complication on pregnancy?

What is your purpose in getting this insurance policy?

If you're getting an insurance with investment plan, describe what kind of investor are you?

Conservative (not willing to lose money) - Bonds, Money Market Funds Moderate (not conservative and not aggressive) - Balanced Fund Aggressive (willing to invest in more fluctuating options) - Index (Stock Market), Equity

Valid Government ID (1)*

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Valid Government ID (2)

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Selfie with ID*

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Signature

Clear

Mode of Payment

GCash - Bank Transfer, RCBC, Account Name - Sun life of Canada Phils., Inc. Account Number - 3001008438 BPI - Transfer online to 0073175437, Name - Sun life of Canada (Phils.), Inc. BDO - Transfer online to 00460028464, Name - Sun life of Canada (Phils.), Inc. RCBC - Transfer online to 3001008438, Name - Sun life of Canada (Phils.), Inc. Security Bank - Transfer online to 0514018635201, Name - Sun life of Canada (Phils.), Inc. PayMaya - Bank Transfer, RCBC, Account Name - Sun life of Canada Phils., Inc. Account Number - 3001008438 I'll make a payment later

Upload your transaction / payment screenshot here

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If payment is not made throughout this form, let me know the date you plan to make the transaction*

Online Application Form

Personal Details

Beneficiaries

Health Information

Additional Questions for Insurability

Identification

Payment