issued by Sun Life Assurance Company of Canada

Transcription

1 Sun Life Assurance Company of Canada Electronic Signature Form - May Updated with CPA requirements Only to be used in conjunction with the Sun Life Financial Electronic Application Including SunWise Elite Plus is an individual variable annuity contract issued by Sun Life Assurance Company of Canada, a member of the Sun Life Financial group of companies. managed by CI Investments Inc. issued by Sun Life Assurance Company of Canada

2 What you understand and agree to when you sign this application. Your signature in the Owner Acknowledgement/Authorization section of this application confirms you understand the following: Annuitant Designation For Registered Contracts, the Annuitant must be the Owner. For Non-Registered Joint Ownership Contracts, if no single Annuitant is named, the Contract will be deemed to have Joint Annuitants and the Contract Maturity Date will be determined based on the age of the younger Annuitant. Investment Directions the fund code selected will determine the guarantee class and sales charge option of the units invested a minimum of $50 per fund is required for PACs. to invest in Plus (GMWB) you must allocate the $25,000 minimum required to Plus (GMWB) fund codes ending in P as shown on the attached fund list. Beneficiary Designation the beneficiary designation is revocable, unless the owner designates the beneficiary as irrevocable. for Contracts signed in Quebec, the relationship of the beneficiary must be to the owner and the designation of a spouse (married or civil union) as beneficiary is irrevocable unless the Owner indicates revocable in the Beneficiary Designation section of the Application. the person(s) is (are) appointed as the beneficiary(ies) of the Contract in the event of the death of the Annuitant, if living at the date of that death. if the beneficiary(ies) predecease the Annuitant, the contingent beneficiary, if still alive at the death of the Annuitant, shall receive that share of the death benefit. the contingent beneficiary listed in section 8 applies to the primary beneficiary of the same row in all provinces other than Quebec, if you designate minor children as beneficiaries, you should also name a trustee to receive funds on their behalf. In Quebec, if you wish to designate minor children as beneficiaries, an administrator may be designated. A trustee may also be designated but a trust must then be set up more formally in accordance with the Civil Code of Quebec. A lawyer or notary should then be consulted. Unless specifics of a trust are provided, an appointment of trustee/administrator herein shall refer to an administrator according to the Civil Code of Quebec. if you name an irrevocable beneficiary you will limit certain rights you have unless you obtain their signature. A parent or guardian or tutor cannot provide consent on behalf of a minor who has been named as irrevocable beneficiary. for LIRA/LRSP/RLSP/LIF/LRIF/PRIF or RLIF the beneficiary designation may not be effective as spousal rights under applicable pension legislation may take precedence over the beneficiary designation. Optional Riders by selecting any of the riders you acknowledge having read the applicable sections of the Information Folder and Contract and agree to the applicable fees. Plus: Guaranteed Minimum Withdrawal Benefit (GMWB) The GMWB rider may be elected only prior to the annuitant s 80th birthday, or prior to the age limits defined in the contract. Investment selection and minimum premium deposit restrictions apply, please see your contract Payment Options GWB Lifetime Option May be selected prior to Annuitant s 65th birthday but the LWA is only calculated on December 31 of the year in which the Annuitant (the LWA Annuitant for Joint Annuitants Contracts) turns 65. Guaranteed income under the GWB Lifetime Option ends upon the death of the LWA Annuitant. If a redemption is placed on or before December 31 of the year in which the Annuitant/LWA Annuitant turns 65, the payment option will be changed to the GWB Withdrawal Period Option. GWB Withdrawal Period Option Guaranteed income under the rider ends: when the Remaining GWB is reduced to nil; when the contract is terminated; on the contract maturity date or upon the death of the last surviving annuitant. We will default to the GWB Withdrawal Period Option if a GMWB fund code is used and/or the GMWB rider is selected but a specific GWB Payment option is no indicated. 