Certificate of Insurance. These are the details of this Certificate of Insurance. SAMPLE. Insured Individual's Date of Birth July 3, 1976

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1 Overview Certificate details Certificate of Insurance These are the details of this Certificate of Insurance. Group Policy Item Details Insured Individual John A. Sample Insured Individual's Date of Birth July 3, 1976 Group Policy issued to Hudson's Bay Company Certificate Number HB Original Effective Date October 1, 2011 Revision Date October 7, 2011 Beneficiary Jane A Sample Amount of Insurance $100,000 Subject to Reductions at Older Refer to the section Benefit Reductions at Ages Older Ages for more details. Current Annual/Monthly Premium Payable [includes applicable sales taxes] Contact Address $8.75 Monthly The Canada Life Assurance Company 140 Fullarton Street, 10th Floor London, Ontario N6A 5P2 The Group Policy ("Policy") is the contract under which benefits are paid is issued to Hudson's Bay Company the ("Policyholder"), and pays benefits under one Certificate only. Coverage under more than one Certificate When an Insured Individual has more than one Certificate of Insurance under Group Policy 90310, then the following applies. When the Insured Individual... is alive Then... the Insured Individual selects which Certificate is in effect. Canada Life pays the benefit from the Certificate with the largest benefit, and considers any other Certificate under this Policy as void. has died without selecting which Certificate is in effect Certificate version Terminology This Certificate replaces any other Certificate version with an earlier issue date, issued to you for coverage under the Group Policy. This is the terminology used in this Certificate. This term... Refers to... "you" and "your" the Insured Individual. "we", "us", and "our" The Canada Life Assurance Company.

2 Cancellation/ refund Paragraph headings In this Certificate Insured Individuals may cancel their insurance at any time by notifying Canada Life in writing of their wish to cancel. What happens When an insurance Certificate coverage is cancelled within 30 days of receiving the initial Certificate of Insurance: insurance is void from inception, and Canada Life returns any premiums paid. Coverage under this Certificate Introduction When your coverage begins When your coverage ends The division of this Certificate into sections with headings is for convenience only, and does not affect the construction or interpretation of this Certificate. This Certificate is made up of the following topics. Topic See Page Coverage under this Certificate 2 Insuring Provisions 4 Beneficiaries 5 Claims 5-6 General Provisions 6-8 Terms Used in the Certificate 8-9 Protecting Your Personal Information 10 The following coverage provisions apply under this Certificate and are detailed below: when your coverage begins when your coverage ends suicide limitation what is covered what's not covered grace period reinstatement of coverage, and benefit reductions at older ages. Your insurance coverage takes effect on the Effective Date shown on the Certificate of Insurance. Your insurance coverage ends on the earliest of the following: the date Canada Life receives your written request that this coverage be cancelled the date the you reach the age of 75 the date this Group Policy terminates, or the date on which you fail to pay the premium required to keep coverage in force. Suicide Limitation There is a 2-year period of limitation for any Insured Individuals who die from suicide. This limitation is described below. When you... Then Canada Life... die from suicide within 2 years of pays no death benefits, and the Effective Date of coverage or only refunds premiums paid for such reinstatement of coverage coverage. have increased your Amount of Insurance and die from suicide more than 2 years after the Effective Date of coverage or last reinstatement of coverage, but within 2 years of an increase in your Amount of Insurance pays the death benefit in the original Amount of Insurance in effect before the increase, subject to any benefit reduction at older ages, and refunds only the premiums paid on the increased portion.

