0000791683-09-000075 Sample Contracts

Service Office: [One Sun Life Executive Park Wellesley Hills, MA 02481 Home Office: [60 East 42nd Street Suite 1115 New York, NY 10165]
Service Office • July 29th, 2009 • Sun Life Ny Variable Account D

This is a legal contract between the Policy Holder and Us, Sun Life Insurance and Annuity Company of New York (“the Company”, “we”, “our”). We agree to pay the benefits under this Group Policy according to its provisions. The Certificate Owner and Insured are named in each certificate. We agree to pay the Death Benefit proceeds to the beneficiary upon receipt of due proof of the Insured’s death. Signed for the Company: [[Missing Graphic Reference]] [Westley V. Thompson], [President] [Missing Graphic Reference] [ ] [Michael S. Bloom, Secretary]

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