4% Annual Automatic Death Benefit Reset (Class B Units only) if this rider is elected, you will be replacing client selected resets on maturity and death benefit guarantees with the 4% annual automatic death benefit reset. This rider may only be elected at the time of this application. Earnings Enhancement Benefit the Optional Earnings Enhancement Benefit (EEB) is offered as an enhancement to the Death Benefit described in the Contract. The EEB is available only for deposits made prior to the Annuitant s 75th birthday. If the EEB is elected, it will be applicable to all Class options under the Contract. This rider may only be elected at the time of this application. Banking Authorization Pre-Authorized Chequing Plans (PAC) Terms and Conditions By signing this application, you hereby waive any pre-notification requirements as specified by section 15(a) and (b) of the Canadian Payments Association Rule H1 with regards to PACs If you have indicated on the Electronic Application that you wanted to make regular deposits using a Pre-Authorized Chequing Plan (PAC), you authorize CI Investments Inc. on behalf of Sun Life (CI) to debit the bank account provided for the specified amount(s) and in the frequencies selected. You understand that Funds withdrawn will be invested according to the Investment Direction in the Electronic Application. If this is for your own personal investment, your debit will be considered a Personal Pre-authorized debit agreement (PAD) by Canadian Payments Association definition. If this is for business purposes, it will be considered a Business PAD. Monies transferred between CPA members will be considered a Funds Transfer PAD.

3 You have certain recourse rights if any debit does not comply with this agreement. For example, you have the right to receive reimbursement for any debit that is not authorized or is not consistent with this PAC agreement. To obtain more information on your recourse rights, you may contact your financial institution, CI or visit You may change these instructions or cancel this plan at any time, subject to providing CI notice of at least 48 hours prior to the next PAC run date. To obtain a sample cancellation form, or for more information on your right to cancel a PAC agreement, you may contact your financial institution, CI or visit the Canadian Payments Association website at You agree to release the financial institution and CI of all liability if the revocation is not respected, except in the case of gross negligence by the financial institution or CI. CI is authorized to accept changes to this agreement from your registered dealer or your financial advisor in accordance with the policies of that company, in accordance with the disclosure and authorization requirements of the CPA. You agree that the information in this form will be shared with the financial institution, insofar as the disclosure of this information is directly related to and necessary for the proper application of the rules applicable for PACs. You acknowledge and agree that you are fully liable for any charges incurred if the debits cannot be made due to insufficient funds or any other reason for which you may be held accountable. You confirm that all persons whose signatures are required to authorize transactions in the bank account provided have read and agreed to these terms and signed this application. Withdrawals withdrawals in excess of the annual GWA/LWA or minimum annual payment (MAP) may have a negative impact on future guaranteed payments under the Guaranteed Minimum Withdrawal Benefit rider. Automatic Withdrawal (AWD) Plans by electing to establish an AWD you authorize CI to deposit the income payments directly to your bank account as indicated on the Electronic Application. If no date or payment amount is indicated for your automatic withdrawal (AWD), CI will pay the