Variable Life Insurance -

Request for Fund Withdrawal

For Company Use Only In this Applica on, “you” and “your” mean persons whose informa on we are processing or disclosing. We, us,
our and the Company refer to Sun Life of Canada (Phils.), Inc., a member of the Sun Life group of companies.
Pick up Date :
Pick up Time :
Pick up Loca on : Please write legibly by using capital le ers. Write N/A if ques on is not applicable. Mark the box(es) with
Received Date :
an “X” to indicate your choice(s) then sign the form when completely filled out.

1 General Informa on
Policy Owner (Last Name, First Name, M.I.) Policy Number

Ci zenship Country/ies of Legal Residence other than the Philippines

Present Residence Address (No., Street, Municipality/City, Province, Country, Zip Code(P.O. Box is not acceptable)

Permanent Residence Address (No., Street, Municipality/City, Province, Country, Zip Code(P.O. Box is not acceptable)

Work Address (No., Street, Municipality/City, Province, Country, Zip Code(P.O. Box is not acceptable)

Do you want us to update the mailing address on your exis ng Life Insurance Policies? (Considered NO if unanswered)
Yes (All policies) Yes (Only the policy specified in this form) No
If Yes, pls mark the box with an X to indicate your choice: Present Residence Address Permanent Residence Address Work Address

Home Phone Work Phone Mobile Phone Email Address

(Country Code, Area Code ,Tel. No) (Country Code, Area Code ,Tel. No) (Country Code, Mobile No.)

Note : Your contact informa on will be updated based on above

Life Insured (Last Name, First Name, M.I.) if different from Policy Owner

2 Request Details
You hereby request for a withdrawal from the Fund Value, in accordance with the Fund Withdrawal provision of your policy, as specified below:
Currency Amount in words and figures
US $ Php

Special Instruc ons (Op onal, specify for which Fund and the corresponding amount)

3 Acknowledgement and Agreement

This sec on must be signed by the policy owner, assignee and all of the nominated irrevocable beneficiaries and witnessed by an Advisor or Staff of Sun Life of Canada (Philippines), Inc. If signed
before a disinterested witness, please have the form notarized by a notary public by affixing his/her signature and official seal at the back of this form.

If this form is signed outside the Philippines, please have the form authen cated or notarized by the nearest Philippine Consul in your locality.

If the policy owner or irrevocable beneficiary is a minor (less than 18 years of age) or incompetent, the legal guardian should sign on his/her behalf. Addi onal documents may be required from
the said guardian. If any of the irrevocable beneficiaries has passed away, addi onal documents may be required.

By affixing your signature and presen ng valid ID, you confirm, agree and hereby authorize the Company to honor and effect transac ons on the basis hereof:

a. You will inform us within 30 calendar days of any changes in your circumstances, including but not limited to ci zenship(s)/na onality (-ies), and submit the applicable documents accordingly.

b. You acknowledge the Company’s statutory responsibility to provide your informa on, including but not limited to local or foreign tax status, to the appropriate authority.

c. You acknowledge that the Company, its employees, duly authorized representa ves, related companies, third party service providers, and vendors shall process and share your and the
insured’s informa on, with any person or organiza on to (i) service this account, (ii) process transac ons and enforce contract, and (iii) pursue its legi mate and lawful rights and interests and
other purpose allowed under laws and regula ons, including but not limited to, those rela ng to data privacy and an -money laundering.

VRFW.05.23
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 3 Acknowledgement and Agreement (Con nua on)
d. You (i) agree to the processing of your personal data in accordance with, and for purposes declared in, the Company’s Privacy Policy available at h ps://online.sunlife.com.ph/privacy and for
the addi onal purpose of implemen ng your request/instruc ons herein; and (ii) reaffirm your consent to the processing of your personal data as recorded in your most recent
insurance applica on form, and acknowledge that such consent con nues to be in full force and effect.
e. You agree to indemnify and hold free and harmless the Company, its affiliates, directors, employees, legal representa ves, and assignees against loss and damage from any claims and/or
ac ons made by any third person including the par es to this policy or their representa ves in rela on to the processing of this request.
f. If release of proceeds is through Telegraphic Transfer - Credit to Account and/or Currency Conversion op on, you confirm and agree that:
1. The informa on and details are correct and that you declare under the penalty of fraud that you are the owner of the stated bank account number;
2. You will shoulder any bank charge fees and charges related to the deposit to your account;
3. Deposit of the amount through your designated bank account number or account name fully releases and discharges the Company from any claims or liabili es related thereto;
4. You shall indemnify and hold the Company free and harmless from and against any and all claims, losses, including opportunity loss, damages, or expenses as a result of your credit to
account and/or currently conversion request, including any misrepresenta on as to the owner of the bank account, and/or failure of your bank or its intermediary to honor the transac on.

