Certificate of Insurance. These are the details of this Certificate of Insurance. Item SAMPLE. Insured Individual's Date of Birth July 3, 1990

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1 Overview Certificate details Certificate of Insurance These are the details of this Certificate of Insurance. Item Insured Individual John A. Sample Insured Individual's Date of Birth July 3, 1990 Group Policy Certificate Number HB Original Effective Date October 1, 2011 Revision Date October 7, 2011 Amount of Insurance $50,000 Subject to Reductions at Older Ages Current Annual/Monthly Premium Payable [includes applicable provincial sales tax and/or any applicable rider premium] Critical Illness Rider Contact Address Details issued to Hudson's Bay Company Refer to the section Benefit Reductions at Older Ages for more details. $12.39 Monthly Yes The Canada Life Assurance Company 140 Fullarton Street, 10th Floor London, Ontario N6A 5P2 Group Policy 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 90311, then the following applies. When the Insured Individual... is alive has died without selecting which Certificate is in effect 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. Restricted benefits: Preexisting conditions Certificate version You may not have coverage for medical conditions and/or symptoms if you have a pre-existing condition. Refer to the section What is not covered. This Certificate replaces any other Certificate version with an earlier issue date, issued to you for coverage under the Group Policy.

2 Terminology 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. Cancellation/ refund Paragraph headings 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. The division of this Certificate into sections with headings is for convenience only, and does not affect the construction or interpretation of this Certificate. In this Certificate This Certificate is made up of the following topics. Topic See Page Coverage under this Certificate 2 Insuring Provisions 4 Claims 5 General Provisions 6 Terms Used in the Certificate 8 Protecting Your Personal Information 11 Coverage under this Certificate Introduction The following coverage provisions apply under this Certificate and are detailed below: When your coverage begins When your coverage ends What is covered when your coverage begins when your coverage ends 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 70 the date this Group Policy terminates the date on which you fail to pay the premium required to keep coverage in force the date on which you are paid a benefit for any one Covered Condition, or the date of your death. The following benefits are covered under this Certificate. Benefit Basic Policy Benefits Covered as Defined in this Policy and Rider Heart Attack Stroke Coronary Artery By-pass Surgery, and life-threatening Cancer.

3 What is covered The following benefits are covered under this Certificate. Additional Rider Benefits under the Critical Illness Rider Alzheimer's Disease Coma Kidney Failure Major Organ Transplant Multiple Sclerosis Parkinson's Disease Paralysis, and Heart Valve Replacement. What's not covered Canada Life does not pay benefits under the following conditions. Exclusion We do not pay benefits... Qualifying period Pre-existing condition 90-day cancer exclusion Other when you do not survive for at least 30 days after the earliest of the date of Diagnosis, or the date of Surgery. for any Covered Condition that is first Diagnosed within 2 years of - the Effective Date, or - any reinstatement date, and that is directly or indirectly related to a Pre-existing condition, as defined in this Certificate. during the first 90 days of coverage under this Certificate if the following conditions apply. When you have... Then we... obtained any do not pay any benefits medical advice or refund all premiums you have paid under this treatment leading Certificate, and to a Diagnosis of consider insurance under this Certificate never to have Cancer, or been in force. been Diagnosed with Cancer when a claim or Covered Condition is caused directly or indirectly by any of the following: any injury or sickness that - is not a Covered Condition, but - may have been affected by a Covered Condition skin cancer other than malignant melanoma any condition which is or results from or is a complication or infection with Human Immunodeficiency Virus (HIV) or any variance including - Acquired Immune Deficiency Syndrome (AIDS) and - AIDS Related Complex (ARC) any treatment that has not been prescribed by a doctor self-inflicted injuries, whether while sane or insane misuse of medication or the abuse of drugs or intoxicants, or failure to seek or follow medical advice. Grace period 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.

4 Reinstatement of coverage Your insurance may be reinstated after coverage is terminated for non-payment of premiums under these circumstances: Canada Life must receive Benefit Reductions at Older Ages 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. Starting at age 66, your benefits are reduced by 20% of the original amount each year until the Policy terminates at age 70. 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 The following Insuring Provisions apply under this Certificate and are detailed below: determining premiums payable changes in coverage, and Determining premiums payable Changes in coverage Changes to smoking status changes to smoking status. You must pay the monthly premium amount that is set out in the Monthly Table of Premiums, based on your age, sex, and smoking status on the date of Policy enrollment. 5-year terms Your premiums will not change for a period of 5 years from the Effective Date, and for every renewable 5-year term after. 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 are subject to a new 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.