RRIF/LIF/LRIF/PRIF/RLIF minimum during the month of December, and will redeem units proportionately across all funds. For scheduled payments that are below the MAP requirement, CI will pay the balance of the RRIF/LIF/LRIF/PRIF/RLIF MAP during the month of December and will redeem units proportionately across the funds indicated in section 12. If no fund selection is indicated, the MAP balance will be redeemed proportionally across all funds held in the contract. CI Investments Privacy Statements for Canada Upon receipt of this application, CI will establish a file in which will be placed personal information about you concerning this application, endorsement, rider or other documents issued in connection with this application, and other documents or information relating to the investigation, servicing and administration of this application. We collect personal information about you from this application and any supplementary forms, and from your representative and other organizations and persons you identify in support of your application. We use your personal information for the purposes of, servicing and administering this application, and for such other purposes as are specified in this application. Your information may be shared with your representative of record for the purposes identified above. Your Social Insurance Number will be used for income reporting purposes in the context of the administration of your account. Your banking information will be disclosed to the financial institution(s) processing your pre-authorized deposit plan. Employees or authorized representatives of CI or its affiliates, who will be responsible for functions relevant to the purposes identified above, and other persons authorized by you or by law, will have access to the personal information contained in your file. Note that your financial advisor or broker is not an employee of CI. Subject to exceptions set out in applicable legislation, you may access your file and request corrections to your personal information by sending a written request to CI Investments Inc, Attn: Privacy Officer, 151 Yonge Street, Eighth Floor, Toronto, Ontario M5C 2W7. By completing and signing this application, you consent to the collection, use and disclosure of your personal information as described herein. CI s Privacy Policy is available on the CI Website, Sun Life Financial Privacy Statements for Canada At Sun Life Financial, protecting your privacy is a priority. We maintain a confidential file in our offices containing personal information about you and your contract(s) with us. Our files are kept for the purpose of providing you with investment and insurance products or services that will help you meet your lifetime financial objectives. Access to your personal information is restricted to those employees, representatives, distribution partners (such as advisors and their companies) and third party service providers who are responsible for the administration, processing and servicing of your contract(s) with us, our reinsurers or any other person whom you authorize. In some instances these persons may be located outside Canada, and your personal information may be subject to the laws of those foreign jurisdictions. You are entitled to consult the information contained in our file and, if applicable, to have it corrected by sending a written request to us. To find out about our Privacy Policy, visit our website at or call SUN-LIFE ( ) and request that a copy of our Privacy Brochure be sent to you.

4 Class B (Combined Guarantee) Class C (Basic Guarantee) 75% maturity/100% death 75% maturity/75% death Fund Name ISC DSC ISC DSC ISC DSC ISC DSC Global Equity Funds Plus Plus (GMWB) (GMWB) SWE CI Global Fund P 7050P P 7830P SWE CI Global Value Fund P 7051P P 7831P SWE CI International Value Fund P 7052P P 7832P SWE CI Synergy Global Corporate Fund P 7053P P 7833P SWE Fidelity NorthStar Fund P 7054P P 7834P SWE Trimark Select Growth Fund P 7055P P 7835P SWE Dynamic Global Value Fund P 7091P P 7871P SWE CI Harbour Foreign Equity Corporate Fund P 7093P P 7873P SWE CI Global High Dividend Advantage Fund P 7095P P 7875P SWE RBC O Shaughnessy