SELECT LANGUAGE

001

English

ANNUAL STATEMENT ON MARKET CONDUCT
Property and Casualty Insurance

010

Insurer name:

020

Client number:

030

Name of the contact person:

040

Email of the contact person:

050

For fiscal year ended:

060

Jurisdiction of incorporation:

070

If "Foreign", Country or State:

Federal

*Provinces and territories in which the organization is licensed:
(01)
080

Alberta ###

081

British Columbia

082

Manitoba

083

New Brunswick

084

Newfoundland and
Labrador

090

(02)
FAUX

FAUX

FAUX

FAUX

FAUX

(03)

Northwest Territories

FAUX

Quebec

FAUX

Nova Scotia

FAUX

Saskatchewan

FAUX

Nunavut

FAUX

Yukon

FAUX

Ontario

FAUX

Prince Edward Island

FAUX

Type(s) of insurance offered by the organization:

Commercial and Personal

Commercial lines insurers are only required to fill Governance (2.0) and Complaints sections (9.0 and 9.6).

100

Are you currently offering insurance products?

You are offering insurance products if you are issuing new insurance contracts. Insurers that are only servicing
existing policies are only required to complete sections on governance (2.0) and complaints (9.0 and 9.6).

Identification

 ANNUAL STATEMENT ON MARKET CONDUCT
Property and Casualty Insurance
TABLE OF CONTENTS
SCHEDULE
Identification

Identification

2.0

Governance

3.0

Policies

4.0

Products

5.0

Premiums, Commissions and Claims

6.0

Distributors

7.0

Sales and Incentives Management

8.0

Claims

9.0

Complaint Examination

9.6

Complaint Reporting

10.0

Protection of Personal Information

Validation

Validation
Note that, during the transmission of your form via the e-services, the system proceeds to
validations of the data given in the Annual Statement (mandatory sections, Yes / No
questions, respect of format required, etc.)
The "Validation" tab allows you to ensure that your Annual Statement form can be
submitted without problems in the system.
There are two types of validation messages:
E = Error. Means that you need to correct this data before submitting your form. Blocking.
A = Alert. Means that this response may not be consistent with what is requested. Just
make sure your answer is correct. Not blocking.
"Error" or "Alert" messages are reported by the red color in the "Result" column. You can
filter by color to more easily identify all the messages.
In order to transmit the Annual Statement, you must complete the form in the
language of your data software (Excel). You must keep this same language for the
entire form.

LEGEND
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Hyperlink

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DEFINITIONS
INSTRUCTIONS

The definitions are also accessible from each tab by clicking on the pictogram provided for
this purpose.
Please read the general instructions carefully before completing the Annual
Statement.

0.0

 2. GOVERNANCE

DEFINITIONS

Question 1: This individual is often the CCO or CEO for smaller organization. It is not the Ombudsperson.
Question 2: Total number of employees includes all types of employees (full time, contractual, etc.).
Questions 7.1 and 7.2: "Reviews and audits" refers to those conducted by the insurer and include, but are not limited to, examinations, compliance reviews, internal audits and other assessments of
market conduct.
Question 9: "Organizational or operational changes" includes mergers and acquisitions or other material changes within the insurer that may impact or affect the outcomes associated with FTC as
described by the International Association of Insurance Supervisors (IAIS).

1. Identify the senior officer(s) in charge of ensuring the development, implementation and enforcement of policies and practices related to the
fair treatment of consumers at the end of the reference period:
(01)
001

Check this box if no senior officer is in charge:

010

a) Name of the senior officer:

020

b) Title:

030

c) Address:

040

d) Telephone number:

050

e) Email:

060

a) Name of the senior officer:

070

b) Title:

080

c) Address:

090

d) Telephone number:

100

e) Email:

110

a) Name of the senior officer:

120

b) Title:

130

c) Address:

140

d) Telephone number:

150

e) Email:

##
0

1.1 Provide an overview of the processes and responsibilities regarding the development, implementation and enforcement of policies and
practices related to the fair treatment of consumers within your organization:
(01)

160

(01)
170

180

2. Please indicate the total number of employees in your organization:
2.1 Please indicate the total number of employees whose primary responsibilities (50% or more) are
related to the oversight of fair treatment of consumers:

(01)
190

3. Do you have a code or policy that specifically addresses the fair treatment of consumers?
If yes, please answer the questions below:

200

a) When was the last time you reviewed your code or policy (YYYY-MM-DD) whether or not the review resulted in
a change

210

b) Have you communicated this code or policy to all of your staff?
If no, please answer the question below:

220

c) Do you intend to develop such a document within the next year?

