Invoice Number: 00149

Invoice Due on: 2021/08/27

Invoice Created on: 2021/08/27
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Contact Us
[TPA Phone Number]
[TPA Email]

STATEMENT FOR SEPTEMBER 1, 2021 - SEPTEMBER 30, 2021

STATEMENT SUMMARY

Previous balance $ 0.00

Payments received $ 0.00
Premium due for the current month $ 15,495.97
Insurance Tax $ 886.63
GST / HST $ 106.77
QST / PST $ 95.78
Sub-total $ 16,585.15
ASO Amount $ 16,585.15
TOTAL AMOUNT DUE $ 0.00

Additions/changes: Any additions, terminations or changes after the created date will reflect on the next billing statement as an
adjustment.
Late Fees: A fee of 1.5% may apply to the amount of the invoice for any late payments of more than 30 days past the due date.

NSF Fees: A fee of $ 40.00 + taxes will be applied for any type of payment.
Payment by pre-automated debit: Opt for pre-automated debit to never miss a payment, contact us for more details.

DETACH AND RETURN THIS SLIP WITH PAYMENT

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Invoice Number: 00149
Period of 2021/09/01 - 2021/09/30
[TPA Name] Payment Type:
Attn: Accounting Department
[TPA Address Line 1]
[TPA Address Line 2]
[TPA City], [TPA Province] [TPA Postal code]

Due Upon Receipt Amount Due Amount Paid

$ 0.00 $ 0.00
Payment will be withdrawn from your bank account on August 27
as per the terms of your PAC agreement."

Page 1 of 12
 Invoice Number : 00149
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DIVISION SUMMARY for SEPTEMBER 1, 2021 - SEPTEMBER 30, 2021

All Division

Member Coverage / Total Insurance GST QST

Benefits Total
Count Volume Premium Tax HST PST
Accidental Death & Dismemberment Insurance
43 $ 6,309,848 $ 123.14 $ (5.12) $ 0.00 $ 0.00 $ 118.02
(AD&D)
Assurance salaire de longue durée 43 $ 446,261 $ 10,650.84 $ 684.43 $ 0.00 $ 0.00 $ 11,335.27
Assurance soins médicaux 4 $ 444.60 $ 0.00 $ 14.82 $ 0.00 $ 459.42
Assurance soins médicaux 7 Couple $ 917.08 $ 53.51 $ 22.23 $ 40.13 $ 1,032.95
Assurance soins médicaux 3 Family $ 109.24 $ (1.65) $ 14.82 $ (1.24) $ 121.17
Assurance soins médicaux 27 Single $ 1,499.40 $ 74.44 $ 36.86 $ 46.07 $ 1,656.77
Assurance soins médicaux 4 Single Parent $ 360.60 $ 14.42 $ 18.04 $ 10.82 $ 403.88
Assurance vie facultative 42 $ 980,000 $ 1,126.00 $ 60.98 $ 0.00 $ 0.00 $ 1,186.98
Critical Illness Insurance 43 $ 440,000 $ 143.14 $ 1.91 $ 0.00 $ 0.00 $ 145.05
Dependent Life Insurance 18 $ 100,000 $ 30.77 $ 1.37 $ 0.00 $ 0.00 $ 32.14
Health Care Insurance 4 $ 444.60 $ 0.00 $ 14.82 $ 0.00 $ 459.42
Health Care Insurance 7 Couple $ 917.08 $ 53.51 $ 22.23 $ 40.13 $ 1,032.95
Health Care Insurance 3 Family $ 109.24 $ (1.65) $ 14.82 $ (1.24) $ 121.17
Health Care Insurance 27 Single $ 1,499.40 $ 74.44 $ 36.86 $ 46.07 $ 1,656.77
Health Care Insurance 4 Single Parent $ 360.60 $ 14.42 $ 18.04 $ 10.82 $ 403.88
Life Insurance 43 $ 580,626 $ 87.59 $ 2.22 $ 0.00 $ 0.00 $ 89.81
Long Term Disability Insurance 43 $ 446,261 $ 10,650.84 $ 684.43 $ 0.00 $ 0.00 $ 11,335.27
Optional Life Insurance 3 $0 $ 0.00 $ 0.00 $ 0.00 $ 0.00 $ 0.00
Optional Life Insurance 42 $ 980,000 $ 1,126.00 $ 60.98 $ 0.00 $ 0.00 $ 1,186.98
Short Term Disability Insurance 43 $ 45,777 $ 3.57 $ 0.12 $ 0.00 $ 0.00 $ 3.69
Division Total $ 15,495.97 $ 886.63 $ 106.77 $ 95.78 $ 16,585.15

Page 2 of 12
All Eligible - 436436

Member Coverage / Total Insurance GST QST

Benefits Total
Count Volume Premium Tax HST PST
Accidental Death & Dismemberment Insurance
43 $ 6,309,848 $ 123.14 $ (5.12) $ 0.00 $ 0.00 $ 118.02
(AD&D)
Assurance salaire de longue durée 43 $ 446,261 $ 10,650.84 $ 684.43 $ 0.00 $ 0.00 $ 11,335.27
Assurance soins médicaux 4 $ 444.60 $ 0.00 $ 14.82 $ 0.00 $ 459.42
Assurance soins médicaux 7 Couple $ 917.08 $ 53.51 $ 22.23 $ 40.13 $ 1,032.95
Assurance soins médicaux 3 Family $ 109.24 $ (1.65) $ 14.82 $ (1.24) $ 121.17
Assurance soins médicaux 27 Single $ 1,499.40 $ 74.44 $ 36.86 $ 46.07 $ 1,656.77
Assurance soins médicaux 4 Single Parent $ 360.60 $ 14.42 $ 18.04 $ 10.82 $ 403.88
Assurance vie facultative 42 $ 980,000 $ 1,126.00 $ 60.98 $ 0.00 $ 0.00 $ 1,186.98
Critical Illness Insurance 43 $ 440,000 $ 143.14 $ 1.91 $ 0.00 $ 0.00 $ 145.05
Dependent Life Insurance 18 $ 100,000 $ 30.77 $ 1.37 $ 0.00 $ 0.00 $ 32.14
Health Care Insurance 4 $ 444.60 $ 0.00 $ 14.82 $ 0.00 $ 459.42
Health Care Insurance 7 Couple $ 917.08 $ 53.51 $ 22.23 $ 40.13 $ 1,032.95
Health Care Insurance 3 Family $ 109.24 $ (1.65) $ 14.82 $ (1.24) $ 121.17
Health Care Insurance 27 Single $ 1,499.40 $ 74.44 $ 36.86 $ 46.07 $ 1,656.77
Health Care Insurance 4 Single Parent $ 360.60 $ 14.42 $ 18.04 $ 10.82 $ 403.88
Life Insurance 43 $ 580,626 $ 87.59 $ 2.22 $ 0.00 $ 0.00 $ 89.81
Long Term Disability Insurance 43 $ 446,261 $ 10,650.84 $ 684.43 $ 0.00 $ 0.00 $ 11,335.27
Optional Life Insurance 3 $0 $ 0.00 $ 0.00 $ 0.00 $ 0.00 $ 0.00
Optional Life Insurance 42 $ 980,000 $ 1,126.00 $ 60.98 $ 0.00 $ 0.00 $ 1,186.98
Short Term Disability Insurance 43 $ 45,777 $ 3.57 $ 0.12 $ 0.00 $ 0.00 $ 3.69
Division Total $ 15,495.97 $ 886.63 $ 106.77 $ 95.78 $ 16,585.15

Page 3 of 12
 Invoice Number : 00149
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MEMBER DETAILS for SEPTEMBER 1, 2021 - SEPTEMBER 30, 2021

All Eligible - 436436

bill - bill

Adjustment / Policy Volume / Province of

Member / Benefit Insurer Option Premium Insurance Tax GST / HST QST / PST Total
Retro Date Number Coverage Res / Work
ret, test, SEB000001388, $ 86,866.00
Accidental Death & Dismemberment Insurance (AD&D) Manulife 655643 $ 86,866 option 1 ON / ON $ 4.95 $ 0.40 $ 0.00 $ 0.00 $ 5.35
Critical Illness Insurance Manulife 655643 $ 10,000 10000 ON / ON $ 8.42 $ 0.67 $ 0.00 $ 0.00 $ 9.09
Health Care Insurance Manulife 655643 Single Option 1 ON / ON $ 148.20 $ 11.86 $ 0.00 $ 8.89 $ 168.95
Life Insurance Manulife 655643 $ 10,000 Basic ON / ON $ 2.82 $ 0.23 $ 0.00 $ 0.00 $ 3.05
Long Term Disability Insurance Manulife 655643 $ 1,253 option 1 ON / ON $ 107.39 $ 8.59 $ 0.00 $ 0.00 $ 115.98
Optional Life Insurance Manulife 655643 $0 Opt out ON / ON $ 0.00 $ 0.00 $ 0.00 $ 0.00 $ 0.00
Short Term Disability Insurance Manulife 655643 $ 1,002 Option 1 ON / ON $ 0.21 $ 0.02 $ 0.00 $ 0.00 $ 0.23
Total $ 271.99 $ 21.77 $ 0.00 $ 8.89 $ 302.65

ret1, test, SEB000001397, $ 76,777.00

Accidental Death & Dismemberment Insurance (AD&D) Manulife 655643 $ 76,777 option 1 ON / ON $ 4.38 $ 0.35 $ 0.00 $ 0.00 $ 4.73
Critical Illness Insurance Manulife 655643 $ 10,000 10000 ON / ON $ 8.42 $ 0.67 $ 0.00 $ 0.00 $ 9.09
Dependent Life Insurance Manulife 655643 $ 5,000 option 1 ON / ON $ 1.81 $ 0.14 $ 0.00 $ 0.00 $ 1.95
Health Care Insurance Manulife 655643 Couple option 2 ON / ON $ 60.12 $ 4.81 $ 0.00 $ 3.61 $ 68.54
Life Insurance Manulife 655643 $ 10,000 Basic ON / ON $ 2.82 $ 0.23 $ 0.00 $ 0.00 $ 3.05
Long Term Disability Insurance Manulife 655643 $ 1,107 option 1 ON / ON $ 94.92 $ 7.59 $ 0.00 $ 0.00 $ 102.51
Optional Life Insurance Manulife 655643 $0 Opt out ON / ON $ 0.00 $ 0.00 $ 0.00 $ 0.00 $ 0.00
Optional Life Insurance Manulife 655643 $0 Opt out ON / ON $ 0.00 $ 0.00 $ 0.00 $ 0.00 $ 0.00
Short Term Disability Insurance Manulife 655643 $ 886 Option 1 ON / ON $ 0.21 $ 0.02 $ 0.00 $ 0.00 $ 0.23
Total $ 172.68 $ 13.81 $ 0.00 $ 3.61 $ 190.10