International Equity Fund P 7097P P 7877P SWE CI Cambridge Global Equity Corporate Fund P 7659P P 7559P Global Balanced & Asset Allocation Funds SWE CI International Balanced Fund P 7057P P 7837P SWE Fidelity Global Asset Allocation Fund P 7058P P 7838P SWE Trimark Global Balanced Fund P 7059P P 7839P SWE CI Harbour Foreign Growth & Income Corporate Fund P 7094P P 7874P SWE CI Signature Global Income & Growth Fund P 7651P P 7551P SWE Northwest Growth & Income Fund P 7652P P 7552P SWE Manulife Global Monthly Income Fund P 7653P P 7553P U.S. Equity Funds SWE CI American Value Fund P 7061P P 7841P SWE CI Synergy American Fund P 7062P P 7842P SWE Fidelity Growth America Fund P 7064P P 7844P Canadian Equity Funds SWE Trimark Canadian First Class Fund P 7065P P 7845P SWE CI Canadian Investment Fund P 7066P P 7846P SWE CI Harbour Fund P 7067P P 7847P SWE CI Signature Select Canadian Fund P 7068P P 7848P SWE CI Synergy Canadian Fund P 7069P P 7849P SWE Fidelity True North Fund P 7070P P 7850P SWE RBC Canadian Dividend Fund P 7098P P 7878P SWE CI Cambridge Canadian Equity Corporate Fund P 7658P P 7558P Canadian Balanced Funds SWE CI Signature Canadian Balanced Fund P 7072P P 7852P SWE CI Harbour Growth & Income Fund P 7073P P 7853P SWE Fidelity Canadian Asset Allocation Fund P 7074P P 7854P SWE CI Signature Income & Growth Fund P 7076P P 7856P SWE Trimark Income Growth Fund P 7077P P 7857P SWE CI Cambridge Canadian Asset Allocation Corporate Fund P 7657P P 7557P

5 Including SunWise Elite Plus Class B (Combined Guarantee) Class C (Basic Guarantee) 75% maturity/100% death 75% maturity/75% death Fund Name ISC DSC ISC DSC ISC DSC ISC DSC Portfolio Series Plus Plus (GMWB) (GMWB) SWE Portfolio Series Balanced Fund P 7078P P 7858P SWE Portfolio Series Conservative Fund P 7079P P 7859P SWE Portfolio Series Income Fund P 7080P P 7860P SWE Portfolio Series Balanced Growth Fund P 7081P P 7861P SWE Portfolio Series Conservative Balanced Fund P 7082P P 7862P SWE Portfolio Series Growth Fund P 7083P P 7863P SWE Portfolio Series Maximum Growth Fund P 7084P P 7864P Bundles SWE CI Harbour Core Bundle P 7662P P 7562P SWE CI Harbour Balanced Bundle P 7663P P 7563P SWE CI Cambridge Core Bundle P 7671P P 7571P SWE CI Cambridge Balanced Bundle P 7672P P 7572P SWE CI Signature Core Bundle P 7664P P 7564P SWE Fidelity Disciplined Core Bundle P 7673P P 7573P SWE Dynamic Core Bundle P 7674P P 7574P Quotential Portfolios Quotential Diversified Income Portfolio P 9929P P 9949P Quotential Balanced Income Portfolio P 9930P P 9950P Quotential Balanced Growth Portfolio P 9931P P 9951P Quotential Global Balanced Portfolio P 9932P P 9952P Quotential Growth Portfolio P 9933P P 9953P Quotential Canadian Growth Portfolio P 9934P P 9954P Quotential Global Growth Portfolio P 9935P P 9955P Quotential Maximum Growth Portfolio P 9936P P 9956P Income Funds SWE CI Signature Canadian Bond Fund P 7085P P 7865P SWE CI Signature Corporate Bond Corporate Fund P 7661P P 7561P SWE CI Signature Dividend Fund P 7088P P 7868P SWE CI Signature High Income Fund P 7089P P 7869P SWE TD Canadian Bond Fund P 7096P P 7876P Money Market Funds SWE CI Money Market Fund P 7090P P 7870P

6 SunWise Elite Including SunWise Elite Plus Individual Variable Annuity Contract Signature Form 1 Contract Number (if available) Contract Number Distributor s Account Number 2 Contract Type *Subject to the terms of the applicable endorsement Non-registered accounts (Open) Retirement savings accounts Retirement income accounts m Individual m Retirement Savings Plan (RSP) m Retirement Income Fund (RIF) m Joint m Locked-in RSP (LRSP)* m Spousal RIF m In trust for m Locked-in Retirement Account (LIRA)* m Life Income Fund (LIF)* m Estate/Trust m Restricted Locked-in Savings Plan (RLSP)* m Locked-in Retirement Income Fund (LRIF)* m Sole Proprietorship m Spousal RSP m Prescribed Retirement Income Fund (PRIF)* m Partnership m Group RSP m Restricted Life Income Fund (RLIF)* m Corporate 3 Dealer and Representative Information Sun Life Financial Distributors (Canada) Inc. Dealer's Name Representative's Name Dealer Number Representative Number Telephone Number Address Training Supervisor's signature (Quebec