3 What is covered The following benefits are covered under this Certificate. Benefit Death Benefit Description Canada Life pays death benefits according to the terms of this Certificate in one lump sum equal to the Amount of Insurance in effect on your life at the time of your death, less any - Benefit Reductions at Older Ages, and - any Vital Living Benefit already paid. What's not covered Grace period Reinstatement of coverage Vital Living Benefit Canada Life pays up to 50% of death benefits to a maximum of $50,000 as a Vital Living Benefit when you are - diagnosed by a licensed medical practitioner in Canada as having a life expectancy of less than 12 months, and - not expected to live beyond age 75, and assignees, if any, consent to such payment. Death Benefits Canada Life pays death benefits reduced by the amount of the Vital Living Benefit that has been paid. Canada Life does not pay benefits for any death resulting directly or indirectly from an act of war, whether declared or not, or from any insurrection or hostilities of any kind, whether the insured is involved in the such actions or not. You have a 31-day grace period to pay your premiums. Exception There is no 31-day grace period on your initial payment. You must pay it for your coverage to come into effect. Failure to pay by end of grace period Any premium not paid by the end of the grace period results in the end of insurance coverage, and the cancellation of this Certificate of Insurance. Your insurance may be reinstated after coverage is cancelled for non-payment of premiums under these circumstances: Canada Life must receive your request for reinstatement within 2 years of the date on which coverage cancelled satisfactory evidence of insurability, and payment of any past-due premiums. Status on reinstatement You and Canada Life will have the same rights as existed immediately before the date on which coverage previously terminated. Exception: The amount of benefit payable upon your death is based on the amount at the most recent reinstatement date, and not based on your - original enrollment date, or - an earlier reinstatement date.

4 Benefit Reductions at Older Ages Starting at age 71, your benefits are reduced by 20% of the original amount each year until the Policy terminates at age 75. This table illustrates how this benefit reduction works. Birthday Reduction Example: Amount of Insurance $50, % $10,000 reduction to $40, % Further $10,000 reduction to $30, % Further $10,000 reduction to $20, % Further $10,000 reduction to $10, % The insurance coverage terminates. Insuring Provisions Introduction Determining premiums payable Changes in coverage Changes to smoking status The following Insuring Provisions apply under this Certificate and are detailed below: determining premiums payable changes in coverage, and changes to smoking status. You must pay the monthly premium amount set out in the Monthly Table of Premiums. We determine those rates for the first 5 years of coverage based on your age, sex and smoking status on the date of Policy enrolment, and the underwriting standard (Standard, Level One or Level Two) to your original enrolment by Canada Life. Subsequent 5-year terms We determine those rates for subsequent 5-year periods based on the then current Monthly Table of Premiums, and your age, sex and smoking status at the beginning of each 5-year term. Insured Individuals who are also insured under group policy no issued to Hudson's Bay Company shall be entitled to a 15% discount on the rate applicable under this Policy, for as long as such person remains insured under both policies. You may apply to increase or decrease your insurance at any time. Increases are subject to the same underwriting process as the initial application for insurance take effect on the first day of the next month following the day Canada Life approves the increase, and contain a new suicide exclusion and Contestability Period that applies to the increased portion of insurance. Decreases Decreases take effect on the first day of the next month following the day Canada Life receives your written request. If you are currently being charged the Smoker rate, you may change your status to Non-Smoker by doing the following: Notify Canada Life of your change in smoking status. Present evidence acceptable to Canada Life that you have not used any of the following in the previous 12 months: tobacco tobacco products, or smoking cessation aids. If Canada Life approves the request for change, then you are charged the Non- Smoker rate going forward.

5 Beneficiaries Designating beneficiaries You may designate a beneficiary or beneficiaries to receive the Amount of Insurance paid under this Certificate should you die. Lack of beneficiary Canada Life pays your estate when you do not designate a beneficiary, or the designated beneficiary does not survive you. Changing beneficiaries Claims Introduction Making a claim You must notify Canada Life in writing to designate a beneficiary, or change a revocable beneficiary. The designation or changes come into effect once you have signed and dated the request, and Canada Life has recorded the request in its offices. The following Claims provisions apply under this Certificate and are detailed below: making a claim contacting our Claims Department proof of claim, and paying Policy proceeds. The following conditions must be met for Canada Life to pay benefits on a claim. Stage Description Timeline 1 Canada Life must be notified of your death. Exception: If it is not possible to notify Canada Life within 30 days, we must be notified as soon as possible, and no later than one year from the date of the loss. 2 Canada Life sends a form with instructions on how to complete it. 3 Canada Life must receive the completed claim form, and any other proof of loss requested by us Within 30 days of the loss Within 15 days of being notified Within 90 days, or as circumstances allow 4 Canada Life pays the claim. Within 60 days of receiving proof of the loss. Contacting our Claims Department You can contact our Claims Department by phone at , or by mail at The Canada Life Assurance Company 330 University Ave. Toronto, ON M5G 1R8