Retro, Test, 1000001408, $ 874,564.00

Accidental Death & Dismemberment Insurance (AD&D) Manulife 655643 $ 250,000 option 1 AB / ON $ 14.25 $ 0.00 $ 0.00 $ 0.00 $ 14.25
Critical Illness Insurance Manulife 655643 $ 10,000 10000 AB / ON $ 8.42 $ 0.00 $ 0.00 $ 0.00 $ 8.42
Health Care Insurance Manulife 655643 Single Option 1 AB / ON $ 148.20 $ 0.00 $ 14.82 $ 0.00 $ 163.02
Life Insurance Manulife 655643 $ 10,000 Basic AB / ON $ 2.82 $ 0.00 $ 0.00 $ 0.00 $ 2.82
Long Term Disability Insurance Manulife 655643 $ 10,000 option 1 AB / ON $ 857.13 $ 57.74 $ 0.00 $ 0.00 $ 914.87
Optional Life Insurance Manulife 655643 $0 Opt out AB / ON $ 0.00 $ 0.00 $ 0.00 $ 0.00 $ 0.00
Optional Life Insurance Manulife 655643 Non smoker Male Option 4 AB / ON $ 0.00 $ 0.00 $ 0.00 $ 0.00 $ 0.00
Short Term Disability Insurance Manulife 655643 $ 1,500 Option 1 AB / ON $ 0.21 $ 0.00 $ 0.00 $ 0.00 $ 0.21
Total $ 1,031.03 $ 57.74 $ 14.82 $ 0.00 $ 1,103.59

Retro 41, Test, 1000001470, $ 874,564.00

Accidental Death & Dismemberment Insurance (AD&D) Manulife 655643 $ 250,000 option 1 AB / ON $ 14.25 $ 0.00 $ 0.00 $ 0.00 $ 14.25
Assurance salaire de longue durée 2021/06/01 Manulife 655643 option 1 AB / ON $ (197.80) $ (15.32) $ 0.00 $ 0.00 $ (213.12)
Assurance salaire de longue durée 2021/07/01 Manulife 655643 option 1 AB / ON $ (197.80) $ (15.32) $ 0.00 $ 0.00 $ (213.12)
Assurance salaire de longue durée 2021/08/01 Manulife 655643 option 1 AB / ON $ (197.80) $ (15.32) $ 0.00 $ 0.00 $ (213.12)
Critical Illness Insurance Manulife 655643 $ 10,000 10000 AB / ON $ 8.42 $ 0.00 $ 0.00 $ 0.00 $ 8.42
Health Care Insurance Manulife 655643 Single Option 1 AB / ON $ 50.12 $ 0.00 $ 5.01 $ 0.00 $ 55.13
Life Insurance Manulife 655643 $ 10,000 Basic AB / ON $ 2.82 $ 0.00 $ 0.00 $ 0.00 $ 2.82
Long Term Disability Insurance Manulife 655643 $ 10,000 option 1 AB / ON $ 857.13 $ 52.25 $ 0.00 $ 0.00 $ 909.38
Long Term Disability Insurance 2021/06/01 Manulife 655643 option 1 AB / ON $ (197.80) $ (15.32) $ 0.00 $ 0.00 $ (213.12)
Long Term Disability Insurance 2021/07/01 Manulife 655643 option 1 AB / ON $ (197.80) $ (15.32) $ 0.00 $ 0.00 $ (213.12)
Long Term Disability Insurance 2021/08/01 Manulife 655643 option 1 AB / ON $ (197.80) $ (15.32) $ 0.00 $ 0.00 $ (213.12)
Optional Life Insurance Manulife 655643 $0 Opt out AB / ON $ 0.00 $ 0.00 $ 0.00 $ 0.00 $ 0.00
Short Term Disability Insurance Manulife 655643 $ 1,500 Option 1 AB / ON $ 0.21 $ 0.00 $ 0.00 $ 0.00 $ 0.21
Total $ (253.85) $ (39.67) $ 5.01 $ 0.00 $ (288.51)

Retro 42, Test, 1000001471, $ 874,564.00

Accidental Death & Dismemberment Insurance (AD&D) Manulife 655643 $ 250,000 option 1 AB / ON $ 14.25 $ 0.00 $ 0.00 $ 0.00 $ 14.25
Critical Illness Insurance Manulife 655643 $ 10,000 10000 AB / ON $ 8.42 $ 0.00 $ 0.00 $ 0.00 $ 8.42
Dependent Life Insurance Manulife 655643 $ 5,000 option 1 AB / ON $ 1.81 $ 0.00 $ 0.00 $ 0.00 $ 1.81
Health Care Insurance Manulife 655643 Couple option 2 AB / ON $ 60.12 $ 0.00 $ 6.01 $ 0.00 $ 66.13
Life Insurance Manulife 655643 $ 10,000 Basic AB / ON $ 2.82 $ 0.00 $ 0.00 $ 0.00 $ 2.82
Long Term Disability Insurance Manulife 655643 $ 10,000 option 1 AB / ON $ 857.13 $ 54.92 $ 0.00 $ 0.00 $ 912.05
Optional Life Insurance Manulife 655643 $ 30,000 Option 3 AB / ON $ 36.00 $ 0.00 $ 0.00 $ 0.00 $ 36.00
Short Term Disability Insurance Manulife 655643 $ 1,500 Option 1 AB / ON $ 0.21 $ 0.00 $ 0.00 $ 0.00 $ 0.21
Total $ 980.76 $ 54.92 $ 6.01 $ 0.00 $ 1,041.69

Retro 43, Test, 1000001472, $ 874,564.00

Accidental Death & Dismemberment Insurance (AD&D) Manulife 655643 $ 250,000 option 1 AB / ON $ 14.25 $ 0.00 $ 0.00 $ 0.00 $ 14.25
Accidental Death & Dismemberment Insurance (AD&D) Manulife 655643 $ 250,000 option 1 AB / ON $ 14.25 $ 0.00 $ 0.00 $ 0.00 $ 14.25
Critical Illness Insurance Manulife 655643 $ 10,000 10000 AB / ON $ 8.42 $ 0.00 $ 0.00 $ 0.00 $ 8.42
Critical Illness Insurance Manulife 655643 $ 10,000 10000 AB / ON $ 8.42 $ 0.00 $ 0.00 $ 0.00 $ 8.42
Dependent Life Insurance Manulife 655643 $ 5,000 option 1 AB / ON $ 1.81 $ 0.00 $ 0.00 $ 0.00 $ 1.81

Page 4 of 12
Dependent Life Insurance Manulife 655643 $ 5,000 option 1 AB / ON $ 1.81 $ 0.00 $ 0.00 $ 0.00 $ 1.81
Health Care Insurance Manulife 655643 Family Option 1 AB / ON $ 148.20 $ 0.00 $ 14.82 $ 0.00 $ 163.02
Health Care Insurance Manulife 655643 Single option 2 AB / ON $ 60.12 $ 0.00 $ 6.01 $ 0.00 $ 66.13
Life Insurance Manulife 655643 $ 10,000 Basic AB / ON $ 2.82 $ 0.00 $ 0.00 $ 0.00 $ 2.82
Life Insurance Manulife 655643 $ 10,000 Basic AB / ON $ 2.82 $ 0.00 $ 0.00 $ 0.00 $ 2.82
Long Term Disability Insurance Manulife 655643 $ 10,000 option 1 AB / ON $ 857.13 $ 51.75 $ 0.00 $ 0.00 $ 908.88
Long Term Disability Insurance Manulife 655643 $ 10,000 option 1 AB / ON $ 857.13 $ 68.57 $ 0.00 $ 0.00 $ 925.70
Optional Life Insurance Manulife 655643 $ 40,000 Option 4 AB / ON $ 76.00 $ 0.00 $ 0.00 $ 0.00 $ 76.00
Optional Life Insurance Manulife 655643 $ 50,000 Option 5 AB / ON $ 95.00 $ 0.00 $ 0.00 $ 0.00 $ 95.00
Short Term Disability Insurance Manulife 655643 $ 1,500 Option 1 AB / ON $ 0.21 $ 0.00 $ 0.00 $ 0.00 $ 0.21
Short Term Disability Insurance Manulife 655643 $ 1,500 Option 1 AB / ON $ 0.21 $ 0.00 $ 0.00 $ 0.00 $ 0.21
Total $ 2,148.60 $ 120.32 $ 20.83 $ 0.00 $ 2,289.75