Only) X 4 Owner Information The owner is the annuitant unless otherwise noted in section 6 m Mr. m Mrs. m Miss m Ms. m Dr. Gender m Male m Female Language Preference m English m French Owner's Name (last, first, middle) Residence Telephone Number Owner's Address Date of Birth Social Insurance Number (SIN) 5 Joint, In Trust For or Spousal Registered Plan Information Joint Owner and In Trust for contracts are not applicable to Registered Contracts m Mr. m Mrs. m Miss m Ms. m Dr. Gender m Male m Female Name (last, first, middle) Date of Birth Social Insurance Number (SIN) Country of Residency Joint Ownership Information - (Joint Non-Registered contracts only) Joint Ownership Type: Signing Authority: m Joint Owners with Right of Survivorship (not applicable in Quebec) m Only one signature required m Joint Owners NOTE: If not selected both signatures are required. 6 Annuitant Information Complete if Different from Owner(s) For Registered Contracts, the Annuitant must be the Owner. For Non-Registered Joint Ownership Contracts, if no single Annuitant is named in this section, the Contract will be deemed to have Joint Annuitants and the Contract Maturity Date will be determined based on the age of the younger Annuitant. m Mr. m Mrs. m Miss m Ms. m Dr. Gender m Male m Female Annuitant's Name (last, first, middle) Annuitant's Address (if different from owner) City or Town Province Postal Code Date of Birth Country of Residency Relationship to Owner PART 1 - CI/DEALER COPY PART 2 - REPRESENTATIVE COPY PART 3 - CLIENT COPY

7 7 Successor Owner Optional - For Non-Registered Contracts only This section should be completed in situations where the Annuitant is not the Owner. 8 Beneficiary Designation For Contracts signed in Quebec the designation of a spouse (married or civil union) as beneficiary is irrevocable unless the Owner checks revocable here: m revocable m Mr. m Mrs. m Miss m Ms. m Dr. Gender m Male m Female Successor Owner's Name (last, first, middle) Address City or Town Province Postal Code Date of Birth Relationship to Owner Primary Beneficiary Relationship * Share (%) Contingent Beneficiary Relationship* Name(s) Name(s) m I have attached a letter of direction with additional/alternate/irrevocable beneficiary instructions. * Relationship of the beneficiary to the Annuitant in all provinces excluding Quebec where the relationship is to the owner. Total 100% EEB Beneficiary: (if different from above) % See section 9 to elect EEB Rider. EEB Beneficiary Relationship* Name of Trustee(s) appointed for minor beneficiary(ies) (except in Quebec) 9 Optional Riders By selecting any of these riders you acknowledge having read the applicable sections of the Information Folder and Individual Variable Annuity Contract and agree to the applicable fees. * We will default to the GWB Withdrawal Period Option if a GMWB fund code is used and/or the GMWB rider is selected but a specific GWB Payment option is not indicated. m Plus Guaranteed Minimum Withdrawal Benefit (GMWB) Payment Options - please select one* m GWB Lifetime Option (LWA) m GWB Withdrawal Period Option (GWA) LWA Annuitant to be completed for Plus Joint Annuitant Contracts Only and must be one of the above named Joint Annuitants. LWA Annuitant's Name (last, first, middle) m 4 % Annual Automatic Death Benefit Reset Rider (Class B units only) Date of Birth m Earnings Enhancement Benefit (EEB) Rider Please see the front of this application for the minimum investment amounts and the age restrictions for electing the riders. 10 Banking Authorization Please attach a void cheque. m Pre-Authorized Chequing Plan (PAC) - I(We) authorize CI to make the withdrawals as indicated in the Electronic Application. I (We) confirm that all persons whose signatures are required to authorize bank withdrawals have signed below. Funds withdrawn will be invested according to the Investment Direction in the Electronic Application. I (We) understand that I (we) may terminate this authorization by giving CI ten days written notice. X Signature Date Signature(s) required if Depositor(s) is (are) other than the Owner(s) indicated in Section 4 and/or 5. By signing you confirm that you have read and agree to the PAC terms and conditions outlined at the front of this application. m Automatic Withdrawal Plan - I (We) authorize CI to deposit the income payments directly to my (our) bank account as indicated on the Electronic Application. PART 1 - CI/DEALER COPY PART 2 - REPRESENTATIVE COPY PART 3 - CLIENT COPY

