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Certificate of Insurance Overview Certificate details These are the details of this Certificate of Insurance.

Item Details Insured Individual John Sample Insured Individuals Date of Birth February 3, 1971 Group Policy 90289 issued to Hudsons Bay Company Certificate Number HB11 12345 Original Effective Date January 1, 2017 Beneficiary Jane Sample Survivor Jane Sample Primary Benefit $150,000 Subject to Reductions at Older Ages Refer to the section Benefit Reductions

at Older Ages for more details. Coverages Basic Benefit

Serious Injury Rider Hospital and Home Recovery Rider Fracture Rider

Current Annual/Monthly Premium Payable (includes applicable sales taxes)

$19.25 Monthly

Contact Address The Canada Life Assurance Company 140 Fullarton Street, 10th Floor London, Ontario N6A 5P2

Group Policy The Group Policy 90289(Policy) is the contract under which benefits are paid is issued to Hudsons Bay Company the (.Policyholder.), and pays benefits under one Certificate only, per household.

Coverage under more than one Certificate

When you have more than one Certificate of Insurance under Group Policy 90289, 90261 or 90279, then the following applies. When you ... Then... are alive you may select which Certificate is in effect. have died without selecting which Certificate is in effect

Canada Life pays the benefit from the Certificate with the largest benefit, and considers any other Certificate as void.

have purchased the Family Plan, and your Family is covered under more than 1 certificate

Canada Life pays the benefit from the Certificate with the largest benefit, and considers any other Certificate as void.

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Certificate version This Certificate replaces any other Certificate version with an earlier issue date, issued to you for coverage under the Group Policy.

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 You may cancel your insurance at any time by notifying us with a written or verbal notice of your wish to cancel.

What happens When an insurance Certificate is cancelled within 30 days of receiving the initial Certificate of Insurance: insurance is void from inception.

- except for the Basic Benefit if applicable, and we will return any premiums paid.

Any request to cancel after 30 days will be effective the date your notice is received by us. If applicable, a refund will be prorated.

Paragraph headings 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 2-6 Insuring Provisions 6 Beneficiaries 6 Claims 7-8 General Provisions 8-9 Terms Used in the Certificate 9-10 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 whats not covered multiple benefits aggregate benefits, and benefit reductions at older ages.

When your coverage begins

Your insurance coverage begins on the earlier of the date: We receive your completed application at our office, or You call or are called by us or our authorized agent and are enrolled.

The Effective Date is shown on the Certificate of Insurance.

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When yourcoverage ends

Your insurance coverage for the Basic Benefit ends on the earliest of the following: the date we receive your written or verbal request that this coverage be cancelled, 5 years from the original Effective Date, the date this Group Policy terminates, or the date of your death.

Your insurance coverage for the Primary Benefit and any Additional Benefits (if applicable) ends on the earliest of the following: the date we receive your written or verbal request that this coverage be cancelled the date this Group Policy terminates, 60 days after you fail to pay the premium required to keep coverage in force, or the date of your death.

Insurance coverage for persons insured under the Family Plan ends on the earliest of the following: when your coverage ends, the date the Family member is no longer eligible, or the date we receive your written or verbal request that the Family Plan be cancelled.

What is covered The following benefits are covered under this Certificate.

Benefit Covered as Defined in this Policy Basic Benefit Pays $1500.00 Primary Benefit Accidental Death Benefit

Double Benefit for Common Carrier Accidents Survivor Benefit

Additional Benefits Serious Injury Rider

Basic Benefit Pays $1500.00 in addition to the Primary Benefit: if you die as a result of an Accident within 1 year of the incident.This benefit applies only to you and is payable for 5 years from the Effective Date.

Primary Benefit Accidental Death Benefit: The Primary Benefit, less any Benefit Reductions at Older Ages, is payable when You or your Family member (if Family Plan purchased) die due to an Accident within 1 year of the Accident. Double Benefit for Common Carrier Accidents: If you or your Family member (if Family Plan is purchased) die as a result of an Accident while: - riding as a fare-paying passenger, and - in or on a public conveyance being operated commercially by a licensed common carrier to transport

passengers for hire we will pay double the Primary Benefit, less any Benefit Reductions at Older Ages.