Retro 44, Test, 1000001473, $ 874,564.00

Accidental Death & Dismemberment Insurance (AD&D) Manulife 655643 $ 250,000 option 1 AB / ON $ 14.25 $ 0.00 $ 0.00 $ 0.00 $ 14.25
Assurance salaire de longue durée 2021/08/01 Manulife 655643 option 1 AB / ON $ (197.80) $ (15.82) $ 0.00 $ 0.00 $ (213.62)
Assurance vie facultative 2021/08/01 Manulife 655643 Option 3 AB / ON $ (33.00) $ 0.00 $ 0.00 $ 0.00 $ (33.00)
Critical Illness Insurance Manulife 655643 $ 10,000 10000 AB / ON $ 8.42 $ 0.00 $ 0.00 $ 0.00 $ 8.42
Dependent Life Insurance Manulife 655643 $ 5,000 option 1 AB / ON $ 1.81 $ 0.00 $ 0.00 $ 0.00 $ 1.81
Health Care Insurance Manulife 655643 Couple option 2 AB / ON $ 162.16 $ 0.00 $ 16.22 $ 0.00 $ 178.38
Life Insurance Manulife 655643 $ 10,000 Basic AB / ON $ 2.82 $ 0.00 $ 0.00 $ 0.00 $ 2.82
Long Term Disability Insurance Manulife 655643 $ 10,000 option 1 AB / ON $ 857.13 $ 60.47 $ 0.00 $ 0.00 $ 917.60
Long Term Disability Insurance 2021/08/01 Manulife 655643 option 1 AB / ON $ (197.80) $ (15.82) $ 0.00 $ 0.00 $ (213.62)
Optional Life Insurance Manulife 655643 $ 30,000 Option 3 AB / ON $ 33.00 $ 0.00 $ 0.00 $ 0.00 $ 33.00
Optional Life Insurance 2021/08/01 Manulife 655643 Option 3 AB / ON $ (33.00) $ 0.00 $ 0.00 $ 0.00 $ (33.00)
Short Term Disability Insurance Manulife 655643 $ 1,500 Option 1 AB / ON $ 0.21 $ 0.00 $ 0.00 $ 0.00 $ 0.21
Total $ 618.20 $ 28.83 $ 16.22 $ 0.00 $ 663.25

Retro 45, Test, 1000001474, $ 874,564.00

Accidental Death & Dismemberment Insurance (AD&D) Manulife 655643 $ 250,000 option 1 AB / ON $ 14.25 $ 0.00 $ 0.00 $ 0.00 $ 14.25
Critical Illness Insurance Manulife 655643 $ 10,000 10000 AB / ON $ 8.42 $ 0.00 $ 0.00 $ 0.00 $ 8.42
Health Care Insurance Manulife 655643 Single Option 1 AB / ON $ 50.12 $ 0.00 $ 5.01 $ 0.00 $ 55.13
Life Insurance Manulife 655643 $ 10,000 Basic AB / ON $ 2.82 $ 0.00 $ 0.00 $ 0.00 $ 2.82
Long Term Disability Insurance Manulife 655643 $ 10,000 option 1 AB / ON $ 857.13 $ 52.25 $ 0.00 $ 0.00 $ 909.38
Optional Life Insurance Manulife 655643 $0 Opt out AB / ON $ 0.00 $ 0.00 $ 0.00 $ 0.00 $ 0.00
Short Term Disability Insurance Manulife 655643 $ 1,500 Option 1 AB / ON $ 0.21 $ 0.00 $ 0.00 $ 0.00 $ 0.21
Total $ 932.95 $ 52.25 $ 5.01 $ 0.00 $ 990.21

Retro 46, Test, 1000001475, $ 874,564.00

Accidental Death & Dismemberment Insurance (AD&D) Manulife 655643 $ 250,000 option 1 AB / ON $ 14.25 $ 0.00 $ 0.00 $ 0.00 $ 14.25
Assurance salaire de longue durée 2021/06/01 Manulife 655643 option 1 AB / ON $ (197.80) $ (15.82) $ 0.00 $ 0.00 $ (213.62)
Assurance salaire de longue durée 2021/07/01 Manulife 655643 option 1 AB / ON $ (197.80) $ (15.82) $ 0.00 $ 0.00 $ (213.62)
Assurance salaire de longue durée 2021/08/01 Manulife 655643 option 1 AB / ON $ (197.80) $ (15.82) $ 0.00 $ 0.00 $ (213.62)
Critical Illness Insurance Manulife 655643 $ 10,000 10000 AB / ON $ 8.42 $ 0.00 $ 0.00 $ 0.00 $ 8.42
Dependent Life Insurance Manulife 655643 $ 5,000 option 1 AB / ON $ 1.81 $ 0.00 $ 0.00 $ 0.00 $ 1.81
Health Care Insurance Manulife 655643 Single Parent Option 1 AB / ON $ 90.15 $ 0.00 $ 9.02 $ 0.00 $ 99.17
Life Insurance Manulife 655643 $ 10,000 Basic AB / ON $ 2.82 $ 0.00 $ 0.00 $ 0.00 $ 2.82
Long Term Disability Insurance Manulife 655643 $ 10,000 option 1 AB / ON $ 857.13 $ 54.59 $ 0.00 $ 0.00 $ 911.72
Long Term Disability Insurance 2021/06/01 Manulife 655643 option 1 AB / ON $ (197.80) $ (15.82) $ 0.00 $ 0.00 $ (213.62)
Long Term Disability Insurance 2021/07/01 Manulife 655643 option 1 AB / ON $ (197.80) $ (15.82) $ 0.00 $ 0.00 $ (213.62)
Long Term Disability Insurance 2021/08/01 Manulife 655643 option 1 AB / ON $ (197.80) $ (15.82) $ 0.00 $ 0.00 $ (213.62)
Optional Life Insurance Manulife 655643 $0 Opt out AB / ON $ 0.00 $ 0.00 $ 0.00 $ 0.00 $ 0.00
Short Term Disability Insurance Manulife 655643 $ 1,500 Option 1 AB / ON $ 0.21 $ 0.00 $ 0.00 $ 0.00 $ 0.21
Total $ (212.01) $ (40.33) $ 9.02 $ 0.00 $ (243.32)

Retro 47, Test, 1000001476, $ 874,564.00

Accidental Death & Dismemberment Insurance (AD&D) Manulife 655643 $ 250,000 option 1 AB / ON $ 14.25 $ 0.00 $ 0.00 $ 0.00 $ 14.25
Critical Illness Insurance Manulife 655643 $ 10,000 10000 AB / ON $ 8.42 $ 0.00 $ 0.00 $ 0.00 $ 8.42
Health Care Insurance Manulife 655643 Option 1 AB / ON $ 148.20 $ 0.00 $ 14.82 $ 0.00 $ 163.02
Life Insurance Manulife 655643 $ 10,000 Basic AB / ON $ 2.82 $ 0.00 $ 0.00 $ 0.00 $ 2.82
Long Term Disability Insurance Manulife 655643 $ 10,000 option 1 AB / ON $ 857.13 $ 62.50 $ 0.00 $ 0.00 $ 919.63
Optional Life Insurance Manulife 655643 $ 50,000 Option 5 AB / ON $ 85.00 $ 0.00 $ 0.00 $ 0.00 $ 85.00
Short Term Disability Insurance Manulife 655643 $ 1,500 Option 1 AB / ON $ 0.21 $ 0.00 $ 0.00 $ 0.00 $ 0.21
Total $ 1,116.03 $ 62.50 $ 14.82 $ 0.00 $ 1,193.35

Retro 48, Test, 1000001477, $ 874,564.00

Accidental Death & Dismemberment Insurance (AD&D) Manulife 655643 $ 250,000 option 1 AB / ON $ 14.25 $ 0.00 $ 0.00 $ 0.00 $ 14.25
Critical Illness Insurance Manulife 655643 $ 10,000 10000 AB / ON $ 8.42 $ 0.00 $ 0.00 $ 0.00 $ 8.42
Health Care Insurance Manulife 655643 Single option 2 AB / ON $ 60.12 $ 0.00 $ 6.01 $ 0.00 $ 66.13
Life Insurance Manulife 655643 $ 10,000 Basic AB / ON $ 2.82 $ 0.00 $ 0.00 $ 0.00 $ 2.82
Long Term Disability Insurance Manulife 655643 $ 10,000 option 1 AB / ON $ 857.13 $ 55.66 $ 0.00 $ 0.00 $ 912.79
Optional Life Insurance Manulife 655643 $ 30,000 Option 3 AB / ON $ 51.00 $ 0.00 $ 0.00 $ 0.00 $ 51.00
Short Term Disability Insurance Manulife 655643 $ 1,500 Option 1 AB / ON $ 0.21 $ 0.00 $ 0.00 $ 0.00 $ 0.21
Total $ 993.95 $ 55.66 $ 6.01 $ 0.00 $ 1,055.62