8 11 Banking Information/ Payment Plan Details Withdrawals m Deposit directly to bank account (You will receive your payments in a more timely manner if you choose this option) Please attach a void cheque, or complete financial information. Account Owner's Name Name of Financial Institution Financial Institutions Address Bank Number Transit Number Account Number For a joint bank account, all Depositors must sign if more than one signature is required on cheques issued against the account. 12 Automatic Withdrawal Plan (AWD) & RRIF/LIF/LRIF/ PRIF/RLIF Plan Payment Details Please accept this authorization to surrender sufficient units to provide the stated payment (please chose only one) *Withdrawals in excess of the annual GWA/LWA or minimum annual payment (MAP) may have a negative impact on future guaranteed payments under the Guaranteed Minimum Withdrawal Benefit Rider. Deposits X Signature(s) required if Depositor(s) is (are) other than the Owner(s) indicated in Section 4 and/or 5. By signing you confirm that you have read and agree to the PAC terms and conditions outlined at the front of this application. RRIF/LIF/LRIF/PRIF/RLIF Payment Instructions (The payment date may be between the 1st and 25th of any month) m The minimum annual payment (MAP) requirements m The maximum annual gross amount (for LIF/LRIF/RLIF Plans only) m The annual GWA/LWA (for Plus contract holders only) m An annual amount of $ m Gross or m Net of fees* I elect the term of RRIF payments be based on m My age m Age of my spouse if younger Non-Registered AWD Plans m An annual amount of $ m Gross or m Net of fees* m The annual GWA/LWA (for Plus contract holders only) (please provide spouse's date of birth) Payment Instructions (For all regularly scheduled payments) Payment Frequency (please select only one) m Monthly m Quarterly m Sem-Annually m Annually Payment Start Date Fund Code Surrender Amount $ or % Payment Method (please select only one) m Deposit directly to bank account m Mail to Owner(s) at address on file m Mail to Owner s alternate address (Indicate address below) Address City Province Postal Code 13 LIF/LRIF/PRIF/RLIF Information SPOUSE: Do you have a spouse within the meaning of the applicable pension legislation? m Yes m No Note: If you have a spouse within the meaning of the applicable legislation, then the form noted at the end of this Application must be fully completed and accompany the Application. PART 1 - CI/DEALER COPY PART 2 - REPRESENTATIVE COPY PART 3 - CLIENT COPY

9 14 Transaction Authorization 15 Owner Acknowledgement/ Authorization All owners must read and sign this Section I (We), the applicant(s) of this Policy, authorize CI to act upon any written contribution, surrender or exchange request relating to this Policy. I (We) authorize Sun Life Financial Distributors (Canada) Inc., Sun Life Assurance Company of Canada and any of their agents to act upon any contribution, surrender or exchange request relating to this Policy that they receive orally or by telephone or by electronic means, if they reasonably believe that the request was made by me (us). I (We), the Owner(s), declare that all statements and answers made by me (us) on this Application are fully complete and true. I (We) hereby acknowledge having read the provisions contained in the Sun Life Privacy Statements for Canada and CI Investments Privacy Statements for Canada, contained in this Application, and I (we) hereby agree to them. I (We) have requested that this Application Form be drafted in the English language only. J ai (nous avons) demandé que le présent formulaire de demande soit rédigé uniquement en anglais. I (We), the Owner(s), acknowledge receipt of the Client Complaint Information document (not applicable to residents of Quebec) and the relationship brochure entitled A Clear Connection: Our Relationship with