I understand I may be refused those group benefits or any benefit amounts for which proof of good health is required if, in the opinion of Sun Life Assurance Company of Canada, I am not insurable.

I certify that all the statements in this form are true and complete. I understand that the intentional falsification, misrepresentation or omission of information on or relating to this form constitutes fraud and coverage granted may be voided.

I, for myself and on behalf of my spouse or dependent child who is age 18 years or older, and being duly and specifically authorized to do so, authorize Sun Life Assurance Company of Canada, its agents and service providers to use and exchange information needed for underwriting, administrating and adjudicating claims under this Plan with any person or organization who has relevant information about me, my spouse and/or dependents (if applicable), pertaining to this Health Statement. This includes any health professionals, institutions, investigative agencies, insurers, reinsurers and Third Party administrator retained by my plan sponsor to administer this group contract.

If this Health Statement is being submitted on behalf of my spouse and/or dependents, I am authorized to disclose information about them, for the purposes of underwriting, administrating and adjudicating claims. I confirm that my spouse and/or dependents, if any, also authorize Sun Life Assurance Company of Canada to disclose information about this Health Statement to me, for the purpose of assessing this statement and managing my group benefits plan.

If I apply for other Sun Life Financial products, the information in this Health Statement may be used to determine my eligibility.

I agree that a photocopy of this authorization or electronic version is as valid as the original and shall continue to have effect throughout the duration of my coverage under this group contract.