SAMPLE YOUR ADVISOR. SSQ CLIENT SERVICES Tel.: Visit our website: ssq.ca. Policy date December 28, 2014

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1 David Smith Mary Smith 2172 Front Street TORONTO ON S1S 1Q0 Your universal life insurance statement From December 28, 2014 to December 27, 2015 Universal Life Do you have questions regarding your statement? Contact your financial security advisor or our Client services: YOUR ADVISOR Summary of your universal life insurance policy Policy number William Jones Tel.: SSQ CLIENT SERVICES Tel.: Visit our website: ssq.ca V12,345,678 Policy date December 28, 2014 Policyowner(s) Beneficiary(ies) David Smith Mary Smith Steven Smith Total sum insured $200, Total value of the accumulated fund (excluding the transitory deposit account) $9, Cash surrender value (excluding the transitory deposit account) $9, Transitory deposit account value $ Deposits made into the policy during the statement period $10, Deposits made into the transitory deposit account during the statement period $ Estimated maximum deposit for the next policy year (from December 28, 2015 to December 27, 2016) $3, Annualized rate of return 3.07% Balance of cash advances $ The estimated maximum deposit for the next policy year corresponds to an estimation for the following year of the amount of money that can be deposited into your policy without losing exempt policy status. This amount is not guaranteed and is calculated based on the policy data and the criteria set forth in the Income Tax Act to maintain exempt policy status, presuming that no changes are made to the policy during the following year. If the total amount deposited exceeds the maximum deposit amount, the excess amount is transferred directly into the policy s transitory deposit account. Page 1 of 7

2 Summary of your insurance benefits as of December 27, 2015 This section presents the benefits included in your policy and their respective cost of insurance on the last date of the statement period. Benefit(s) and type Insured Effective date End date Sum Monthly cost Annual cost of benefit(s) (yyyy/mm/dd) (yyyy/mm/dd) insured of insurance of insurance person(s) deducted deducted Universal Life David Smith , Waiver of premium in case David Smith of disability of policyowner Total 200, The monthly cost of insurance represents the last cost of insurance for the statement period that has been deducted from the accumulation fund to pay for the insurance component of the policy. It varies according on the sum insured, risk class, sex and the age of the insured person(s). The annual cost of insurance represents the sum of the monthly cost of insurance deducted from the accumulation fund during the statement period. Additional information about your policy Death benefit option Increasing Adjustment option of sum insured No increase Premium charged (monthly) $ The premium charged is the amount the policyowner chose to pay, subject to a certain minimum. Page 2 of 7

3 Evolution of your accumulation fund from December 28, 2014 to December 27, 2015 The accumulation fund consists, at a given date, of the total value of all investment accounts that you chose in your policy. This section shows how the transactions that were made during the statement period impacted the balance of your accumulation fund. Account Annualized Value at Funds in Interest Costs Funds out Value at end of name rate of start of the = the period return period (%) European Equity , , TD Global Dividend , , Equity CI Cambridge Canadian Asset , , Allocation US Equity, Science , , and Technology Guardian Monthly , , Income Guardian Canadian , , Dividend Equity Total , , Total value of your accumulation fund as of December 27, , The annualized rate of return is based on a formula that takes into account the time that Funds in and Interest have been credited and Costs and Funds out have been deducted. Funds in correspond to the total amount of all premiums paid and additional deposits made into the accumulation fund during the statement period, including transfers made from other investment accounts and transfers made from the transitory deposit account. This amount also includes any bonus paid, if any, for the elapsed year. Interest corresponds to the gain or loss of an investment account during the statement period. Costs correspond to the total amount, for the statement period, which is deducted from the accumulation fund to pay for the provincial premium tax (established based on the province of residence and can change at any time), the cost of insurance, cost of additional or complementary benefits, policy fees, administrative fees and fees relating to various requests made by the policyowner. Funds out correspond to the total amount of all the withdrawals made from the accumulation fund during the statement period, including transfers made to other investment accounts and transfers made into the transitory deposit account. This amount also includes the market value adjustment, if any. Your cash surrender value as of December 27, 2015 At a given date, the cash surrender value is equal to the balance of your accumulation fund, less, if applicable, the policy surrender charges, the market value adjustment and the amount of any outstanding cash advances plus interest accrued and due. The cash surrender value may be null due to surrender charges and may be taxable in case of a cash advance or partial or full surrender. Your total cash surrender value 9, Less Surrender charges Market value adjustment 0.00 Cash advance balance (including unpaid interest) Your total cash surrender value as of December 27, , Surrender charges, if any, will be deducted if you decide to access your cash surrender value. These charges are guaranteed and will not change unless you make changes to your policy. Market value adjustment is the amount deducted if the interest rate in effect on the date the request is made is greater than the interest rate credited to the account whenever a transfer, a cash advance, a partial or full surrender of a guaranteed interest investment account is requested by the policyowner. Page 3 of 7