You. I (We), the Owner(s), acknowledge receipt of the Individual Variable Annuity Contract and Information Folder and the financial highlights of the Funds prior to signing the Application. I (We) have reviewed and confirmed the accuracy of the information recorded in the Electronic Application on the date as indicated below. I (We) certify that all information in the Electronic Application is full, complete and true, and may be relied upon as if on this signature form. I (We) agree to provide any further information which may be required in connection with the registration and administration of this Contract. By completing the Banking Authorization and/or Banking Information/Payment Plan Details section(s), I (we) the owner(s) declare that all persons whose signatures are required to authorize transactions in the bank account provided have read and agreed to the PAC terms and conditions as outlined at the front of this application. Will this Contract replace or cause a change in, or involve a loan under, any insurance or annuity policy on the Annuitant s life or owned by the Owner? m Yes m No If yes, please complete the information below: Company and plan:. If LIRA, Locked-in RSP, RLSP, LIF, LRIF, PRIF or RLIF the amount being transferred to the Contract was determined on the basis of the Owner's gender m Yes m No Request for Registration (Must be completed for RSP, LIRA, Locked-In RSP, RLSP, LIF, LRIF, PRIF and RLIF Contracts) m Yes, Sun Life Assurance Company of Canada is requested to register the above policy as a Retirement Savings Plan under the Income Tax Act (Canada) and under any applicable provincial legislation. m Yes, Sun Life Assurance Company of Canada is requested to register the above policy as a Retirement Income Fund under the Income Tax Act (Canada) and under any applicable provincial legislation. X X Owner's Signature Date Signature of Witness X Joint Owner's Signature Date Signed At (City and Province) Annuitant's Signature (Only required if Annuitant is not the Owner) X 16 Representative's Acknowledgement All advisors must read and sign this Section I, the advisor, confirm that I have reviewed the details provided in this form with the applicant/owner(s) and to the best of my knowledge, unless otherwise noted, these details are full, complete and true. In regard to the purchase of a non-registered product, I the advisor, confirm that all of the identification details provided in this form match the original identification documents shown to me. I confirm that I have disclosed to the Owner(s) (a) the company I represent, (b) that I will receive compensation in the form of commissions or salary for the sale of this product, (c) that I may also receive additional compensation in the form of bonuses or non-monetary benefits such as travel incentives or attendance at conferences, and (d) any conflict of interest I may have with respect to the sale of this product. X Representative's Signature Date Complete the following if the Representative verifying identity is different from the Servicing Representative (applicable for non-registered plans only) X Representative's Name Dealer - Representative Number Date SUBJECT TO ANY APPLICABLE DEATH AND MATURITY GUARANTEES, ANY AMOUNT THAT IS ALLOCATED TO A SEGREGATED FUND IS INVESTED AT THE RISK OF THE CONTRACT HOLDER AND MAY INCREASE OR DECREASE IN VALUE. PART 1 - CI/DEALER COPY PART 2 - REPRESENTATIVE COPY PART 3 - CLIENT COPY

10 Spousal Consent/Waiver Forms (Complete if you indicated yes in section 13) If the Plan being applied for is a LIF, LRIF, PRIF or RLIF and the Owner has a spouse as defined by applicable pension legislation, then the appropriate form below must be completed. No form is necessary for P.E.I, Quebec and New Brunswick or for federally governed plans. Province that governs the plan Name of form Form type Province that governs the plan Name of form Form type British Columbia Spouse s Consent Form 3 (original) Ontario Spouse s Consent Spousal Consent (original) Alberta Spouse s Waiver Form 6 Part 1 Option 2 Nova Scotia Spouse s Waiver Form 4 (original) Saskatchewan Spouse s Waiver Form 1 (copy) Newfoundland Spouse s Waiver