0000791683-09-000027 Sample Contracts

Insurer Address: One Sun Life Executive Park, Wellesley Hills, MA 02481
Sun Life Ny Variable Account D • April 30th, 2009

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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