Sun Life Assurance Company of Canada 227 King St S Waterloo ON N2J 4C5 1-877-459-6503 Customer Confirmation Form Payout Annuity Customer Information: Date: << date>> Payout Annuity Policy Number: RP-xxxx,xxx-x Owner: << only print if owner is not deceased, otherwise suppress >> Annuitant: << name >> Please take a moment to do the following: 1. Complete and sign the “Confirmation” section below. If you are signing this form on behalf of someone else, please complete the “Power of Attorney or Alternate signer” section of the form. 2. Check the address on the back of this form. If the address has changed, please provide the details by making any corrections on this form. 3. In the additional contact section, please provide the name of someone we can contact in case we are unable to reach you. 4. Return the form to us in the enclosed return envelope, no later than <<date>>. 5. <<Please attach the corporate/non-corporate documents that clearly indicate the authorized person(s) who is signing this form.>> Confirmation Please check one of the appropriate statements and sign below: __ __ __ I confirm that the Annuitant is living. The Annuitant died on _________________. The Owner of this policy died on _________________, but the Annuitant is living. only print if owner is not deceased, otherwise suppress>> X Sign here Date Print your name ( ) Telephone # - << Address Confirmation: If there are changes or corrections to your address, please provide an update: << Address __________________________________________ Address __________________________________________ Address __________________________________________ Address __________________________________________>> To be completed by the Power of Attorney if applicable: 1. If you are signing this by Power of Attorney and have not already provided us with a General or Enduring Power of Attorney document, please send them to us with this form. Please note that Personal Care and Banking Power of Attorneys are not acceptable. 2. Please provide us with your name, address and phone number for our records: To be completed by Alternate signer: If you are signing on behalf of our customer and do not have General or Enduring Power of Attorney, please explain why our customer cannot sign and your relationship to them: Additional contact: We want to make sure we stay in touch with you even if your circumstances change. Please provide the name, address and phone number of someone we can contact if we are unable to reach you. Include their relationship to you: Sun Life Assurance Company of Canada is a member of the Sun Life Financial group of companies.
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