Retro 49, Test, 1000001478, $ 874,564.00

Accidental Death & Dismemberment Insurance (AD&D) Manulife 655643 $ 250,000 option 1 AB / ON $ 14.25 $ 0.00 $ 0.00 $ 0.00 $ 14.25
Assurance salaire de longue durée 2021/06/01 Manulife 655643 option 1 AB / ON $ (197.80) $ (15.82) $ 0.00 $ 0.00 $ (213.62)
Assurance salaire de longue durée 2021/07/01 Manulife 655643 option 1 AB / ON $ (197.80) $ (15.82) $ 0.00 $ 0.00 $ (213.62)
Assurance salaire de longue durée 2021/08/01 Manulife 655643 option 1 AB / ON $ (197.80) $ (15.82) $ 0.00 $ 0.00 $ (213.62)
Critical Illness Insurance Manulife 655643 $ 10,000 10000 AB / ON $ 8.42 $ 0.00 $ 0.00 $ 0.00 $ 8.42
Dependent Life Insurance Manulife 655643 $ 5,000 option 1 AB / ON $ 1.81 $ 0.00 $ 0.00 $ 0.00 $ 1.81
Health Care Insurance Manulife 655643 Single Parent Option 1 AB / ON $ 90.15 $ 0.00 $ 9.02 $ 0.00 $ 99.17
Life Insurance Manulife 655643 $ 10,000 Basic AB / ON $ 2.82 $ 0.00 $ 0.00 $ 0.00 $ 2.82
Long Term Disability Insurance Manulife 655643 $ 10,000 option 1 AB / ON $ 857.13 $ 54.59 $ 0.00 $ 0.00 $ 911.72
Long Term Disability Insurance 2021/06/01 Manulife 655643 option 1 AB / ON $ (197.80) $ (15.82) $ 0.00 $ 0.00 $ (213.62)
Long Term Disability Insurance 2021/07/01 Manulife 655643 option 1 AB / ON $ (197.80) $ (15.82) $ 0.00 $ 0.00 $ (213.62)

Page 5 of 12
Long Term Disability Insurance 2021/08/01 Manulife 655643 option 1 AB / ON $ (197.80) $ (15.82) $ 0.00 $ 0.00 $ (213.62)
Optional Life Insurance Manulife 655643 $0 Opt out AB / ON $ 0.00 $ 0.00 $ 0.00 $ 0.00 $ 0.00
Short Term Disability Insurance Manulife 655643 $ 1,500 Option 1 AB / ON $ 0.21 $ 0.00 $ 0.00 $ 0.00 $ 0.21
Total $ (212.01) $ (40.33) $ 9.02 $ 0.00 $ (243.32)

Retro 50, Test, 1000001479, $ 874,564.00

Accidental Death & Dismemberment Insurance (AD&D) Manulife 655643 $ 250,000 option 1 BC / ON $ 14.25 $ 0.00 $ 0.00 $ 0.00 $ 14.25
Critical Illness Insurance Manulife 655643 $ 10,000 10000 BC / ON $ 8.42 $ 0.00 $ 0.00 $ 0.00 $ 8.42
Dependent Life Insurance Manulife 655643 $ 5,000 option 1 BC / ON $ 1.81 $ 0.00 $ 0.00 $ 0.00 $ 1.81
Health Care Insurance Manulife 655643 Option 1 BC / ON $ 148.20 $ 0.00 $ 0.00 $ 0.00 $ 148.20
Life Insurance Manulife 655643 $ 10,000 Basic BC / ON $ 2.82 $ 0.00 $ 0.00 $ 0.00 $ 2.82
Long Term Disability Insurance Manulife 655643 $ 10,000 option 1 BC / ON $ 857.13 $ 57.84 $ 0.00 $ 0.00 $ 914.97
Optional Life Insurance Manulife 655643 $0 Opt out BC / ON $ 0.00 $ 0.00 $ 0.00 $ 0.00 $ 0.00
Short Term Disability Insurance Manulife 655643 $ 1,500 Option 1 BC / ON $ 0.21 $ 0.00 $ 0.00 $ 0.00 $ 0.21
Total $ 1,032.84 $ 57.84 $ 0.00 $ 0.00 $ 1,090.68

Retro 51, Test, 1000001480, $ 56,475.00

Accidental Death & Dismemberment Insurance (AD&D) Manulife 655643 $ 56,475 option 1 BC / ON $ 3.22 $ 0.00 $ 0.00 $ 0.00 $ 3.22
Critical Illness Insurance Manulife 655643 $ 10,000 10000 BC / ON $ 8.42 $ 0.00 $ 0.00 $ 0.00 $ 8.42
Health Care Insurance Manulife 655643 Single option 2 BC / ON $ 60.12 $ 2.50 $ 0.00 $ 1.87 $ 64.49
Life Insurance Manulife 655643 $ 10,000 Basic BC / ON $ 2.82 $ 0.00 $ 0.00 $ 0.00 $ 2.82
Long Term Disability Insurance Manulife 655643 $ 815 option 1 BC / ON $ 69.82 $ 5.59 $ 0.00 $ 0.00 $ 75.41
Optional Life Insurance Manulife 655643 $0 Opt out BC / ON $ 0.00 $ 0.00 $ 0.00 $ 0.00 $ 0.00
Short Term Disability Insurance Manulife 655643 $ 652 Option 1 BC / ON $ 0.21 $ 0.02 $ 0.00 $ 0.00 $ 0.23
Total $ 144.61 $ 8.11 $ 0.00 $ 1.87 $ 154.59

Retro 52, Test, 1000001481, $ 7,477.00

Accidental Death & Dismemberment Insurance (AD&D) Manulife 655643 $0 option 1 BC / ON $ 0.00 $ 0.00 $ 0.00 $ 0.00 $ 0.00
Assurance salaire de longue durée 2021/08/05 Manulife 655643 option 1 BC / ON $ (2.13) $ (0.17) $ 0.00 $ 0.00 $ (2.30)
Assurance vie facultative 2021/08/05 Manulife 655643 Option 3 BC / ON $ (33.00) $ 0.00 $ 0.00 $ 0.00 $ (33.00)
Critical Illness Insurance Manulife 655643 $0 10000 BC / ON $ 0.00 $ 0.00 $ 0.00 $ 0.00 $ 0.00
Dependent Life Insurance Manulife 655643 $ 5,000 option 1 BC / ON $ 1.81 $ 0.14 $ 0.00 $ 0.00 $ 1.95
Health Care Insurance Manulife 655643 Single Option 1 BC / ON $ 50.12 $ 4.01 $ 0.00 $ 3.01 $ 57.14
Life Insurance Manulife 655643 $ 10,000 Basic BC / ON $ 2.82 $ 0.23 $ 0.00 $ 0.00 $ 3.05
Long Term Disability Insurance Manulife 655643 $ 108 option 1 BC / ON $ 9.24 $ 0.74 $ 0.00 $ 0.00 $ 9.98
Long Term Disability Insurance 2021/08/05 Manulife 655643 option 1 BC / ON $ (2.13) $ (0.17) $ 0.00 $ 0.00 $ (2.30)
Optional Life Insurance Manulife 655643 $ 30,000 Option 3 BC / ON $ 33.00 $ 0.00 $ 0.00 $ 0.00 $ 33.00
Optional Life Insurance 2021/08/05 Manulife 655643 Option 3 BC / ON $ (33.00) $ 0.00 $ 0.00 $ 0.00 $ (33.00)
Short Term Disability Insurance Manulife 655643 $ 86 Option 1 BC / ON $ 0.21 $ 0.02 $ 0.00 $ 0.00 $ 0.23
Total $ 26.94 $ 4.80 $ 0.00 $ 3.01 $ 34.75

Retro 53, Test, 1000001482, $ 747,474.00

Accidental Death & Dismemberment Insurance (AD&D) Manulife 655643 $ 250,000 option 1 BC / ON $ 14.25 $ 0.00 $ 0.00 $ 0.00 $ 14.25
Critical Illness Insurance Manulife 655643 $ 10,000 10000 BC / ON $ 8.42 $ 0.00 $ 0.00 $ 0.00 $ 8.42
Health Care Insurance Manulife 655643 Single Option 1 BC / ON $ 50.12 $ 0.00 $ 0.00 $ 0.00 $ 50.12
Life Insurance Manulife 655643 $ 10,000 Basic BC / ON $ 2.82 $ 0.00 $ 0.00 $ 0.00 $ 2.82
Long Term Disability Insurance Manulife 655643 $ 10,000 option 1 BC / ON $ 857.13 $ 52.25 $ 0.00 $ 0.00 $ 909.38
Optional Life Insurance Manulife 655643 $0 Opt out BC / ON $ 0.00 $ 0.00 $ 0.00 $ 0.00 $ 0.00
Short Term Disability Insurance Manulife 655643 $ 1,500 Option 1 BC / ON $ 0.21 $ 0.00 $ 0.00 $ 0.00 $ 0.21
Total $ 932.95 $ 52.25 $ 0.00 $ 0.00 $ 985.20

Retro 54, Test, 1000001483, $ 7,474,754.00

Accidental Death & Dismemberment Insurance (AD&D) Manulife 655643 $ 250,000 option 1 BC / ON $ 14.25 $ 0.00 $ 0.00 $ 0.00 $ 14.25
Critical Illness Insurance Manulife 655643 $ 10,000 10000 BC / ON $ 8.42 $ 0.00 $ 0.00 $ 0.00 $ 8.42
Health Care Insurance Manulife 655643 Single Option 1 BC / ON $ 50.12 $ 0.00 $ 0.00 $ 0.00 $ 50.12
Life Insurance Manulife 655643 $ 74,748 Basic BC / ON $ 21.08 $ 0.00 $ 0.00 $ 0.00 $ 21.08
Long Term Disability Insurance Manulife 655643 $ 10,000 option 1 BC / ON $ 857.13 $ 57.08 $ 0.00 $ 0.00 $ 914.21
Optional Life Insurance Manulife 655643 $ 40,000 Option 4 BC / ON $ 68.00 $ 0.00 $ 0.00 $ 0.00 $ 68.00
Short Term Disability Insurance Manulife 655643 $ 1,500 Option 1 BC / ON $ 0.21 $ 0.00 $ 0.00 $ 0.00 $ 0.21
Total $ 1,019.21 $ 57.08 $ 0.00 $ 0.00 $ 1,076.29