6 Claims... (continued) Proof of claim Paying Policy proceeds General Provisions Introduction Incorrect statement of age or sex Canada Life must receive the following proof satisfactory to us before we will pay any claims on this Policy: evidence and cause of death age at the time of your death right of the claimant to receive payment the name and age of the beneficiary if there is a beneficiary, and any other information required by us to establish the validity of the claim. Right to autopsy Canada Life reserves the right to require an autopsy to support proof of claim, unless prohibited by law. Canada Life pays the Amount of Insurance payable under this Policy to the surviving beneficiary, or the surviving beneficiaries when there is more than one in equal shares, or as otherwise stated in the designation, your or estate, when there is no designated beneficiary or surviving beneficiary. The following General Provisions apply under this Certificate and are detailed below: incorrect statement of age or sex incorrect smoking status incontestability of individual coverage conversion privilege non-participating Policy assignment of insurance benefits premium rate change legal action access currency right to offset, and entire contract. This is what happens under this Policy when your age or sex is listed incorrectly. When... Then Canada Life... your age or sex is listed calculates the following based on incorrectly your correct age and sex: Effective Date or termination date the Amount of Insurance the applicable premiums, and any other rights or benefits in the Policy. your age or sex is listed incorrectly, and your true age disqualifies you from this Policy has the right to cancel coverage from the date it began, and refund an amount equal to the premiums that have been paid. Incorrect smoking status When your status as Non-Smoker is listed incorrectly, then Canada Life cancels coverage from the date it began, and refunds an amount equal to the premiums that have been paid.

7 General Provisions... (continued) Incontestability of individual coverage Conversion Privilege Nonparticipating Policy Assignment of insurance benefits Canada Life may dispute the accuracy of your statements only during the 2- year Contestability Period after coverage has been put in force, increased or been reinstated. After the 2-year Contestability Period, Canada Life assumes that all the statements on your application for insurance are truthful and complete. Exceptions All for information is considered truthful and complete except information provided fraudulently, or the date of birth, sex or smoking status was listed incorrectly. Conversion to Individual Insurance If coverage under this Certificate terminates, including as a result of termination of the Policy or your own decision to terminate your coverage, any Insured Individual under age 65 may convert all or part of their life insurance in force at that time to: 1. an individual life insurance policy, temporary or permanent; or 2. an individual one-year life insurance policy, convertible to a temporary or permanent policy as in option 1 above; without providing evidence of insurability. The amount of insurance you may convert must be at least $10,000 ($5,000 for insured Spouse, if applicable) and the amount may not exceed the lesser of all your life insurance which could be payable under the Policy on the date of conversion and $200,000 ($400,000 if you are a resident of Quebec). Application for conversion must be made and the first premium must be paid within 31 days of termination of your life insurance under the Policy. The individual policy then takes effect at the end of the 31-day period allowed for the conversion. Extension of Coverage If you die during the 31-day period in which you are eligible to apply for conversion, the amount of your life insurance which you were eligible to convert shall be payable as a claim under the Policy. Any individual insurance policy issued or for which application has been made under the conversion privilege shall be of no effect and without claim other than for the return of any premiums paid. Premiums The individual life insurance policy will be subject to the payment of premiums at the insurer's current individual life insurance rates. If the premium for your life insurance under the Policy was based on a higher rate because you did not qualify for approval for coverage at standard group rates, then a comparable extra premium may also be applied to the individual policy issued as a result of conversion. You or any other person are not entitled to any share of Canada Life profits under this Group Policy or Certificate. You can assign the benefits paid under this Policy, subject to all the terms and conditions of this Certificate. You must file the original assignment with Canada Life at its head office, however Canada Life assumes no responsibility for any such assignment, nor takes any action to undertake or validate such an assignment. Premium rate change Canada Life may change the premium rates. However, Canada Life can only increase the premium rates the same for all Insured Individuals of the same age insured under the Group Policy, and must give you at least 30 days notice of such a change.