IMPORTANT
Your Variable Life product is an insurance plan with Investment Component. Frequent fund withdrawals and subsequent reinvestment of this amount
will incur new premium charges. As such, the policy may not match the financial objec ve you have set forth at the me of applica on.

Signature of Policy Owner Printed Name

X
(New) Signature Specimen (New) Signature Specimen
X X
Signature of Witness Printed Name
X
Address of Witness (no.,street,municipality,city/province,country,zip code)
(If witness is a Sun Life Advisor, write the NBO and advisor’s code, if Sun Life employee, write the Client Service Center)

Place of Signing Date of Signing

Month - Day - Year

Signature of Assignee Printed Name Date of Signing

X Month - Day - Year
Signature of Irrevocable Beneficiary, if any Printed Name Date of Signing
X
Month - Day - Year

Signature of Irrevocable Beneficiary, if any Printed Name Date of Signing

X Month - Day - Year

Signature of Witness Printed Name

X
Address of Witness (no.,street,municipality,city/province,country,zip code)
(If witness is a Sun Life Advisor, write the NBO and advisor’s code, if Sun Life employee, write the Client Service Center)

Place of Signing Date of Signing

Month - Day - Year

4 Notariza on
Before me, a Notary Public for and in the City of ________________________________________________, this _______________ day of
___________________ 20____,___________________________________ personally appeared before me and exhibited to me his/her (valid ID)
____________________________ issued on____________at_______________, known to me and to me known to be the same person who executed
the foregoing document that is duly signed by him/her and acknowledged to me that the same is his/her free and voluntary act and deed, consis ng of
_______ (__) pages including this page on which this Acknowledgment is wri en.
Doc No.:
Page No.:
Book No.:
Series of

VRFW.05.23 Page 2 of 3
 5 Special Instruction
Indicate how you would want to receive the proceeds. Choose from the following options:
Note : Use BPI Remittance Instruction Form for Pick Up at Any BPI Branch or Door-to-Door Delivery
Check (Deposit to account only)

RCBC Demand Dra (for US$ policy)

Branch Address for Encashment

Telegraphic Transfer - Credit to Account and/or Currency Conversion

Mark “A” if request is for deposit to local bank. Mark “B” if request is for currency conversion and to deposit through cross border (overseas)
transfer for clients living overseas.
A be credited to your bank account
B be converted to ( please mark your preferred currency)

US Dollar Canadian Dollar *Others, please specify_________________________

Please provide the following informa on below:

Account Name

Account Number

Name of Bank

Address of Bank

Rou ng or Serial Number (applicable for le er B only) Swi Code Number (applicable for le er B only)

* Subject to availability of the currency in the bank

Notes:
1. Please ensure that you provide the correct account informa on. The Company will not be liable if the remi ance is credited to an
erroneous bank account number.
2. Submit any of the following proofs of bank account:
Bank Statement of Account First Page of the Passbook ATM card (with account name and number)
Certificate of Bank Deposit Check (with account name)

The bank account number and the account name must appear on one (1) page and should be readable and clear.
Please mask account details and names of other account holders, if any. The Company may require presenta on of addi onal documents to
validate submission.

VRFW.05.23 Page 3 of 3

Pick Up Stub for VUL- Request for Fund Withdrawal

Please present this stub together with: Policy Number

a) One (1) Original Valid ID of Policy Owner
b) One (1) Original Valid ID of Policy Owner and Policy Owner
Representa ve if Policy Owner is unable to pick-up
the check personally. The check will be ready for pick up on:
c) Authoriza on Le er if Policy Owner is unable to
pick-up the check personally (Please indicate the Policy Number) Date at Place Time