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 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 , 200 . Witness Signature Address W.S.I.B. Claim File No.