Common use of AGREEMENT AND UNDERTAKING Clause in Contracts

AGREEMENT AND UNDERTAKING. In consideration of the payment to me by Sun Life Assurance Company of Canada of Disability Income benefits under Group Contract 25038, Certificate Number with respect to my total disability claim which commenced on (date) I do hereby undertake to repay the total of such benefits, or such portion thereof as circumstances may require to Sun Life Assurance Company of Canada, should the Workplace Safety and Insurance Board accept liability and pay Workplace Safety and Insurance Board Benefits for my total disability claim. I hereby authorize the Workplace Safety and Insurance Board to reimburse the Sun Life Assurance Company of Canada from any such Workplace Safety and Insurance Board benefits to the extent of the amount of disability income benefits paid. Dated at this day of , 2002 . Witness Signature Address W.S.I.B. Claim File No. This Letter will confirm the understanding reached by the parties with respect to leave for illness for those employees on the Sick Leave Credit Day System.

AGREEMENT AND UNDERTAKING. In consideration of the payment to me by Sun Life Assurance Company of Canada of Disability Income benefits under Group Contract 25038, Certificate Number with respect to my total disability claim which commenced on (date) I do hereby undertake to repay the total of such benefits, or such portion thereof as circumstances may require to Sun Life Assurance Company of Canada, should the Workplace Safety and Insurance Board accept liability and pay Workplace Safety and Insurance Board Benefits for my total disability claim. I hereby authorize the Workplace Safety and Insurance Board to reimburse the Sun Life Assurance Company of Canada from any such Workplace Safety and Insurance Board benefits to the extent of the amount of disability income benefits paid. Dated at this day of , 2002 200 . Witness Signature Address W.S.I.B. Claim File No. This Letter will confirm the understanding reached by the parties with respect to leave for illness for those employees on the Sick Leave Credit Day System.

AGREEMENT AND UNDERTAKING. In consideration of the payment to me by Sun Life Assurance Company of Canada of Disability Income benefits under Group Contract 25038, Certificate Number with respect to my total disability claim which commenced on (date) I do hereby undertake to repay the total of such benefits, or such portion thereof as circumstances may require to Sun Life Assurance Company of Canada, should the Workplace Safety and Insurance Board accept liability and pay Workplace Safety and Insurance Board Benefits for my total disability claim. I hereby authorize the Workplace Safety and Insurance Board to reimburse the Sun Life Assurance Company of Canada from any such Workplace Safety and Insurance Board benefits to the extent of the amount of disability income benefits paid. Dated at this day of , 2002 20 . Witness Signature Address W.S.I.B. Claim File No. This Letter will confirm the understanding reached by the parties with respect to leave for illness for those employees on the Sick Leave Credit Day System.