230

4. Is the fair treatment of consumers a priority at each stage of the product life cycle and in every area of
your operations?

(01)

If yes, please indicate if you engage in each of the following practices to ensure the fair treatment of consumers:
240

a) Develop strategies, objectives and initiatives to promote the fair treatment of consumers

250

b) Embed the fair treatment of consumers in the organization’s policies and code of ethics

260
270

c) Develop mechanisms and procedures to identify and address any conflicts that could impact the fair treatment
of consumers
d) Develop measures and reports to inform management of the organization’s performance in the fair treatment
of consumers
If no, please explain why the fair treatment of consumers is not a priority of each stage at the product life cycle and in every area of your
operations in the space below:
(01)

280

2.0

 5. Please provide an overview of the type and length of training employees receive on hiring and on an ongoing basis with respect to the fair
treatment of consumers:
(01)

290

(01)

300

6. During the past year, have you been the subject of any regulatory action of significance by a regulator
outside of Canada that relates to fair treatment of consumers that could have a material impact on
market conduct practices in Canada?
If yes, please provide details (which regulator, product concerned, outcome, etc.):
(01)

310

(01)
320

7. Please select the option that reflects the method of distribution adopted by your organization:

Both independent channels and direct or
exclusive agents

If you distribute your products exclusively through independent channels, answer questions 7.1
If you distribute your products exclusively through direct or exclusive agents, answer questions 7.2
If you distribute your products through both independent channels and direct or exclusive agents, answer questions 7.1 and 7.2
"Other distribution channels" are not covered by this question.

7.1 Independent Channels
(01)
330

a) Please indicate the total number of distribution contracts you have with independent agents (brokers)

340

b) Please indicate the total number entities holding distribution contracts (e.g. brokerage firms)

350

c) Please indicate the total number of independent agents (brokers) and brokerage firms within your distribution
channel that were the subject of a review or audit that included a focus on fair treatment of consumers

360

d) Please identify the scope of the audit(s)/review(s) conducted over the independent agents (brokers)

370

e) Please identify the three most pervasive/frequent market conduct activities and/or conditions ("triggers") that
led to targeted, risk-based audits or reviews of independent agents (brokers) and/or entities

7.2 Direct or Exclusive Agents
380

a) Please indicate the total number of direct or exclusive agents included within your distribution network

390

b) Please indicate the total number of direct or exclusive agents that were reviewed or audited

400

c) Please indicate the total number of direct or exclusive agents within your distribution network channel that
were the subject of a review or audit that included a focus on market conduct practices

410

d) Please identify the scope of the audit(s)/review(s) conducted over the direct or exclusive agents

420

e) Please identify the three most pervasive/frequent market conduct activities and/or conditions ("triggers") that
led to target, risk-based audits or reviews of direct or exclusive agents

8. Please indicate if each element listed below is provided or addressed before or at the time of purchase and if you have processes / mechanisms
in place to ensure that it is disclosed or addressed:
(01)
430

a) Insurer name and contact information

Information not disclosed or not complied with

440

b) Product and its main features

Information disclosed/complied with but no
mechanism in place

450

c) Suitability risks associated with the product

Information disclosed and mechanism in place

460

d) Right of termination or rescission

Non applicable

470

e) Clear, plain language communication that is not misleading

480

f) Formatting that is easy to read and understand

490

g) Up-to-date information provided in a timely manner

500

h) Potential conflicts of interest

9. Please indicate if each type of information listed below is provided after the sale and if mechanisms are in place to ensure that it is provided:
(01)
510

a) Substitutions or replacement of a product

Information provided and mechanism in place

520

b) Contract amendments

Information provided but no mechanism in
place

530

c) Customer rights and obligations in connection to any material changes in the product that was sold or offered

Information not provided

540

d) Changes in the environment that may impact the product (e.g. legislative changes)
2.0

 550

e) Organizational or operational changes that may impact the customer, product or related services