5 Claims Introduction The following Claims provisions apply under this Certificate and are detailed below: making a claim contacting our Claims Department proof of claim, and payment of claims. Making a claim Contacting our Claims Department Proof of claim 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 Diagnosis. 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 Diagnosis. 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 Diagnosis 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 Covered Condition. 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 Canada Life must receive the following proof satisfactory to us before we will pay any claims on this Policy: the right of the claimant to receive payment the Diagnosis of a Covered Condition, and any other information required by us to establish the validity of the claim. Right to autopsy If you die, Canada Life reserves the right to require an autopsy to support proof of claim, unless prohibited by law. Payment of claims The critical illness benefit is paid to you in one lump sum equal to the Amount of Insurance in effect at the time of Diagnosis minus any Benefit Reductions at Older Ages.

6 General Provisions Introduction Incorrect statement of age or sex Incorrect smoking status Incontestability of individual coverage 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 non-participating Policy 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 listed listed incorrectly If your age or sex is listed incorrectly, and your true age disqualifies you from this Policy calculates the following based on 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. has the right to cancel coverage from the date it began, and refund an amount equal to the premiums that have been paid. 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. 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 information is considered truthful and complete except for information provided fraudulently, or the date of birth, sex, or smoking status was listed incorrectly. Nonparticipating Policy Premium rate change You or any other person are not entitled to any share of Canada Life profits under this Group Policy or Certificate. 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.

7 General Provisions... (continued) Legal action Access Currency Right to offset Entire contract 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 Act, 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. 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 to you. 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.

8 Terms Used in the Certificate The following defines the terms used in this Certificate of Insurance. Term Amount of Insurance Cancer Contestability Period Coronary By- Pass Surgery Surgery Covered Conditions Credit Card Credit Cardholder Customer Definition The sum insured as set out at the top of this Certificate less any Benefit Reductions at Older Ages. A malignant tumour characterized by the uncontrolled growth and spread of malignant cells and invasion of tissue that is confirmed in writing by a certified oncologist includes - leukemia - Hodgkin's disease - invasive melanoma, and does not include - carcinoma cancer in situ - Kaposi's Sarcoma or other AIDS related cancers or cancer in the presence of HIV - skin cancer or melanoma that is not invasive and has not exceeded 0.75 millimetres in depth, and - prostate cancer diagnosed as T1N0 M0 or equivalent staging. 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. Surgery performed by a certified cardiovascular surgeon to correct narrowing or blockage of one or more coronary arteries with bypass grafts. Excluded Coronary By-Pass Surgery does not include any non-surgical techniques, such as balloon angioplasty laser relief of an obstruction, or other intra-arterial techniques. means the following, as defined in this Certificate: Cancer Heart Attack Stroke, and Coronary By-Pass Surgery. 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.

9 Terms Used in the Certificate... (continued) The following defines the terms used in this Certificate of Insurance. Term Diagnosis Doctor Effective Date Eligible Person Group Policy Heart Attack Hudson's Bay Rewards Card Definition The identification of an Insured Individual's Covered Condition provided in writing by a Doctor. The effective date of the Diagnosis is the date established by the Doctor. Physician or surgeon licensed in Canada practicing medicine in Canada, and who is not - you, or - one of your relatives or business associates. 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. 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 65 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 death of a portion of heart muscle due to inadequate blood supply. Criteria Diagnosis must be confirmed in writing by a Doctor who is - a certified specialist in internal medicine, or - a certified cardiologist, and based on - new electrocardiograph changes consistent with heart attack, and - elevation to levels consistent with heart attack of at least one of the following: cardiac biochemical markers, or cardiac enzyme. Excluded Heart Attack does not include elevations in the following that are due to coronary angioplasty: cardiac biochemical markers, or cardiac enzyme. Exception: Elevation due to coronary angioplasty is considered criteria for Heart Attack when accompanied by diagnostic changes of a new Q wave infarction of the ECG. The card issued to a person with a customer rewards program account administered by the Policyholder.