Retro 55, Test, 1000001484, $ 4,234.00

Accidental Death & Dismemberment Insurance (AD&D) Manulife 655643 $ 4,234 option 1 MB / ON $ 0.24 $ 0.02 $ 0.00 $ 0.00 $ 0.26
Assurance salaire de longue durée 2021/08/01 Manulife 655643 option 1 MB / ON $ (1.21) $ (0.10) $ 0.00 $ 0.00 $ (1.31)
Critical Illness Insurance Manulife 655643 $ 10,000 10000 MB / ON $ 8.42 $ 0.59 $ 0.00 $ 0.00 $ 9.01
Dependent Life Insurance Manulife 655643 $ 5,000 option 1 MB / ON $ 1.81 $ 0.13 $ 0.00 $ 0.00 $ 1.94
Health Care Insurance Manulife 655643 Family option 2 MB / ON $ 161.16 $ 9.64 $ 0.00 $ 7.23 $ 178.03
Life Insurance Manulife 655643 $ 10,000 Basic MB / ON $ 2.82 $ 0.20 $ 0.00 $ 0.00 $ 3.02
Long Term Disability Insurance Manulife 655643 $ 61 option 1 MB / ON $ 5.23 $ 0.42 $ 0.00 $ 0.00 $ 5.65
Long Term Disability Insurance 2021/08/01 Manulife 655643 option 1 MB / ON $ (1.21) $ (0.10) $ 0.00 $ 0.00 $ (1.31)
Optional Life Insurance Manulife 655643 $0 Opt out MB / ON $ 0.00 $ 0.00 $ 0.00 $ 0.00 $ 0.00
Short Term Disability Insurance Manulife 655643 $ 49 Option 1 MB / ON $ 0.21 $ 0.02 $ 0.00 $ 0.00 $ 0.23
Total $ 177.47 $ 10.82 $ 0.00 $ 7.23 $ 195.52

Retro 56, Test, 1000001485, $ 3,242,525.00

Accidental Death & Dismemberment Insurance (AD&D) Manulife 655643 $ 250,000 option 1 MB / ON $ 14.25 $ 1.00 $ 0.00 $ 0.00 $ 15.25
Critical Illness Insurance Manulife 655643 $ 10,000 10000 MB / ON $ 8.42 $ 0.59 $ 0.00 $ 0.00 $ 9.01
Dependent Life Insurance Manulife 655643 $ 5,000 option 1 MB / ON $ 1.81 $ 0.13 $ 0.00 $ 0.00 $ 1.94
Health Care Insurance Manulife 655643 Option 1 MB / ON $ 148.20 $ 0.00 $ 0.00 $ 0.00 $ 148.20
Life Insurance Manulife 655643 $ 32,425 Basic MB / ON $ 9.14 $ 0.64 $ 0.00 $ 0.00 $ 9.78
Long Term Disability Insurance Manulife 655643 $ 10,000 option 1 MB / ON $ 857.13 $ 67.27 $ 0.00 $ 0.00 $ 924.40
Optional Life Insurance Manulife 655643 $0 Opt out MB / ON $ 0.00 $ 0.00 $ 0.00 $ 0.00 $ 0.00
Short Term Disability Insurance Manulife 655643 $ 1,500 Option 1 MB / ON $ 0.21 $ 0.01 $ 0.00 $ 0.00 $ 0.22
Total $ 1,039.16 $ 69.64 $ 0.00 $ 0.00 $ 1,108.80

Retro 57, Test, 1000001486, $ 150,000.00

Accidental Death & Dismemberment Insurance (AD&D) Manulife 655643 $ 150,000 option 1 MB / ON $ 8.55 $ 0.60 $ 0.00 $ 0.00 $ 9.15
Accidental Death & Dismemberment Insurance (AD&D) 2021/08/02 Manulife 655643 option 1 MB / ON $ (102.60) $ (7.18) $ 0.00 $ 0.00 $ (109.78)

Page 6 of 12
Accidental Death & Dismemberment Insurance (AD&D) 2021/08/02 Manulife 655643 option 1 MB / ON $ (102.60) $ (7.18) $ 0.00 $ 0.00 $ (109.78)
Assurance salaire de longue durée 2021/08/01 Manulife 655643 option 1 MB / ON $ (42.79) $ (3.42) $ 0.00 $ 0.00 $ (46.21)
Assurance soins médicaux 2021/08/02 Manulife 655643 Option 1 MB / ON $ (200.12) $ (11.29) $ 0.00 $ (8.47) $ (219.88)
Assurance vie facultative 2021/08/01 Manulife 655643 Option 2 MB / ON $ (24.00) $ (1.68) $ 0.00 $ 0.00 $ (25.68)
Critical Illness Insurance Manulife 655643 $ 10,000 10000 MB / ON $ 8.42 $ 0.59 $ 0.00 $ 0.00 $ 9.01
Critical Illness Insurance 2021/08/02 Manulife 655643 10000 MB / ON $ (101.04) $ (7.07) $ 0.00 $ 0.00 $ (108.11)
Critical Illness Insurance 2021/08/02 Manulife 655643 10000 MB / ON $ (101.04) $ (7.07) $ 0.00 $ 0.00 $ (108.11)
Dependent Life Insurance Manulife 655643 $ 5,000 option 1 MB / ON $ 1.81 $ 0.13 $ 0.00 $ 0.00 $ 1.94
Dependent Life Insurance Manulife 655643 $0 option 1 MB / ON $ 0.00 $ 0.00 $ 0.00 $ 0.00 $ 0.00
Dependent Life Insurance 2021/08/02 Manulife 655643 option 1 MB / ON $ (1.81) $ (0.13) $ 0.00 $ 0.00 $ (1.94)
Dependent Life Insurance 2021/08/02 Manulife 655643 option 1 MB / ON $ (1.81) $ (0.13) $ 0.00 $ 0.00 $ (1.94)
Health Care Insurance 2021/08/02 Manulife 655643 Option 1 MB / ON $ (200.12) $ (11.29) $ 0.00 $ (8.47) $ (219.88)
Health Care Insurance Manulife 655643 Single Option 1 MB / ON $ 50.12 $ 0.90 $ 0.00 $ 0.68 $ 51.70
Life Insurance Manulife 655643 $ 10,000 Basic MB / ON $ 2.82 $ 0.20 $ 0.00 $ 0.00 $ 3.02
Life Insurance 2021/08/02 Manulife 655643 Basic MB / ON $ (33.84) $ (2.37) $ 0.00 $ 0.00 $ (36.21)
Life Insurance 2021/08/02 Manulife 655643 Basic MB / ON $ (33.84) $ (2.37) $ 0.00 $ 0.00 $ (36.21)
Long Term Disability Insurance Manulife 655643 $ 2,163 option 1 MB / ON $ 185.44 $ 14.84 $ 0.00 $ 0.00 $ 200.28
Long Term Disability Insurance 2021/08/01 Manulife 655643 option 1 MB / ON $ (42.79) $ (3.42) $ 0.00 $ 0.00 $ (46.21)
Optional Life Insurance Manulife 655643 $ 20,000 Option 2 MB / ON $ 24.00 $ 1.68 $ 0.00 $ 0.00 $ 25.68
Optional Life Insurance 2021/08/01 Manulife 655643 Option 2 MB / ON $ (24.00) $ (1.68) $ 0.00 $ 0.00 $ (25.68)
Short Term Disability Insurance Manulife 655643 $ 1,500 Option 1 MB / ON $ 0.21 $ 0.02 $ 0.00 $ 0.00 $ 0.23
Short Term Disability Insurance 2021/08/02 Manulife 655643 Option 1 MB / ON $ (2.52) $ (0.20) $ 0.00 $ 0.00 $ (2.72)
Short Term Disability Insurance 2021/08/02 Manulife 655643 Option 1 MB / ON $ (2.52) $ (0.20) $ 0.00 $ 0.00 $ (2.72)
Total $ (736.07) $ (47.72) $ 0.00 $ (16.26) $ (800.05)

Retro 58, Test, 1000001469, $ 5,345,345.00

Accidental Death & Dismemberment Insurance (AD&D) Manulife 655643 $ 250,000 option 1 MB / ON $ 14.25 $ 1.00 $ 0.00 $ 0.00 $ 15.25
Critical Illness Insurance Manulife 655643 $ 10,000 10000 MB / ON $ 8.42 $ 0.59 $ 0.00 $ 0.00 $ 9.01
Health Care Insurance Manulife 655643 Single Option 1 MB / ON $ 50.12 $ 0.00 $ 0.00 $ 0.00 $ 50.12
Life Insurance Manulife 655643 $ 53,453 Basic MB / ON $ 15.07 $ 1.05 $ 0.00 $ 0.00 $ 16.12
Long Term Disability Insurance Manulife 655643 $ 10,000 option 1 MB / ON $ 857.13 $ 66.61 $ 0.00 $ 0.00 $ 923.74
Optional Life Insurance Manulife 655643 $0 Opt out MB / ON $ 0.00 $ 0.00 $ 0.00 $ 0.00 $ 0.00
Short Term Disability Insurance Manulife 655643 $ 1,500 Option 1 MB / ON $ 0.21 $ 0.01 $ 0.00 $ 0.00 $ 0.22
Total $ 945.20 $ 69.26 $ 0.00 $ 0.00 $ 1,014.46

