Date Of Birth Confirmation Form

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Date of birth - confirmation
You must initial any corrections to the form
1. List the policy numbers for which you are confirming:
Policy number
Policy number
Policy number
Policy number
Policy number
Policy number
Policy number
Policy number
2. Name of insured person/annuitant:
3. Date of birth:
Day
Month
Year
4. Date of birth proof reviewed by advisor:
Indicate: Registration number/expiry date/issue date/ID number
Canadian, USA, or UK driver’s licence
registration number ________________________________________
Canadian, USA, or UK birth certificate
registration number ________________________________________
Provincial ID health insurance card
expiry date/registration number______________________________
(if date of birth is indicated)
Current valid Canadian passport
expiry date ________________________________________________
Current valid passport, other than Canadian
expiry date ________________________________________________
Hospital certificate of birth
issue date _________________________________________________
Baptismal certificate
issue date _________________________________________________
Provincial age of majority card
issue date _________________________________________________
Indian status card
registration number ________________________________________
Canadian citizenship
registration number ________________________________________
Military card
registration number/identification number ____________________
Register of civil status in Quebec
registration number ________________________________________
Permanent resident card
expiry date/ID number _____________________________________
Provincial identification card
registration number ________________________________________
Note: If the date of birth is incorrect and age has already been admitted, send a photocopy of a proof of age document (see list of
acceptable documents above)
5. By signing below I confirm that,
• I’ve reviewed the document and confirmed that the date of birth is as shown on the document
Sign and date here
Date (d/m/y)
Advisor’s ID number
Advisor’s signature
Advisor’s name (please print)
Return to:
Sun Life Assurance Company of Canada
227 King Street South
Waterloo, Ontario
N2J 4C5
For HO use only:
E35-09-06
Please send fax or original
DOBE

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