560

10. Do you engage in advertising campaigns directed toward consumers?

(01)

If yes, please indicate if you have processes/mechanisms in place to ensure / address the following in your advertising campaigns:
570

a) Advertising satisfies all applicable legal and regulatory requirements

580

b) Name of the insurer is clearly indicated

590

c) Advertising is appropriate for the target consumer group

600

d) Written advertisements are presented in a format that is easy to read and understand

610

e) Advertising is truthful and authentic with respect to the use of statistics and testimonials

620

f) Unclear, misleading or inaccurate advertisements are promptly modified or withdrawn

630

g) Advertising is reviewed independently of the person who designed or prepared the advertisement prior to its
dissemination

(01)
640

11. Do you conduct customer satisfaction surveys?
If yes, please indicate the frequency at which you conduct customer satisfaction surveys for each of the following:

650

a) Sale

Immediately after each event

660

b) Claim

Annually

670

c) Complaint

On an ad-hoc basis

680

d) Other

No satisfaction survey done

12. General comments:
(01)

690

2.0

 3. POLICIES

DEFINITIONS

The information to be reported in this tab excludes commercial insurance products.
All fields must be completed. If you do not offer products in a class of insurance, simply indicate 0.

Class of Insurance

010

Property

020

Aircraft

030

Automobile

040

Credit Protection

050

Legal Expense

060

Liability

070

Mortgage

080

Title

090

Marine

100

Accident and Sickness

110

Other Approved Products

129

TOTAL

Number of New
Policies Issued

Number of
Number of Insurer Applications from
Number of
Number of Insurer
Number of
Number of Policies
Initiated NonConsumer
Customer Initiated
Initiated
Customer Initiated
Renewed
renewals
Declined by
Non-renewal
Cancellations
Cancellations
Insurer

Number of Insurer
Number of Insurer Initiated
Initiated
Cancellations with Refund of Premium
Cancellations
without any
Fully Refunded Prorated and ShortRefund of
(ab initio)
rated
Premium

(01)

(02)

(03)

(04)

(05)

(06)

(07)

(08)

(09)

(10)

0

0

0

0

0

0

0

0

0

0

General comments:
(01)

140

3.0

 4. PRODUCTS

DEFINITIONS

The information to be reported in this tab excludes commercial insurance products.
(01) Product families that were available for sale during the reporting year are to be reported.
(02) In the "class of insurance" column, please indicate the main guarantee only.
(03) Material changes to be reported are limited to material changes initiated by the insurer or are the result of a decision made by the insurer. Excludes regulatory required changes.

(01)
010

1. How many product families do you have?

020

2. How many product families were reviewed with a focus on fair treatment of consumers and consumers'needs in the reference period?

(01)

Product Family

(01)
030
040
050
060
070
080
090
100
110
120
130

Material Change(s) If yes, Indicate the
Class of Insurance in the Offer or in
Initial Date of
the Product?
Change
(02)

Property
Aircraft
Automobile
Credit Protection
Legal Expense
Liability
Mortgage
Title
Marine
Accident and
Sickness
Other Approved
Products

(03)

Yes

Type of Change

(04)

(05)

Did the Change
Result in a Change Is it a New Product
in the Target
Family?
Market?
(06)

Product features
Yes
Pricing
No
Product features & pricing Non applicable
New product
Discontinued product
Non applicable

No

140

4.0

(07)

Yes
No

Comments or Additional
Information

(08)

 150
160
170
180
190
200
210
220
230
240
250
260
270
280
290
300
310
320
330
340
350
360
370
380
390
400
410
420
430
440
450
460
470
480
490
500
510
520