4 Your policy cash advances from December 28, 2014 to December 27, 2015 You may borrow from your policy cash surrender value. The minimum cash advance amount that you can take is $500. The cash advance interest rate is 5.20% and the maximum cash advance amount available as of December 27, 2015 is $8, Your cash advance balance at the start of the period 0.00 Plus Cash advances during the statement period Interest on the cash advances (interest rate of 5.20%) Less Cash advance reimbursements during the statement period Your cash advance balance at the end of the period as of December 27, 2015 Any cash advance bears interest at a rate determined by SSQ and the interest on the cash advance will be payable on each policy anniversary date. Interest not paid on that date will be added to the cash advance and will bear interest at the same rate. Each cash advance, plus interest accrued and due, constitutes indebtedness under the policy and will be deducted from the amount payable at death. Once the cash advance balance exceeds the cash surrender value, the policy is terminated. Evolution of your transitory deposit account from December 28, 2014 to December 27, 2015 The transitory deposit account consists of the portion of the accumulation fund that exceeds the maximum allowed by the Income Tax Act and its regulations in order to maintain the policy exempt status and to take full advantage from benefits offered by this status. On each policy anniversary, a transfer will be made from this account to the accumulation fund of the policy if the value of the accumulation fund allows for it. Account Annualized Value at start of Funds in Interest Funds out Value at end name rate of return the period = of the period (%) Guaranteed interest 1 yr Total Value of the transitory deposit account as of December 27, The annualized rate of return is based on a formula that takes into account the time that Funds in and Interest have been credited and Funds out have been deducted. Funds in correspond to the total amount of transfers made from the accumulation fund into the transitory deposit account that exceeds the maximum allowed by the Income Tax Act. Interest corresponds to the gain or loss of transitory deposit account during the statement period. It is taxable annually. Funds out correspond to the total amount of all the withdrawals or transfers made by the policyowner from the transitory deposit account during the statement period, which may be subject to market value adjustment. Page 4 of 7

5 Breakdown for your investment accounts as of December 27, 2015 This breakdown lists the investment accounts that you have chosen and their respective allocation as a percentage of the total value of the accumulation fund. Investment option Account name Breakdown of your accounts (%) Guardian Monthly Income 18 Index accounts CI Cambridge Canadian Asset Allocation 15 29% TD Global Dividend Equity 19 Guardian Canadian Dividend Equity % Index accounts European Equity 18 US Equity, Science and Technology Total 100 Breakdown of your premiums/deposits as of December 27, 2015 This breakdown indicates the percentage of your premiums/deposits that you have chosen to allocate to each of your investments. Breakdown of Investment option Account name your premiums/deposits (%) Guardian Monthly Income 18 CI Cambridge Canadian Asset Index accounts Allocation 14 TD Global Dividend Equity 19 Guardian Canadian Dividend Equity European Equity Index accounts 20 US Equity, Science and Technology 10 Total New investment options for your universal life insurance policy are now available! Upon written request, you can change your choice of investment accounts, the distribution of your premiums/deposits as well as the respective allocated percentages. For more information on your investment options or for any questions on your policy, contact your advisor. Page 5 of 7

6 Terms used in your statement Here is a list of certain terms that may appear in your policy statement. For a complete definition or any other definition, please refer to your insurance policy. Additional deposits Level death benefit option Additional deposits are premiums that the policyowner can A level death benefit option means that the amount payable pay at any time. A minimum amount is required for each upon death of the insured or the insureds corresponds to the additional deposit. greater of the sum insured and the value of the accumulation fund. Amount payable upon death This is the amount payable upon death of the insured or the Level indexed death benefit option insureds. It varies according to the death benefit option A level indexed death benefit option means that the amount chosen by the policyowner. payable upon death of the insured or the insureds corresponds to the greater of the value of the accumulation Beneficiary fund plus the net amount at risk (the amount on which the The person designated as such by the policyowner as a cost of insurance is calculated) and the indexed sum recipient of the amount payable upon death of the insured or insured. the insureds. Policy date Bonus This is the date the policy was issued. Any bonus granted by SSQ Insurance Company Inc. is credited to the accumulation fund. The policy specifies the Policyowner type of bonus that will be paid, if any, as well as the Any person designated as such in the application for conditions under which the bonus is granted. insurance or any person who has subsequently substituted the original policyowner. Increasing death benefit option An increasing death benefit option means that the amount Premium payable upon death of the insured or the insureds Premium payments (from which the premium tax is corresponds to the value of the accumulation fund in deducted) are deposited into the investment accounts that addition to the sum insured. the policyowner has selected. Increasing indexed death benefit option Sum insured adjustment options An increasing indexed death benefit option means that the To the extent that tax legislation permits, SSQ Insurance amount payable upon death of the insured or the insureds Company Inc. undertakes to maintain the exempt status of corresponds to the value of the accumulation fund in the policy by applying the sum insured adjustment option addition to the indexed sum insured. chosen by the policyowner. Insured person The policyowner can choose between different adjustment Any person who is insured under the benefit(s). options of the sum insured to keep the policy exempt: No increase; Investment account Exempt test increase; Increase and decrease (minimum initial sum These may be fixed interest rate accounts with a guaranteed insured); return for a fixed period or accounts with a rate of return, With increase (reduction at age 85); or which may vary daily, that is linked to one or more stock Maximizer. indices or one or more designated funds. The policyowner can choose between numerous investment accounts to achieve their savings objectives: Daily interest account; Guaranteed interest account; Index accounts; and. Page 6 of 7

7 Contact us Call your advisor William Jones Tel.: Call us For any additional information, please contact our Client Services at or at Visit our website at: ssq.ca Important notes Your statement is intended to give you accurate and practical information helping you to manage and track your investment activity. For more details, please refer to your policy. This is not a premium notice but a statement of your policy. For more details, contact your advisor. Please verify the information contained in this statement and notify us if you believe there is an error or omission. All amounts are expressed in Canadian dollars. The information regarding historical rate of returns, if necessary, will be provided upon request by contacting your advisor. Page 7 of 7