Retro 59, Test, 1000001487, $ 324,325.00

Accidental Death & Dismemberment Insurance (AD&D) Manulife 655643 $ 250,000 option 1 MB / ON $ 14.25 $ 1.14 $ 0.00 $ 0.00 $ 15.39
Critical Illness Insurance Manulife 655643 $ 10,000 10000 MB / ON $ 8.42 $ 0.67 $ 0.00 $ 0.00 $ 9.09
Dependent Life Insurance Manulife 655643 $ 5,000 option 1 MB / ON $ 1.81 $ 0.14 $ 0.00 $ 0.00 $ 1.95
Health Care Insurance Manulife 655643 $0 option 2 MB / ON $ 0.00 $ 0.00 $ 0.00 $ 0.00 $ 0.00
Life Insurance Manulife 655643 $ 10,000 Basic MB / ON $ 2.82 $ 0.23 $ 0.00 $ 0.00 $ 3.05
Long Term Disability Insurance Manulife 655643 $ 4,678 option 1 MB / ON $ 0.00 $ 0.00 $ 0.00 $ 0.00 $ 0.00
Optional Life Insurance Manulife 655643 $ 40,000 Option 4 MB / ON $ 76.00 $ 5.32 $ 0.00 $ 0.00 $ 81.32
Short Term Disability Insurance Manulife 655643 $0 Option 1 MB / ON $ 0.00 $ 0.00 $ 0.00 $ 0.00 $ 0.00
Total $ 103.30 $ 7.50 $ 0.00 $ 0.00 $ 110.80

Retro 60, Test, 1000001468, $ 23,213.00

Accidental Death & Dismemberment Insurance (AD&D) Manulife 655643 $ 23,213 option 1 MB / ON $ 1.32 $ 0.09 $ 0.00 $ 0.00 $ 1.41
Assurance salaire de longue durée 2021/08/03 Manulife 655643 option 1 MB / ON $ (6.62) $ (0.53) $ 0.00 $ 0.00 $ (7.15)
Critical Illness Insurance Manulife 655643 $ 10,000 10000 MB / ON $ 8.42 $ 0.59 $ 0.00 $ 0.00 $ 9.01
Dependent Life Insurance Manulife 655643 $ 5,000 option 1 MB / ON $ 1.81 $ 0.13 $ 0.00 $ 0.00 $ 1.94
Health Care Insurance Manulife 655643 Couple option 2 MB / ON $ 162.16 $ 12.55 $ 0.00 $ 9.41 $ 184.12
Life Insurance Manulife 655643 $ 10,000 Basic MB / ON $ 2.82 $ 0.20 $ 0.00 $ 0.00 $ 3.02
Long Term Disability Insurance Manulife 655643 $ 335 option 1 MB / ON $ 28.70 $ 2.30 $ 0.00 $ 0.00 $ 31.00
Long Term Disability Insurance 2021/08/03 Manulife 655643 option 1 MB / ON $ (6.62) $ (0.53) $ 0.00 $ 0.00 $ (7.15)
Optional Life Insurance Manulife 655643 $ 50,000 Option 5 MB / ON $ 60.00 $ 4.20 $ 0.00 $ 0.00 $ 64.20
Short Term Disability Insurance Manulife 655643 $ 268 Option 1 MB / ON $ 0.21 $ 0.02 $ 0.00 $ 0.00 $ 0.23
Total $ 252.20 $ 19.02 $ 0.00 $ 9.41 $ 280.63

Retro 61, Test, 1000001466, $ 23,214.00

Accidental Death & Dismemberment Insurance (AD&D) Manulife 655643 $ 23,214 option 1 MB / ON $ 1.32 $ 0.09 $ 0.00 $ 0.00 $ 1.41
Critical Illness Insurance Manulife 655643 $ 10,000 10000 MB / ON $ 8.42 $ 0.59 $ 0.00 $ 0.00 $ 9.01
Dependent Life Insurance Manulife 655643 $ 5,000 option 1 MB / ON $ 1.81 $ 0.13 $ 0.00 $ 0.00 $ 1.94
Health Care Insurance Manulife 655643 Couple option 2 MB / ON $ 162.16 $ 11.32 $ 0.00 $ 8.49 $ 181.97
Life Insurance Manulife 655643 $ 10,000 Basic MB / ON $ 2.82 $ 0.20 $ 0.00 $ 0.00 $ 3.02
Long Term Disability Insurance Manulife 655643 $ 335 option 1 MB / ON $ 28.70 $ 2.30 $ 0.00 $ 0.00 $ 31.00
Optional Life Insurance Manulife 655643 $ 20,000 Option 2 MB / ON $ 38.00 $ 2.66 $ 0.00 $ 0.00 $ 40.66
Short Term Disability Insurance Manulife 655643 $ 268 Option 1 MB / ON $ 0.21 $ 0.02 $ 0.00 $ 0.00 $ 0.23
Total $ 243.44 $ 17.31 $ 0.00 $ 8.49 $ 269.24

Retro 62, Test, 1000001449, $ 34,344.00

Accidental Death & Dismemberment Insurance (AD&D) Manulife 655643 $0 option 1 MB / ON $ 0.00 $ 0.00 $ 0.00 $ 0.00 $ 0.00
Critical Illness Insurance Manulife 655643 $0 10000 MB / ON $ 0.00 $ 0.00 $ 0.00 $ 0.00 $ 0.00
Health Care Insurance Manulife 655643 $0 Option 1 MB / ON $ 0.00 $ 0.00 $ 0.00 $ 0.00 $ 0.00
Life Insurance Manulife 655643 $0 Basic MB / ON $ 0.00 $ 0.00 $ 0.00 $ 0.00 $ 0.00
Long Term Disability Insurance Manulife 655643 $0 option 1 MB / ON $ 0.00 $ 0.00 $ 0.00 $ 0.00 $ 0.00
Optional Life Insurance Manulife 655643 $0 Option 5 MB / ON $ 0.00 $ 0.00 $ 0.00 $ 0.00 $ 0.00
Short Term Disability Insurance Manulife 655643 $0 Option 1 MB / ON $ 0.00 $ 0.00 $ 0.00 $ 0.00 $ 0.00
Total $ 0.00 $ 0.00 $ 0.00 $ 0.00 $ 0.00

Retro 63, Test, 1000001450, $ 56,757.00

Accidental Death & Dismemberment Insurance (AD&D) Manulife 655643 $ 56,757 option 1 ON / ON $ 3.24 $ 0.26 $ 0.00 $ 0.00 $ 3.50
Assurance salaire de longue durée 2021/08/01 Manulife 655643 option 1 ON / ON $ (16.19) $ (1.30) $ 0.00 $ 0.00 $ (17.49)
Critical Illness Insurance Manulife 655643 $ 10,000 10000 ON / ON $ 8.42 $ 0.67 $ 0.00 $ 0.00 $ 9.09
Health Care Insurance Manulife 655643 Single option 2 ON / ON $ 60.12 $ 4.81 $ 0.00 $ 3.61 $ 68.54
Life Insurance Manulife 655643 $ 10,000 Basic ON / ON $ 2.82 $ 0.23 $ 0.00 $ 0.00 $ 3.05
Long Term Disability Insurance Manulife 655643 $ 819 option 1 ON / ON $ 70.17 $ 5.61 $ 0.00 $ 0.00 $ 75.78

Page 7 of 12
Long Term Disability Insurance 2021/08/01 Manulife 655643 option 1 ON / ON $ (16.19) $ (1.30) $ 0.00 $ 0.00 $ (17.49)
Optional Life Insurance Manulife 655643 $ 100,000 Option 10 ON / ON $ 190.00 $ 15.20 $ 0.00 $ 0.00 $ 205.20
Short Term Disability Insurance Manulife 655643 $ 655 Option 1 ON / ON $ 0.21 $ 0.02 $ 0.00 $ 0.00 $ 0.23
Total $ 302.60 $ 24.20 $ 0.00 $ 3.61 $ 330.41

Retro 64, Test, 1000001451, $ 87,878.00

Accidental Death & Dismemberment Insurance (AD&D) Manulife 655643 $ 87,878 option 1 ON / ON $ 5.01 $ 0.40 $ 0.00 $ 0.00 $ 5.41
Critical Illness Insurance Manulife 655643 $ 10,000 10000 ON / ON $ 8.42 $ 0.67 $ 0.00 $ 0.00 $ 9.09
Health Care Insurance Manulife 655643 Single Option 1 ON / ON $ 50.12 $ 4.01 $ 0.00 $ 3.01 $ 57.14
Life Insurance Manulife 655643 $ 10,000 Basic ON / ON $ 2.82 $ 0.23 $ 0.00 $ 0.00 $ 3.05
Long Term Disability Insurance Manulife 655643 $ 1,267 option 1 ON / ON $ 108.64 $ 8.69 $ 0.00 $ 0.00 $ 117.33
Optional Life Insurance Manulife 655643 $0 Opt out ON / ON $ 0.00 $ 0.00 $ 0.00 $ 0.00 $ 0.00
Short Term Disability Insurance Manulife 655643 $ 1,014 Option 1 ON / ON $ 0.21 $ 0.02 $ 0.00 $ 0.00 $ 0.23
Total $ 175.22 $ 14.02 $ 0.00 $ 3.01 $ 192.25