4.0

 530
540
550
560
570
580
590
600
610
620
630
640
650
660
670
680
690
700
710
720

3. General comments:
(01)

730

4.0

 5. PREMIUMS, COMISSIONS AND CLAIMS

DEFINITIONS

The information to be reported in this tab excludes commercial insurance products.
All amounts are to be reported in thousands of dollars.
The information requested in this section must be expressed in an accounting basis (as in the Quarterly Return / Annual Supplement - P&C).
The premiums, commissions and claims requested in this section excludes business outside Canada.
All premiums, commissions and claims must be provided solely for the entity of insurance submitting the form (non-consolidated data).
The information to be reported in this tab excludes reinsurance.
For commissions, "Direct or Exclusive Agent" includes commissions paid to agents as well as firms for the sales or service of any product.
For increased clarity, references to the Quarterly Return / Annual Supplement are provided for each type of information requested. Please note that the nature of the required information in the Annual Statement on Market Conduct may differ from the reference given. (ex. Consolidated information is requested in the Quarterly Return / Annual
Supplement as the information requested here must be non-consolidated, information must be provided for each distribution channel in the Annual Statement on Market Conduct as it does not in the Quarterly Return / Annual Supplement).
A product is considered to be sold by Internet if the entire sale process is done by Internet. Obtaining an online quote is not considered an Internet sale. If a sale is completed by a licensed agent after the customer obtains information/price from a website, it is not considered an Internet sale either.
All fields must be completed. If you do not offer products in a class of insurance, simply indicate 0.

1. Premiums, commissions and claims by distribution channel (in thousands of dollars - non-consolidated data)
Direct Premiums Written
Reference to the Quarterly Return / Annual Supplement:
Schedule 93.30 for Canadian insurers
Schedule 67.10 for Foreign insurers

Class of Insurance

Independent
Agents (Broker)
(01)

Direct or Exclusive Other Distribution
Agents
Channels
(02)

(03)

Claims incurred

Direct commissions in respect of Premium Written

Reference to the Quarterly Return / Annual Supplement:
Schedule 93.50 for Canadian insurers
Schedule 67.30 for Foreign insurers

Reference to the Quarterly Return / Annual Supplement:
Schedule 95.20 for insurers licensed in Quebec

TOTAL ($000)

Independent
Agents (Broker)

(19)

(04)

Direct or Exclusive Other Distribution
Agents
Channels
(05)

(06)

TOTAL ($000)

Independent
Agents (Broker)

(49)

(08)

Direct or Exclusive Other Distribution
Agents
Channels
(09)

(10)

TOTAL ($000)
(89)

010

Property

0

0

0

020

Aircraft

0

0

0

030

Automobile

0

0

0

040

Credit Protection

0

0

0

050

Legal Expense

0

0

0

060

Liability

0

0

0

070

Mortgage

0

0

0

080

Title

0

0

0

090

Marine

0

0

0

100

Accident and Sickness

0

0

0

110

Other Approved Products

0

0

0

129

TOTAL ($000)

0

0

0

0

0

0

5.0

0

0

0

0

0

0

 (01)
130

140

2. Do you sell your products through affinity groups?
If yes, indicate the number of arrangements in force at the end of the reporting period:

(01)
150

3. Do you sell products through the Internet?
If yes, please provide the following information for direct sales:
(01)

160

a) Number of policies sold

170

b) Direct premiums (in thousands of dollars)

4. General comments:
(01)

180

5.0

 6. DISTRIBUTORS

DEFINITIONS

The information to be reported in this tab excludes commercial insurance products.
All amounts are to be reported in thousands of dollars.
Information on your top 25 distributors (determined by the amount of Direct Premiums Written) is to be reported in this section.
If a distributor has several locations, it is to be considered as a whole and reported only once.
(03) Percentage of total business is based upon sales in the reporting period (Direct Premiums Written).
(07) "Loan" does not include advancement of commissions. If no loan is granted to a distributor listed, please indicate 0.
(07) and (08) If you are not participating in the distributor's equity or have no loan, please indicate 0.

Top 25 Distributors

Licensed?

(01)
010
020
030
040
050
060
070
080
090

(02)

Yes
No

% of Total
Business

(03)

0-5%
6-10%
11-15%
16-20%
21-40%
41-60%
61-75%
76-85%
86-100%

Distribution Channel

Exclusivity
Clause?

(04)

(05)

Direct or exclusive agents Yes
Independent agents (Broker)No
MGA
Other - specify in comments

Binding
Authority?

Loans to
Distributor
($000)

% Participating
in Distributor’s
Equity

(06)

(07)

(08)

Yes
No

Minimum
Volume
Clause?
(09)

Yes
No

100
110
120
130
140
150
160
170
180
190
200
210
220
230
240
250

6.0

First
Refusal
Right Over
Distributor?

Other Types of
Advantages?

