Sun Life Financial / Financière Sun Life

Administration information

This section is to be completed by the Plan Administrator, or the member with information provided by the Plan Administrator.

Coverage is not in effect until you receive notice of approval from Sun Life Assurance Company of Canada.

Information marked with an * is required.

Benefits requested

Basic Life - member

	A Existing amount of coverage (if applicable):
	B New amount of coverage requested:	*
	C Total amount of coverage (A + B):

Basic Life - spouse

	A Existing amount of coverage (if applicable):
	B New amount of coverage requested:	*
	C Total amount of coverage (A + B):

Basic Life - dependent

	A Existing amount of coverage (if applicable):
	B New amount of coverage requested:	*
	C Total amount of coverage (A + B):

Optional Life - member

Optional Life - spouse

Optional Life - dependent

Long-term disability

Short-term disability

Extended Health - member

Extended Health - dependent

Dental - member

Dental - dependent

Other Benefit

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offered by Sun Life Assurance Company of Canada.