Retro 65, Test, 1000001452, $ 89,989.00

Accidental Death & Dismemberment Insurance (AD&D) Manulife 655643 $ 89,989 option 1 ON / ON $ 5.13 $ 0.41 $ 0.00 $ 0.00 $ 5.54
Assurance salaire de longue durée 2021/08/01 Manulife 655643 option 1 ON / ON $ (25.67) $ (2.05) $ 0.00 $ 0.00 $ (27.72)
Critical Illness Insurance Manulife 655643 $ 10,000 10000 ON / ON $ 8.42 $ 0.67 $ 0.00 $ 0.00 $ 9.09
Health Care Insurance Manulife 655643 Single option 2 ON / ON $ 60.12 $ 4.81 $ 0.00 $ 3.61 $ 68.54
Life Insurance Manulife 655643 $ 10,000 Basic ON / ON $ 2.82 $ 0.23 $ 0.00 $ 0.00 $ 3.05
Long Term Disability Insurance Manulife 655643 $ 1,298 option 1 ON / ON $ 111.25 $ 8.90 $ 0.00 $ 0.00 $ 120.15
Long Term Disability Insurance 2021/08/01 Manulife 655643 option 1 ON / ON $ (25.67) $ (2.05) $ 0.00 $ 0.00 $ (27.72)
Optional Life Insurance Manulife 655643 $ 50,000 Option 5 ON / ON $ 60.00 $ 4.80 $ 0.00 $ 0.00 $ 64.80
Short Term Disability Insurance Manulife 655643 $ 1,038 Option 1 ON / ON $ 0.21 $ 0.02 $ 0.00 $ 0.00 $ 0.23
Total $ 196.61 $ 15.74 $ 0.00 $ 3.61 $ 215.96

Retro 66, Test, 1000001453, $ 89,988.00

Accidental Death & Dismemberment Insurance (AD&D) Manulife 655643 $ 89,988 option 1 ON / ON $ 5.13 $ 0.41 $ 0.00 $ 0.00 $ 5.54
Critical Illness Insurance Manulife 655643 $ 10,000 10000 ON / ON $ 8.42 $ 0.67 $ 0.00 $ 0.00 $ 9.09
Dependent Life Insurance Manulife 655643 $ 5,000 option 1 ON / ON $ 1.81 $ 0.14 $ 0.00 $ 0.00 $ 1.95
Health Care Insurance Manulife 655643 Single Parent Option 1 ON / ON $ 90.15 $ 7.21 $ 0.00 $ 5.41 $ 102.77
Life Insurance Manulife 655643 $ 10,000 Basic ON / ON $ 2.82 $ 0.23 $ 0.00 $ 0.00 $ 3.05
Long Term Disability Insurance Manulife 655643 $ 1,298 option 1 ON / ON $ 111.25 $ 8.90 $ 0.00 $ 0.00 $ 120.15
Optional Life Insurance Manulife 655643 $ 60,000 Option 6 ON / ON $ 72.00 $ 5.76 $ 0.00 $ 0.00 $ 77.76
Short Term Disability Insurance Manulife 655643 $ 1,038 Option 1 ON / ON $ 0.21 $ 0.02 $ 0.00 $ 0.00 $ 0.23
Total $ 291.79 $ 23.34 $ 0.00 $ 5.41 $ 320.54

Retro 67, Test, 1000001454, $ 9,988.00

Accidental Death & Dismemberment Insurance (AD&D) Manulife 655643 $ 9,988 option 1 ON / ON $ 0.57 $ 0.05 $ 0.00 $ 0.00 $ 0.62
Critical Illness Insurance Manulife 655643 $ 10,000 10000 ON / ON $ 8.42 $ 0.67 $ 0.00 $ 0.00 $ 9.09
Dependent Life Insurance Manulife 655643 $ 5,000 option 1 ON / ON $ 1.81 $ 0.14 $ 0.00 $ 0.00 $ 1.95
Health Care Insurance Manulife 655643 Couple option 2 ON / ON $ 162.16 $ 12.97 $ 0.00 $ 9.73 $ 184.86
Life Insurance Manulife 655643 $ 10,000 Basic ON / ON $ 2.82 $ 0.23 $ 0.00 $ 0.00 $ 3.05
Long Term Disability Insurance Manulife 655643 $ 144 option 1 ON / ON $ 12.35 $ 0.99 $ 0.00 $ 0.00 $ 13.34
Optional Life Insurance Manulife 655643 $0 Opt out ON / ON $ 0.00 $ 0.00 $ 0.00 $ 0.00 $ 0.00
Short Term Disability Insurance Manulife 655643 $ 115 Option 1 ON / ON $ 0.21 $ 0.02 $ 0.00 $ 0.00 $ 0.23
Total $ 188.34 $ 15.07 $ 0.00 $ 9.73 $ 213.14

Retro 68, Test, 1000001455, $ 10,022.00

Accidental Death & Dismemberment Insurance (AD&D) Manulife 655643 $ 10,022 option 1 / ON $ 0.57 $ 0.05 $ 0.00 $ 0.00 $ 0.62
Critical Illness Insurance Manulife 655643 $ 10,000 10000 / ON $ 8.42 $ 0.67 $ 0.00 $ 0.00 $ 9.09
Health Care Insurance Manulife 655643 Single Option 1 / ON $ 50.12 $ 4.01 $ 0.00 $ 3.01 $ 57.14
Life Insurance Manulife 655643 $ 10,000 Basic / ON $ 2.82 $ 0.23 $ 0.00 $ 0.00 $ 3.05
Long Term Disability Insurance Manulife 655643 $ 145 option 1 / ON $ 12.39 $ 0.99 $ 0.00 $ 0.00 $ 13.38
Optional Life Insurance Manulife 655643 $0 Opt out / ON $ 0.00 $ 0.00 $ 0.00 $ 0.00 $ 0.00
Short Term Disability Insurance Manulife 655643 $ 116 Option 1 / ON $ 0.21 $ 0.02 $ 0.00 $ 0.00 $ 0.23
Total $ 74.53 $ 5.97 $ 0.00 $ 3.01 $ 83.51

Retro 69, Test, 1000001456, $ 67,677.00

Accidental Death & Dismemberment Insurance (AD&D) Manulife 655643 $ 67,677 option 1 ON / ON $ 3.86 $ 0.31 $ 0.00 $ 0.00 $ 4.17
Critical Illness Insurance Manulife 655643 $ 10,000 10000 ON / ON $ 8.42 $ 0.67 $ 0.00 $ 0.00 $ 9.09
Dependent Life Insurance Manulife 655643 $ 5,000 option 1 ON / ON $ 1.81 $ 0.14 $ 0.00 $ 0.00 $ 1.95
Health Care Insurance Manulife 655643 Single Parent Option 1 ON / ON $ 90.15 $ 7.21 $ 0.00 $ 5.41 $ 102.77
Life Insurance Manulife 655643 $ 10,000 Basic ON / ON $ 2.82 $ 0.23 $ 0.00 $ 0.00 $ 3.05
Long Term Disability Insurance Manulife 655643 $ 976 option 1 ON / ON $ 83.67 $ 6.69 $ 0.00 $ 0.00 $ 90.36
Optional Life Insurance Manulife 655643 $ 50,000 Option 5 ON / ON $ 55.00 $ 4.40 $ 0.00 $ 0.00 $ 59.40
Short Term Disability Insurance Manulife 655643 $ 781 Option 1 ON / ON $ 0.21 $ 0.02 $ 0.00 $ 0.00 $ 0.23
Total $ 245.94 $ 19.67 $ 0.00 $ 5.41 $ 271.02

Retro 70, Test, 1000001457, $ 67,677.00

Accidental Death & Dismemberment Insurance (AD&D) Manulife 655643 $ 67,677 option 1 ON / ON $ 3.86 $ 0.31 $ 0.00 $ 0.00 $ 4.17
Critical Illness Insurance Manulife 655643 $ 10,000 10000 ON / ON $ 8.42 $ 0.67 $ 0.00 $ 0.00 $ 9.09
Health Care Insurance Manulife 655643 Single option 2 ON / ON $ 240.48 $ 19.24 $ 0.00 $ 14.43 $ 274.15
Life Insurance Manulife 655643 $ 10,000 Basic ON / ON $ 2.82 $ 0.23 $ 0.00 $ 0.00 $ 3.05
Long Term Disability Insurance Manulife 655643 $ 976 option 1 ON / ON $ 83.67 $ 6.69 $ 0.00 $ 0.00 $ 90.36
Optional Life Insurance Manulife 655643 $ 30,000 Option 3 ON / ON $ 132.00 $ 10.56 $ 0.00 $ 0.00 $ 142.56
Short Term Disability Insurance Manulife 655643 $ 781 Option 1 ON / ON $ 0.21 $ 0.02 $ 0.00 $ 0.00 $ 0.23
Total $ 471.46 $ 37.72 $ 0.00 $ 14.43 $ 523.61

Retro 71, Test, 1000001458, $ 67,677.00

Accidental Death & Dismemberment Insurance (AD&D) Manulife 655643 $ 67,677 option 1 / ON $ 3.86 $ 0.31 $ 0.00 $ 0.00 $ 4.17
Critical Illness Insurance Manulife 655643 $ 10,000 10000 / ON $ 8.42 $ 0.67 $ 0.00 $ 0.00 $ 9.09
Health Care Insurance Manulife 655643 Single option 2 / ON $ 60.12 $ 4.81 $ 0.00 $ 3.61 $ 68.54
Life Insurance Manulife 655643 $ 10,000 Basic / ON $ 2.82 $ 0.23 $ 0.00 $ 0.00 $ 3.05
Long Term Disability Insurance Manulife 655643 $ 976 option 1 / ON $ 83.67 $ 6.69 $ 0.00 $ 0.00 $ 90.36
Optional Life Insurance Manulife 655643 $ 80,000 Option 8 / ON $ 88.00 $ 7.04 $ 0.00 $ 0.00 $ 95.04
Short Term Disability Insurance Manulife 655643 $ 781 Option 1 / ON $ 0.21 $ 0.02 $ 0.00 $ 0.00 $ 0.23