(10)

Yes
No

Compliance
Review
Conducted?

(11)

Yes
No

(12)

Yes
No

If yes, Date of Comments or Additional
the Last Review
Information

(13)

(14)

 2. Other type(s) of advantage(s) (resource loan, marketing, etc.):
(01)

260

3. General comments:
(01)

270

6.0

 7. SALES AND INCENTIVES MANAGEMENT

DEFINITIONS

The information to be reported in this tab excludes commercial insurance products.
All fields must be completed. If you do not offer products in a class of insurance, simply indicate 0.
For all questions: list only the incentives that are provided by the insurer. Compensation practices of any entity distributing the product of the insurer are excluded.

1. This question is limited to the direct sales force (direct or exclusive agents)
Excluding sales force whose remuneration is fully variable, please provide the information requested below:
1.1 List by product the average of commissions paid (% of the premium of a new policies) within the first year of the policy being
in force:
(01)

(%)
010

Property

020

Aircraft

030

Automobile

040

Credit Protection

050

Legal Expense

060

Liability

070

Mortgage

080

Title

090

Marine

100

Accident and Sickness

110

Other Approved Products

1.2 List by product the average of commissions paid for the policy renewal (% of renewal premium):
(01)

(%)
120

Property

130

Aircraft

140

Automobile

150

Credit Protection

160

Legal Expense

170

Liability

180

Mortgage

190

Title

200

Marine

210

Accident and Sickness

220

Other Approved Products

2. For sales force and sales management, indicate if your organization offers each type of the following:
(01)

(02)

Sales Force

Sales Management

230

a) Cash prizes or other gifts

Yes

Yes

240

b) Money loan

No

No

250

c) Profit sharing

260

d) Bonus

270

e) Other, specify in the space below:
(01)

280

3. For sales force only, indicate whether performance measures and incentives or commissions consider the following:
(01)

(02)

Performance Measures

Incentives or Commissions

290

a) Cancellations (ab initio)

Yes

Yes

300

b) Number of complaints

No

No

310

c) Premium volume

320

d) Claims volume

7.0

 330

e) Consumer satisfaction

3.1
Provide details of any other sales force performance measures and incentives or commissions you have that are based on the fair
treatment of consumers:
(01)

340

4. General comments:
(01)

350

7.0

 8. CLAIMS

DEFINITIONS

The information to be reported in this tab excludes commercial insurance products.
All fields must be completed. If you do not offer products in a class of insurance, simply indicate 0.
Question 1:
A claim is considered opened or reported when the insurer opens the claim's file.
A claim is considered denied if the insurer refuses to pay any amount of this claim. In those cases, no indemnity payment is made but payment of certain fees (expert fees, claim adjuster fees, etc.) may be made. Excludes partial denial.
A claim is closed when the final payment was transmitted to the insured.
(10) For the "Accident and Sickness" class of insurance, in case of periodic payments, a claim is considered closed when the initial payment was transmitted to the insured. "Average days to final payment" does not include periodic payments (ex. long-term disability ) or payments made in installments.
Questions 2 and 3:
The information sought is limited to complete denials of claims.
Question 4:
Only lawsuits between a consumer and an insurer regarding an insurance policy must be reported in this section. Subrogation proceedings are excluded, i.e. the proceedings taken to recover the amount of indemnity paid against the person responsible for the loss or his insurer.

1. Complete the table

010

Number of claims opened at the beginning of the period

020

Number of new claims opened during the period

030

Number of claims closed with an indemnity payment during the period

040

Number of claims denied in the period

050

Number of claims opened at the end of the period

060

Average days to final payment

070

Number of claims closed within 0-90 days from date of claim reported

080

Number of claims closed within 91-180 days from date of claim reported

090

Number of claims closed within 181-365 days from date of claim reported

100

Number of claims closed over 365 days from date of claim reported

Property

Aircraft

Automobile

Credit Protection

Legal Expense

Liability

Mortgage

Title

Marine

Accident and
Sickness

Other Approved
Products

(01)

(02)

(03)

(04)

(05)

(06)

(07)

(08)

(09)

(10)

(11)

8.0

 2. Please indicate the three main reasons for denial of claims in the reporting period and the total number of denials for the three reasons
selected:
(01)
110

