Accident cert

SUN LIFE ASSURANCE COMPANY OF CANADA Executive Office: One Sun Life Executive Park Wellesley Hills, MA 02481 (800) 247-6875 www.sunlife.com/us Sun Life Assurance Company of Canada certifies that it has issued and delivered a Group Insurance Policy to the Policyholder shown below. Policy Number: 917800-001 Policy Effective Date: January 1, 2019 Policyholder: DePauw University Employer: DePauw University Issue State: Indiana NOTICE TO BUYER. THIS IS A LIMITED BENEFIT CERTIFICATE. THIS CERTIFICATE PROVIDES ACCIDENT ONLY COVERAGE AND DOES NOT PAY BENEFITS FOR LOSS FROM SICKNESS. PLEASE READ YOUR CERTIFICATE CAREFULLY. This Certificate contains the terms of the Group Insurance Policy that affect your insurance. This Certificate is part of the Group Insurance Policy. This Certificate is governed by the laws of the Issue State shown above unless preempted by the federal Employee Retirement Income Security Act. Signed at Wellesley Hills, Massachusetts. Dean A. Connor Troy Krushel President and Chief Executive Officer Vice-President, Associate General Counsel and Corporate Secretary Group Accident Insurance Certificate Non-Participating 16-AC-C-01 Page1