8 General Provisions... (continued) Legal action Every action or proceeding against an insurer for the recovery of insurance money payable under the contract is absolutely barred unless commenced within the time set out in the Insurance Act (for actions or proceedings governed by the laws of Alberta and British Columbia), The Insurance Act (for actions or proceedings governed by the laws of Manitoba), the Limitations Actt 2002 (for actions or proceedings governed by the laws of Ontario), or other applicable legislation. For those actions or proceedings governed by the laws of Quebec, the prescriptive period is set out in the Quebec Civil Code. Access Currency Right to offset Entire contract You and any claimant under this Policy may obtain and examine a copy of the Group Policy, and certain other written statements or records submitted to Canada Life. Limitations This access is subject to certain limitations. All money payable under this Certificate is in Canadian funds. Canada Life may deduct any unpaid premiums from the benefits payable. The entire contract of insurance is comprised of this Certificate the Group Policy, and the Insured Individual's application. Contract changes Any change in the Group Policy must be signed by a duly authorized executive of The Canada Life Assurance Company, and accepted in writing by the Policyholder. Conflicts with laws Canada Life automatically amends any Provisions in the Group Policy so that they conform with any laws in the jurisdiction where the Policy is written, or where you live. Terms Used in the Certificate The following defines the terms used in this Certificate of Insurance. Term Amount of Insurance Beneficiary Effective Date Contestability Period Definition The sum insured as set out at the top of this Certificate, less any Benefit Reductions at Older Ages, and any Vital Living Benefit paid. The person or persons you name to receive the money that will be paid under your Certificate when you die. The date shown on the front of the Certificate as follows: Original Effective Date is the date your original coverage begins; Revision Date is the date a change, or increase or decrease in coverage begins. The period of 2 consecutive years from the date coverage comes into force, or is reinstated, or is increased, and during which Canada Life may dispute the accuracy of the information in your application.

9 Terms Used in the Certificate... (continued) Term Credit Card Credit Cardholder Customer Eligible Person Group Policy Hudson's Bay Rewards Card Hudson's Bay Rewards Member Insured Individual Non-Smoker Provision Smoker Spouse Definition Any valid Credit Card issued by Capital One Bank in association with the Policyholder, such as Hudson's Bay Credit Card Hudson's Bay Mastercard. The person to whom a Credit Card is issued, and whose name is on the Credit Card. A natural person who is a Customer of Hudson's Bay company receives an offer of insurance under this Policy, and is a resident of Canada outside Quebec. A person who, when enrolling in the Policy, is any of the following: - a Credit Cardholder - a Credit Cardholder's Spouse - a Hudson's Bay Rewards member, or - a Customer, and meets these criteria: -is at least 18 years of age and no more than 69 years of age -is a resident of Canada, and -provides evidence of insurability that is satisfactory to Canada Life. Group Policy issued by Canada Life to the Policyholder, or a Group Policy issued to replace Group Policy The card issued to a person with a customer rewards program account administered by the Policyholder. A person whose name appears on a Hudson's Bay Rewards Card or that person's Spouse. An Eligible Person who has enrolled and is approved for coverage under this Policy has paid the initial premium, and continues to pay the required insurance premiums. An Eligible Person who has not used any of the following in the 12 months previous to the date of application: tobacco tobacco products, or smoking cessation aids. Means a term or condition of the Policy - some of the rules. An Eligible Person who has used any of the following in the 12 months previous to the date of application: tobacco tobacco products, or smoking cessation aids. The person to whom the Credit Cardholder or Hudson's Bay Rewards Member is either legally married at the time of application, or with whom he or she has lived in a conjugal relationship in the same primary residence for a period of at least 24 months at the time of application.

10 Protecting Your Personal Information Your access to your information Canada Life maintains a file of personal information in its offices or in the offices of an authorized Canada Life organization. You may access your information by sending a written request to Canada Life. Restricting access to your information How we use your information For more information Canada Life restricts access to personal information to Canada Life staff or persons authorized by Canada Life who need the information to perform their duties to persons to whom you have granted access, and to persons authorized by law. Canada Life collects, uses, and discloses personal information to process insurance applications, and when approved, provide and administer the financial product(s) applied for, including - investigating and assessing claims, and - creating and maintaining records of its relationship with you. If you want a copy of Our Privacy Guidelines, or have any questions about our personal information policies and practices, including those regarding service providers, then either write to Chief Compliance Officer Canada Life Assurance Company of Canada 330 University Ave. Toronto, ON M5G 1R8 or refer to THE CANADA LIFE ASSURANCE COMPANY 140 Fullarton Street, 10th Floor London, Ontario N6A 5P2 Paul A. Mahon President and Chief Executive Officer