(02)

a) Exclusions and limitations in the policy

120

b) Delay in submitting claim

130

c) Not covered, except for exclusions and limitations in the policy

VRAI

FAUX

FAUX

140

d) Failure to disclose or misrepresentation of a material fact upon subscribtion

150

e) Other, please specify in the space below

FAUX

FAUX

3. Other main reasons for claims denial:
(01)

160

4. Lawsuits:
(01)
170

a) Number of lawsuits outstanding at beginning of the period

180

b) Number of new lawsuits

190

c) Number of closed lawsuits, by Pre-Court settlements

200

d) Number of closed lawsuits, by Court judgment

210

e) Number of certified class actions lawsuits outstanding at the beginning of the period

220

f) Number of new certified class actions lawsuits during the period

5. General comments:
(01)

230

8.0

 9. COMPLAINT EXAMINATION

DEFIN IT IO N S

1. Identify the senior officer(s) responsible for complaint handling at Fiscal Year end:
(01)
001

Check this box if no senior officer is in charge:

###

010

a) Name of the senior officer:

0

020

b) Title:

030

c) Address:

040

d) Telephone number:

050

e) Email:

060

a) Name of the senior officer:

070

b) Title:

080

c) Address:

090

d) Telephone number:

100

e) Email:

110

a) Name of the senior officer:

120

b) Title:

130

c) Address:

140

d) Telephone number:

150

e) Email:

2. Please indicate if the following are present within your organization:
(01)
160

a) Complaint handling policies and procedures guideline

170

b) Complaint handling unit or department

180

c) Reporting mechanism that is sent to management and the board regarding aggregate complaints on a periodic basis

190

d) Ongoing training program regarding complaint handling for staff whose activities include complaint handling

3. Please indicate in the space below at what stage of your complaint process a complaint is declare to the regulator:
(01)

200

(01)

4. Do you have complaints to report (new complaints or complaints opened during a previous reporting period)?
210

If yes, please complete the next tab

5. General comments:
(01)

220

9.0

 9.6 COMPLAINT REPORTING

DEFIN IT IO N S

Complaints declared and not closed in a previous period ("Opened complaints") have been downloaded into the Form, if applicable.
However, it is your responsibility to ensure that all your Opened complaints are reflected in the Annual Statement for the period of reference.
Opened complaints must be updated and reported each year until closed. No Opened complaint downloaded must be erased in the Form, even if no change.

INFORMATION ABOUT THE COMPLAINT

001
002
003

Insurer's Complaint
Reference Number

Complainant's
Postal Code (first
three characters
are required)

Complaint
file opening
date

(01)

(02)

(03)

Complaint file status

(05)

Declared for the first time-Closed during current declaration
period
Declared for the first time-Not closed at the end of current
declaration period
Declared for the first time in a previous period-Voided during
this declaration period
Declared for the first time in a previous period-Closed during
current period
Declared for the first time in a previous period-Not closed
Closed in a previous period-Reopened during current period

IDENTIFICATION OF THE PRODUCT RELATED TO COMPLAINT
Complaint
File Closing
Class of Insurance
Date (if
applicable)
(04)

(06)

If Other, Specify

Type of
Product

(07)

(08)

Property

Personal

Aircraft

Commercial

Automobile

Distribution
Channel

Complaint
Category

(09)

(10)

Direct or exclusive
Underwriting
agents
Independent
Underwriting
distribution channel
Other distribution
Underwriting
channel

Cause for Complaint

(11)

Policy provisions

Not settled

No

No

Refusal

Complaint
withdrawn

Customer service

007
008

Title

Underwriting

009

Marine

Underwriting

Change in risk category
Alleged discrimination
Credit scoring
File confidentiality of
insured
Information collection and
needs analysis

011

Accident and
Sickness
Other Approved
Products

Underwriting

Reporting to client

Underwriting

Performance of mandate

012

Underwriting

013

016

Administration
Administration
Administration
Administration

017

Administration

018
020

Administration
Administration
Administration

021

Administration

022

Administration

023

Administration

014
015

019

Marketing and
Sales
Marketing and
Sales

024
025

Marketing and
Sales

026

Marketing and
Sales
Marketing and
Sales
Marketing and
Sales
Marketing and
Sales
Marketing and
Sales
Product
Product
Product
Product
Product
Product
Product