Survivor Benefit: A benefit payable upon your Accidental Death which pays: 20% of the Primary Benefit paid in 8 equal quarterly instalments over a 24 month period, and less any Benefit Reductions at Older Ages.Survivor means the person(s) you name to receive the Survivor Benefit payable.

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Additional Benefits apply when purchased by you. Hospital Cash and Home Recovery Rider

Hospital Cash benefits are paid for each day of hospitalization if you or your Family member (if Family Plan is purchased): is injured in an Accident, is admitted to the hospital for treatment as a direct result of the injuries, and from no other cause;

and is an in-patient in the hospital under the care of a doctor other than himself or herself for a period

of at least 3 days.

We pay up to 180 days of hospitalization for each hospitalization, or series of hospitalizations caused by the same Accident.

No benefits are paid for: outpatient care, outpatient surgery; or hospitalizations occurring more than 2 years after the date of the Accident.

2 days of Home Recovery benefits are paid for each day of hospitalization to a maximum of 360 days for each hospitalization or series of hospitalizations caused by the same Accident. Where used in this Certificate, hospital means an acute care facility, set up under applicable law, which:

is mainly for the treatment and care of sick, ailing or injured in-patients; has a staff of 1 or more doctors, with patient treatment privileges available at all times; provides skilled nursing care at all times (24 hours); provides organized diagnostic and surgical services, either on the premises or by contract with

another qualified facility; is not primarily a convalescent, chronic care, psychiatric, rehabilitation, rest or nursing home or a

facility for the aged, drug addicts or alcoholics.

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Family Plan Spouse coverage is 100% of the Primary Benefit. Eligible Dependent Children coverage is 25% of the Primary Benefit

with the exception of the Fracture Rider (if applicable).

Whats not covered We do not pay benefits for loss, directly or indirectly caused by or associated with: sickness or disease, medical or surgical treatment, complications or infections that result from

medical or surgical treatment unless the treatment was required as the result of an Accident; suicide, attempted suicide, or whenever the Insured Person injures themselves on purpose,

whether while sane or insane; the commission of, or attempt to commit, a criminal offense, of which a contributing cause

was the Insured Person being engaged in a criminal act or illegal occupation; war or any act of war, whether or not declared; activities and accidents of war, related directly

or indirectly to service in the armed forces of any country; riot or civil insurrection; Insured Persons having a blood alcohol level in excess of .08%, or caused by the taking of any

drug, sedative or narcotic unless in accordance with a medical prescription; voluntary ingestion of poison, toxic substances, or non-toxic substances in such quantity that

they become toxic, the inhalation of gas (excluding the occupational accidents oraccidental smoke inhalation resulting from a fire);

participating in a contest of speed, or caused by participating in scuba-diving, sky-diving,parachuting, hang-gliding or bungee jumping; or

travel or flight in, or getting in or out of:o an aircraft being used for test or experiment;o a military aircraft, other than on a scheduled transport aircraft;o an aircraft the Insured Person is flying, is learning to fly, or is part of the crew of, unless

the Insured is a fare-paying passenger on a regularly scheduled commercial airline.

Multiple Benefits If a Primary Benefit and a Serious Injury Rider are both payable as a result of a single Accident, we will only pay the Primary Benefit per person insured.

Our liability from a single Accident will be limited to the single benefit for which the person is insured (whether Principal Sum, Serious Injury Benefit, or other benefit insured under this Certificate or Schedule, but excluding the Hospital Cash and Home Recovery Rider and Fracture Rider) with the largest amount payable as a result of that Accident.

If you Canada Life will

suffer a Serious Injury in an Accident and are covered by the Serious Injury Rider and you die within 1 year as a result of the Accident

pay the Primary Benefit (plus the Basic Benefit, if applicable), and if the Serious Injury Rider has been paid, this amount will be subtracted from the final benefit payment.

are hospitalized as a result of the Accident

pay the Hospital Cash and Home Recovery Rider in addition to the Primary Benefit.

Aggregate Benefits Canada Lifes liability for a single Accident per Certificate is a maximum of $1,000,000.00 and Payment will be prorated among the Insured Individual and any insured family members involved

in a single common Accident.

Benefit Reductions at Older Ages

Benefits are as shown on the first page of this Certificate if you are between ages 18 and 69 when the Accident occurs. Starting at age 70, all benefits are reduced by 50% of the original amount. At age 75, benefits are further reduced by 25% of the original amount. If you have family coverage, benefits for your Spouse are paid in the same manner, based on your

Spouses age.

