0000791683-07-000035 Sample Contracts

Service Office: One Sun Life Executive Park, Wellesley Hills, MA 02481
Consent to Purchase of Insurance • July 17th, 2007 • Sun Life Ny Variable Account D

The Company/Owner listed above (the “Owner”) intends to purchase a life insurance policy or policies on the life of the Proposed Insured listed below. In advance of any policy issuance [or material increase], the Proposed Insured will be notified in writing of the maximum total amount of insurance to be purchased at the time the policy or policies are issued.

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Service Office: One Sun Life Executive Park Wellesley Hills, MA 02481 Home Office: Suite 1115 New York, NY 10165
Flexible Premium Variable Universal Life Insurance Policy • July 17th, 2007 • Sun Life Ny Variable Account D

This Policy is a legal contract in which We, Sun Life Insurance and Annuity Company of New York, promise to provide the kind of insurance described below. Upon death of the Insured, We agree to pay the Beneficiary such amounts as then become due and payable. Until that time, We agree to provide You, as Owner, the other rights and benefits of this Policy. These rights and benefits are subject to the provisions on the pages which follow. Signed for the Company at its Home Office: [Missing Graphic Reference] [Robert C. Salipante, President] [Missing Graphic Reference] [Michael S. Bloom, Secretary]

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