027
028
029
030
031
032
033
034
035
036
037
038

9.6

(14)

Yes

Underwriting
Underwriting
Underwriting

010

(13)

Yes

Underwriting

006

(12)

Settled

Legal Expense
Liability
Mortgage

005

Was the Complaint
Did the Complaint
Transferred to a
Result in a Lawsuit
Regulatory
(as of the end of
Authority (as of the
the period)
end of the period)

Premium

Credit Protection

004

Result of
Complaint
Examination

Other (fill comments
section)
Administrative procedures
Customer service
Statements
Fees / commissions
Preauthorized debit /
payment plan
Transfers
Credit rating
Non-authorized transaction
Personal information
protection
Collection
Other (fill comments
section)
Advertising
Illustration of cost or return
Alleged misleading
statement or
misrepresentation
Replacement disclosure
form
Delivery of policy
Tied selling
Discontinuation /
termination of service
Other (fill comments
section)
Policy value
Availability / accessibility
Renewal
Rate of return (ror)
Policy provisions
Prospectus
Adequacy of product

Comments or any additional
information

(15)

 9.6 COMPLAINT REPORTING

DEFIN IT IO N S

Complaints declared and not closed in a previous period ("Opened complaints") have been downloaded into the Form, if applicable.
However, it is your responsibility to ensure that all your Opened complaints are reflected in the Annual Statement for the period of reference.
Opened complaints must be updated and reported each year until closed. No Opened complaint downloaded must be erased in the Form, even if no change.

INFORMATION ABOUT THE COMPLAINT

Insurer's Complaint
Reference Number

Complainant's
Postal Code (first
three characters
are required)

Complaint
file opening
date

Complaint file status

(01)

(02)

(03)

(05)

IDENTIFICATION OF THE PRODUCT RELATED TO COMPLAINT
Complaint
File Closing
Class of Insurance
Date (if
applicable)
(04)

(06)

If Other, Specify

Type of
Product

Distribution
Channel

(07)

(08)

(09)

Complaint
Category

(10)

039

Product

040

046

Claims / Settlement
Claims / Settlement
Claims / Settlement
Claims / Settlement
Claims / Settlement
Claims / Settlement
Claims / Settlement

047

Claims / Settlement

041
042
043
044
045

048
049
050
051
052
053
054
055
056
057
058
059
060
061
062
063
064
065
066
067
068
069
070
071
072
073
074
075
076
077
078
079
080
081
082
083
084
085
086
087
088
089
090
091
092
093
094
095
096

9.6

Cause for Complaint

Result of
Complaint
Examination

(11)

(12)

Other (fill comments
section)
Claim procedure
Delay in settlement
Refusal of claim
Customer service
Suspension of benefit
Reporting to client
Performance of mandate
Other (fill comments
section)

Was the Complaint
Did the Complaint
Transferred to a
Result in a Lawsuit
Regulatory
(as of the end of
Authority (as of the
the period)
end of the period)
(13)

(14)

Comments or any additional
information

(15)

 10. PROTECTION OF PERSONAL INFORMATION

DEFIN IT IO N S

The breaches reported in this form are those that have a significant impact on the customer and require disclosure under applicable privacy legislation.
"Breaches" refers to incidents and occurrences based on applicable privacy legislation and provincial insurance legislation. It does not include the number of individuals impacted by the
breach.

010

1.Do you have policies and procedures in place regarding breaches in confidentiality and the protection of personal
information?

(01)

If yes, please indicate if the following are addressed by your policies and procedures:
020

a) Timely notification to consumers of any breaches that could impact their interests or rights

030

b) Timely notification to the appropriate authorities of any breaches that could impact the consumer’s interests or rights

040

c) Timely notification to the responsible and appropriate individuals within your organization

(01)
050

2. Have you had any breaches in the protection of personal information in the reference period?

060

If yes, indicate the number of breaches:

070

3. Were the breaches reported to the proper authorities where required by law (e.g., Privacy Commissioner, regulatory
authority)?
If no, please provide details as to why the incident(s) was not reported to the appropriate authority:
(01)

080

10.0

(01)

 4. General comments:

(01)

 

090

 

 

 

10.0