10 Terms Used in the Certificate... (continued) The following defines the terms used in this Certificate of Insurance. Term Hudson's Bay Rewards Member Insured Individual Non-Smoker Smoker Pre-Existing Condition Spouse Stroke Surgery Definition 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. 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. Any medical condition for which you sought or received medical advice or medical consultation a medical investigation or tests medical treatment, such as pills or medication, or any treatment required or recommended by a doctor or paramedical practitioner, or a Diagnosis during the 24 months before your Effective Date, or any reinstatement date, or the date of any increase in the Amount of Insurance. 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. A cerebrovascular incident that excludes transient attack (TIA), and produces infarction of the brain tissue due to - thrombosis hemorrhage from an intracranial vessel, or - embolization caused by an extracranial source, and must be confirmed by a certified neurologist. The physical intervention on tissues to treat a Covered Condition performed in Canada by a Doctor. Surgery includes the procedure in which bone marrow is transplanted.

11 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. Canada Life restricts access to personal information Restricting access to your information How we use your information For more 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

12 Group Critical Illness Rider Critical Illness Rider Introduction This Group Critical Illness Rider forms a part of and is attached to Group Policy Rider details This Rider Benefits Rider schedule Covered conditions All provisions, conditions and exclusions of the Group Policy and Certificate of Insurance also apply to this Critical Illness Rider. These are the details of this Critical Illness Rider. Insured Individual Group Policyholder Item Group Policy John A. Sample Details Hudson's Bay Company Certificate Number HB Original Effective Date October 1, 2011 Revision Date October 7, 2011 Amount of Insurance $25,000 This Rider describes additional critical illness coverage on you, the Insured Individual named above. Canada Life agrees to pay critical illness benefits to you. This Rider Schedule replaces any Rider Schedule that may have been issued to you in the past under the Group Policy This Rider provides coverage for the following Covered Conditions as defined in this Rider Alzheimer's disease Coma Kidney Failure Major Organ Transplant Multiple Sclerosis Parkinson's Disease Paralysis, and Heart Valve Replacement.

13 Covered conditions under this Rider The following table defines the Covered Conditions under this Rider. Term Alzheimer's disease Coma Heart Valve Replacement Kidney Failure Major Organ Transplant Multiple Sclerosis Paralysis Definition A progressive degenerative disease of the brain where you exhibit the loss of intellectual capacity - involving impaired memory and judgment, and - resulting in significantly reduced mental and social functioning are incapable of independent living, and require a minimum 8 hours of supervision a day. Excluded Alzheimer's disease does not include any other dementia disorders, or psychiatric illnesses. A state of unconsciousness for 96 continuous hours where there is no reaction to - external stimuli, or - internal needs, and the Glasgow coma score is 4 or less. Excluded Coma does not include a medically induced coma. Surgery to replace any heart valve with either a natural or mechanical device. Excluded Heart valve replacement does not include heart valve repair. End stage renal disease resulting in chronic irreversible failure of both kidneys that must initiate regular haemodialysis peritoneal dialysis, or renal transplantation. A medically necessary transplant to replace any of the following major organs that have failed irreversibly: heart both lungs liver both kidneys, or bone marrow. 2 or more clinical attacks, confirmed by magnetic resonance imaging (MRI), showing multiple lesions of demyelination, or well-defined neurological abnormalities - lasting more than 6 months - confirmed by MRI - showing multiple lesions of demyelination, or a single attack, confirmed by MRI, that shows multiple lesions of demyelination that have developed in intervals at least 1 month apart. The total loss of muscle function to two or more limbs due to injury or disease to the nerve supply of those limbs for a period of at least 90 days following the precipitating event.

14 Covered conditions under this Rider The following table defines the Covered Conditions under this Rider. Term Parkinson's Disease Definition Primary idiopathic Parkinson's disease characterized by two or more of the following clinical manifestations: - muscle rigidity; - tremor; or - bradykinesis: abnormal slowness of movement sluggishness of physical and mental responses, and requiring substantial physical assistance from another adult to perform at least 2 of the following 6 activities of daily living. Activity The ability to... Bathing Dressing Toileting Transferring Feeding wash oneself in a bathtub, shower or by sponge bath, with or without the aid of equipment. put on, remove, fasten and unfasten all necessary clothing, braces, artificial limbs, or other surgical appliances. get to and from the toilet and maintain personal hygiene. move into or out of a bed, chair or wheelchair, with or without the use of equipment. consume food or drink that already has been prepared and made available, with or without the use of utensils Bladder and manage bowel and bladder function with or without Bowel protective undergarments or surgical appliances so that Continence a reasonable level of hygiene is maintained. Excluded No benefit is payable for any other type of Parkinsonism.