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Benefit Reductions at Older Ages

This table illustrates how this benefit reduction works.

Birthday Reduction Example: Original Primary Benefit $50,000

70 50% $25,000 payable 75 25% $12,500 payable

Insuring Provisions

Introduction The following Insuring Provisions apply under this Certificate and are detailed below: premiums payable, and changes in coverage.

Premiums payable You must pay the monthly premium amount that is set out in the Certificate Details above.

Coverage will be cancelled if a premium remains unpaid. We will offer you 60 days to continue coverage with an alternate method of payment.

Changes in coverage You may apply to increase or decrease your insurance at any time.

Increases take effect on the day we receive the verbal or written request.Decreases take effect on the day we receive the verbal or written request, and unearned premiums will be refunded to you.

Beneficiaries Designating beneficiaries or survivors

You may designate a beneficiary or beneficiaries to receive the Primary Benefit payable under this Certificate should you die. You may also designate a survivor to receive the Primary Benefit payable for the Survivor Benefit. All Primary Benefits or Additional Benefits are payable to you while you are alive.

Lack of beneficiary We pay your estate when you do not designate a beneficiary, or the designated beneficiary does not survive you, or the beneficiary designation is invalid.

Lack of survivor Survivor Benefits may only be paid to your named survivor. If your survivor dies before you, no benefits will be paid. If your survivor dies before all quarterly payments come due: the last payment due will be made in the quarter that the survivor dies, and no further Survivor Benefits will be made.

Changing be neficiaries or survivors

You must notify us in writing to designate a beneficiary or survivor, or change a revocable beneficiary or survivor.

The designation or changes come into effect once you have signed and dated the request, and we have recorded the request in our offices.

We are not responsible to ensure that the naming of your beneficiary or survivor is valid or sufficient.

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Claims Introduction The following Claims provisions apply under this Certificate and are detailed below:

making a claim contacting our Claims Department proof of claim paying Policy proceeds paying Family Plan proceeds, and payment to a minor

Making a claim The following conditions must be met for us to pay benefits on a claim.

Stage Description Timetable

1 We must be notified of the loss. Exception: If it is not possible to notify us within 30 days, we must be notified as soon as possible, and no later than one year from the date of loss.

Within 30 days of the loss.

2 We will send a form with instructions on how to complete it.

Within 15 days of being notified.

3 We must receive the completed claim form, and any other proof of loss requested by us.

Within 90 days, or as circumstances

allow. 4 We pay the claim. Within 60 days of

receiving satisfactory proof of the loss.

5 Claims of a continuing nature Proof must be sent as often as we require.

As required.

Contacting our Claims Department

You can contact our Claims Department by phone at 1-800-663-6622, or by mail at

The Canada Life Assurance Company330 University Ave.Toronto, ON M5G1R8

Proof of claim To make a claim for benefits under this Policy, we must receive proof satisfactory to us of: the accidental nature of death and cause of death or the occurrence of the loss, proof of age of the Insured Person who has died or become injured, the amount of loss, the right of the claimant to receive payment, and any other information required by us to establish the validity of the claim.

Right to physical examination and autopsy

We reserve the right to request and examine any medical evidence of disability or other loss as reasonably required while the claim is pending and afterwards, if the claim is of a continuing nature. If you die, we reserve the right to require an autopsy to support proof of claim, unless prohibited by law.

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Paying Policy Proceeds

If you are living, any benefits payable under this Certificate are paid to you. If you are not living, we pay the Primary Benefit payable under this Policy to the surviving

beneficiary or the surviving beneficiaries. When there is more than one survivingbeneficiary, we will pay them- in equal shares, or- as otherwise stated in the designation.

Where there is no designated beneficiary or surviving beneficiary, we will pay the benefits to your estate.

Paying Family Plan proceeds

If you are living, benefits payable with respect to the lives of Family members will be paid to you. If you are not living, and your Spouse or Eligible Dependent Children are entitled to claim a

benefit, benefits payable will be paid to your spouse or eligible dependent children as follows:1- Spousal benefits are paid to your Spouse; and 2- Eligible Dependent Childrens benefits are paid to:

a) your child who is claiming, if they are of legal age; orb) to your childs legal guardian until your child becomes of legal age.