Form 3 (original) Manitoba Spouse s Waiver Form MG-1701 (copy) Sun Life Assurance Company of Canada, a member of the Sun Life Financial group of companies, is the sole issuer of the individual variable annuity contract providing for investment in segregated funds. A description of the key features of the applicable individual variable annuity contract is contained in the Information Folder. SUBJECT TO ANY APPLICABLE DEATH AND MATURITY GUARANTEES, ANY AMOUNT THAT IS ALLOCATED TO A SEGREGATED FUND IS INVESTED AT THE RISK OF THE CONTRACT HOLDER AND MAY INCREASE OR DECREASE IN VALUE ACCORDING TO FLUCTUATIONS IN THE MARKET VALUE. CI Investments and the CI Investments design are registered trademarks of CI Investments Inc. SunWise is a registered trademark of Sun Life Assurance Company of Canada. *Trimark and all associated trademarks are trademarks of Invesco Trimark Ltd. Fidelity Investments and the Fidelity design are registered trademarks of FMR Corp. RBC Asset Management is a registered trademark of Royal Bank of Canada. TM TD Asset Management is a trademark of The Toronto-Dominion Bank, used under licence. Franklin Templeton Investments, Franklin Templeton Investments Quotential Program and/or Franklin Templeton Investments and design are registered trademarks of Franklin Templeton Investments Corp. Sun Life Assurance Company of Canada 227 King Street South P.O. Box 1601 STN Waterloo Waterloo, Ontario N2J 4C5 CI Place, 151 Yonge Street, Eighth Floor, Toronto, Ontario M5C 2W7 I Head Office / Toronto Calgary Montreal Vancouver Client Services English: French: SWE CAMFOLDER SIG APP _E

11 Bundles Fund Codes including SunWise Elite Plus Class A (Full Guarantee) 100% maturity/100% death Class B (Combined Guarantee) 75% maturity/100% death Class C (Basic Guarantee) 75% maturity/75% death Bundles Plus (GMWB) Plus (GMWB) Plus (GMWB) ISC DSC ISC DSC ISC DSC ISC DSC ISC DSC ISC DSC SWE CI American Value Core Bundle P 9873P P 9773P P 9673P SWE CI Canadian Investment Core Bundle P 9875P P 9775P P 9675P SWE CI Signature Dividend Core Bundle P 9876P P 9776P P 9676P SWE CI Synergy Canadian Core Bundle P 9877P P 9777P P 9677P SWE CI Harbour Core Bundle P 7762P P 7662P P 7562P SWE CI Signature Core Bundle P 7764P P 7664P P 7564P SWE CI Cambridge Core Bundle P 7771P P 7671P P 7571P SWE CI Cambridge Global Equity Core Bundle P 9874P P 9774P P 9674P SWE Dynamic Core Bundle P 7774P P 7674P P 7574P SWE Fidelity Disciplined Core Bundle P 7773P P 7673P P 7573P SWE Fidelity True North Core Bundle P 9880P P 9780P P 9680P SWE Fidelity NorthStar Core Bundle P 9879P P 9779P P 9679P SWE RBC Canadian Dividend Core Bundle P 9881P P 9781P P 9681P Income Funds SWE CI Signature Corporate Bond Corporate Fund P 7761P P 7661P P 7561P SWE Select Income Advantage Managed Fund P 9872P P 9772P P 9672P Sun Life Assurance Company of Canada, a member of the Sun Life Financial group of companies, is the sole issuer of the individual variable annuity contract providing for investment in SunWise segregated funds. A description of the key features of the applicable individual variable annuity contract is contained in the Information Folder. Any amount that is allocated to a segregated fund is invested at the risk of the contract holder and may increase or decrease in value. CI Investments, the CI Investments design, Synergy Mutual Funds, Harbour Advisors, Harbour Funds, and Signature Global Advisors are registered trademarks of CI Investments Inc. Cambridge, Portfolio Series and Signature Funds are trademarks of CI Investments Inc. SunWise is a registered trademark of Sun Life Assurance Company of Canada. Fidelity Investments and the Fidelity design are registered trademarks of FMR Corp. RBC Asset Management and Phillips, Hager & North are a registered trademarks of Royal Bank of Canada, used under license. Dynamic Funds is a division of Goodman & Company, Investment Counsel Ltd. Sun Life Assurance Company of Canada 227 King Street South P.O. Box 1601 STN Waterloo Waterloo, Ontario N2J 4C5 CI Investments, 15 York Street, Second Floor, Toronto, Ontario M5J 0A3 I Head Office / Toronto Calgary Montreal Vancouver Client Services English: French: _E (08/11)