3- If the survivor you have named is not of legal age when the benefit becomes payable, payment will be made in accordance with the laws of the jurisdiction you reside in.

Payments to a minor If the Primary Benefit is payable to a beneficiary who is a minor and no trustee has been named: We will pay the Primary Benefit according to the law in the minors jurisdiction of residence.

General Provisions

Introduction The following General Provisions apply under this Certificate and are detailed below: non-participating Policy premium rate change legal action access assignment currency right to offset, and entire contract.

Non-participating Policy

This Policy or Certificate does not entitle any person to share in any distribution of Canada Lifes profits or surplus.

Premium rate change Canada Life may change the premium rates. However, we

can only increase the premium rates for all Insured Individuals under the same Group Policy, and must give you at least 30 days notice of such a change.

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 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.

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Access 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 us.

Limitations This access is subject to certain limitations as set out in law.

Assignment This Policy may not be assigned. Right to offset

We may deduct any unpaid premiums from the benefits payable.

Currency All money payable under this Certificate is in Canadian funds.

Entire contract

The entire contract of insurance is comprised of

this Certificate the Group Policy, and the Insured Individuals 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 Definition

Accident A sudden, unforeseen incident causing, directly or indirectly and independently of any other cause, bodily injuries due exclusively to an external event of a violent nature, occurring while coverage under this Policy is in effect.

Canadian Resident A person who makes their primary home residence at a permanent address in Canada. Canadian residents do not include persons living in Canada temporarily for work or personal purposes.

Credit Card Any valid Credit Card issued by Capital One Bank in association with the Policyholder, such as: Hudsons Bay Credit Card Hudsons Bay Mastercard.

Credit Cardholder The person to whom a Credit Card is issued, and whose name is on the Credit Card.

Customer A natural person who is a customer of Hudsons Bay Company receives an offer of insurance under this Policy, and is a resident of Canada outside Quebec.

Effective Date 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.

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Terms Used in the Certificate

The following defines the terms used in this Certificate of Insurance. Term Definition

Eligible Person A person who, when enrolling in the Policy, is any of the following: a Credit Cardholder, or - a Hudsons Bay Rewards Member, or - a Customer, and - is at least 18 years of age and no more than 70 years of age, and is a resident of Canada

Eligible Dependent Child(ren)

Your unmarried dependent children who reside in the same primary residence (unless attending school) and are: --up to the age of 19 (or age 23 if a full-time student), or a Handicapped Dependent.

A dependent child is: - a natural child - stepchild --foster child legally adopted child, or

- a child toward whom you have shown for at least 12 months an intent to treat as your own child.

Family member A Spouse or Eligible Dependent Child who lives in the same primary residence as you. Refer to section Family Plan for more details.

Handicapped Dependents

Dependent children who have reached the maximum age as Eligible Dependent Children and who: live with you and are unable to earn their own living due to:-- an intellectual disability, or a physical handicap.

We reserve the right to request proof from you before we provide coverage for a Handicapped Dependent and at time of claim.

Group Policy Group Policy 90289 issued by Canada Life to the Policyholder, or a Group Policy issued to replace Group Policy 90289.

Hudsons Bay Rewards Card

The card is issued to a person with a customer rewards program account administered by the Policyholder.

Hudsons Bay Rewards Member

A person whose name appears on a Hudsons Bay Rewards Card.

Insured Individual

An Eligible Person who has enrolled for coverage under this Policy has paid the initial premium, andcontinues to pay the required insurance premiums.

Insured Person You when single coverage is purchased or You and/or Your Family members when family coverage is purchased.

Spouse The person to whom the Credit Cardholder or Hudsons Bay Rewards Member is either legally married, or who is the persons civil union spouse as defined in the Quebec Civil Code, or with whom he or she has lived in a conjugal relationship in the same primaryresidence for a period of at least 24 months, at the time of application.

You may only have one Spouse at any given time.

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Protecting Your Personal Information

Your access to yourinformation

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

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.

How we use yourInformation

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.

For more information 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 toChief Compliance OfficerCanada Life Assurance Company ofCanada 330 University Ave.Toronto, ON M5G 1R8

or refer to www.canadalife.com

THE CANADA LIFE ASSURANCE COMPANY 140 Fullarton Street, 10th

Floor London, Ontario N6A 5P2

Paul A. Mahon President and Chief Executive Officer

http:www.canadalife.com

Certificate of Insurance