Page 8 of 12
Total $ 247.10 $ 19.77 $ 0.00 $ 3.61 $ 270.48

Retro 72, Test, 1000001459, $ 77,677.00

Accidental Death & Dismemberment Insurance (AD&D) Manulife 655643 $ 77,677 option 1 ON / ON $ 4.43 $ 0.35 $ 0.00 $ 0.00 $ 4.78
Critical Illness Insurance Manulife 655643 $ 10,000 10000 ON / ON $ 8.42 $ 0.67 $ 0.00 $ 0.00 $ 9.09
Dependent Life Insurance Manulife 655643 $ 5,000 option 1 ON / ON $ 1.81 $ 0.14 $ 0.00 $ 0.00 $ 1.95
Health Care Insurance Manulife 655643 Couple Option 1 ON / ON $ 148.20 $ 11.86 $ 0.00 $ 8.89 $ 168.95
Life Insurance Manulife 655643 $ 10,000 Basic ON / ON $ 2.82 $ 0.23 $ 0.00 $ 0.00 $ 3.05
Long Term Disability Insurance Manulife 655643 $ 1,120 option 1 ON / ON $ 96.03 $ 7.68 $ 0.00 $ 0.00 $ 103.71
Optional Life Insurance Manulife 655643 $ 20,000 Option 2 ON / ON $ 34.00 $ 2.72 $ 0.00 $ 0.00 $ 36.72
Short Term Disability Insurance Manulife 655643 $ 896 Option 1 ON / ON $ 0.21 $ 0.02 $ 0.00 $ 0.00 $ 0.23
Total $ 295.92 $ 23.67 $ 0.00 $ 8.89 $ 328.48

Retro 73, Test, 1000001460, $ 67,677.00

Accidental Death & Dismemberment Insurance (AD&D) Manulife 655643 $ 67,677 option 1 QC / ON $ 3.86 $ 0.35 $ 0.00 $ 0.00 $ 4.21
Assurance salaire de longue durée 2021/06/01 Manulife 655643 option 1 QC / ON $ (19.31) $ (1.54) $ 0.00 $ 0.00 $ (20.85)
Assurance salaire de longue durée 2021/07/01 Manulife 655643 option 1 QC / ON $ (19.31) $ (1.54) $ 0.00 $ 0.00 $ (20.85)
Assurance salaire de longue durée 2021/08/01 Manulife 655643 option 1 QC / ON $ (19.31) $ (1.54) $ 0.00 $ 0.00 $ (20.85)
Critical Illness Insurance Manulife 655643 $ 10,000 10000 QC / ON $ 8.42 $ 0.76 $ 0.00 $ 0.00 $ 9.18
Health Care Insurance Manulife 655643 Single Option 1 QC / ON $ 50.12 $ 4.31 $ 0.00 $ 1.23 $ 55.66
Life Insurance Manulife 655643 $ 10,000 Basic QC / ON $ 2.82 $ 0.25 $ 0.00 $ 0.00 $ 3.07
Long Term Disability Insurance Manulife 655643 $ 976 option 1 QC / ON $ 83.67 $ 6.69 $ 0.00 $ 0.00 $ 90.36
Long Term Disability Insurance 2021/06/01 Manulife 655643 option 1 QC / ON $ (19.31) $ (1.54) $ 0.00 $ 0.00 $ (20.85)
Long Term Disability Insurance 2021/07/01 Manulife 655643 option 1 QC / ON $ (19.31) $ (1.54) $ 0.00 $ 0.00 $ (20.85)
Long Term Disability Insurance 2021/08/01 Manulife 655643 option 1 QC / ON $ (19.31) $ (1.54) $ 0.00 $ 0.00 $ (20.85)
Optional Life Insurance Manulife 655643 $0 Opt out QC / ON $ 0.00 $ 0.00 $ 0.00 $ 0.00 $ 0.00
Short Term Disability Insurance Manulife 655643 $ 781 Option 1 QC / ON $ 0.21 $ 0.02 $ 0.00 $ 0.00 $ 0.23
Total $ 33.24 $ 3.14 $ 0.00 $ 1.23 $ 37.61

Retro 74, Test, 1000001461, $ 57,677.00

Accidental Death & Dismemberment Insurance (AD&D) Manulife 655643 $ 57,677 option 1 QC / ON $ 3.29 $ 0.30 $ 0.00 $ 0.00 $ 3.59
Assurance salaire de longue durée 2021/06/01 Manulife 655643 option 1 QC / ON $ (16.45) $ (1.32) $ 0.00 $ 0.00 $ (17.77)
Assurance salaire de longue durée 2021/07/01 Manulife 655643 option 1 QC / ON $ (16.45) $ (1.32) $ 0.00 $ 0.00 $ (17.77)
Assurance salaire de longue durée 2021/08/01 Manulife 655643 option 1 QC / ON $ (16.45) $ (1.32) $ 0.00 $ 0.00 $ (17.77)
Critical Illness Insurance Manulife 655643 $ 10,000 10000 QC / ON $ 8.42 $ 0.76 $ 0.00 $ 0.00 $ 9.18
Health Care Insurance Manulife 655643 Single Option 1 QC / ON $ 50.12 $ 4.27 $ 0.00 $ 1.43 $ 55.82
Life Insurance Manulife 655643 $ 10,000 Basic QC / ON $ 2.82 $ 0.25 $ 0.00 $ 0.00 $ 3.07
Long Term Disability Insurance Manulife 655643 $ 832 option 1 QC / ON $ 71.30 $ 5.70 $ 0.00 $ 0.00 $ 77.00
Long Term Disability Insurance 2021/06/01 Manulife 655643 option 1 QC / ON $ (16.45) $ (1.32) $ 0.00 $ 0.00 $ (17.77)
Long Term Disability Insurance 2021/07/01 Manulife 655643 option 1 QC / ON $ (16.45) $ (1.32) $ 0.00 $ 0.00 $ (17.77)
Long Term Disability Insurance 2021/08/01 Manulife 655643 option 1 QC / ON $ (16.45) $ (1.32) $ 0.00 $ 0.00 $ (17.77)
Optional Life Insurance Manulife 655643 $0 Opt out QC / ON $ 0.00 $ 0.00 $ 0.00 $ 0.00 $ 0.00
Short Term Disability Insurance Manulife 655643 $ 666 Option 1 QC / ON $ 0.21 $ 0.02 $ 0.00 $ 0.00 $ 0.23
Total $ 37.46 $ 3.38 $ 0.00 $ 1.43 $ 42.27

Retro 75, Test, 1000001462, $ 97,677.00

Accidental Death & Dismemberment Insurance (AD&D) Manulife 655643 $ 97,677 option 1 QC / ON $ 5.57 $ 0.50 $ 0.00 $ 0.00 $ 6.07
Assurance salaire de longue durée 2021/06/01 Manulife 655643 option 1 QC / ON $ (27.87) $ (2.23) $ 0.00 $ 0.00 $ (30.10)
Assurance salaire de longue durée 2021/07/01 Manulife 655643 option 1 QC / ON $ (27.87) $ (2.23) $ 0.00 $ 0.00 $ (30.10)
Assurance salaire de longue durée 2021/08/01 Manulife 655643 option 1 QC / ON $ (27.87) $ (2.23) $ 0.00 $ 0.00 $ (30.10)
Critical Illness Insurance Manulife 655643 $ 10,000 10000 QC / ON $ 8.42 $ 0.76 $ 0.00 $ 0.00 $ 9.18
Health Care Insurance Manulife 655643 Single Option 1 QC / ON $ 50.12 $ 4.40 $ 0.00 $ 0.63 $ 55.15
Life Insurance Manulife 655643 $ 10,000 Basic QC / ON $ 2.82 $ 0.25 $ 0.00 $ 0.00 $ 3.07
Long Term Disability Insurance Manulife 655643 $ 1,409 option 1 QC / ON $ 120.75 $ 9.66 $ 0.00 $ 0.00 $ 130.41
Long Term Disability Insurance 2021/06/01 Manulife 655643 option 1 QC / ON $ (27.87) $ (2.23) $ 0.00 $ 0.00 $ (30.10)
Long Term Disability Insurance 2021/07/01 Manulife 655643 option 1 QC / ON $ (27.87) $ (2.23) $ 0.00 $ 0.00 $ (30.10)
Long Term Disability Insurance 2021/08/01 Manulife 655643 option 1 QC / ON $ (27.87) $ (2.23) $ 0.00 $ 0.00 $ (30.10)
Optional Life Insurance Manulife 655643 $0 Opt out QC / ON $ 0.00 $ 0.00 $ 0.00 $ 0.00 $ 0.00
Short Term Disability Insurance Manulife 655643 $ 1,127 Option 1 QC / ON $ 0.21 $ 0.02 $ 0.00 $ 0.00 $ 0.23
Total $ 20.67 $ 2.21 $ 0.00 $ 0.63 $ 23.51

Retro 76, Test, 1000001463, $ 37,677.00

Accidental Death & Dismemberment Insurance (AD&D) Manulife 655643 $ 37,677 option 1 QC / ON $ 2.15 $ 0.19 $ 0.00 $ 0.00 $ 2.34
Assurance salaire de longue durée 2021/06/01 Manulife 655643 option 1 QC / ON $ (10.75) $ (0.86) $ 0.00 $ 0.00 $ (11.61)
Assurance salaire de longue durée 2021/07/01 Manulife 655643 option 1 QC / ON $ (10.75) $ (0.86) $ 0.00 $ 0.00 $ (11.61)
Assurance salaire de longue durée 2021/08/01 Manulife 655643 option 1 QC / ON $ (10.75) $ (0.86) $ 0.00 $ 0.00 $ (11.61)
Critical Illness Insurance Manulife 655643 $ 10,000 10000 QC / ON $ 8.42 $ 0.76 $ 0.00 $ 0.00 $ 9.18
Health Care Insurance Manulife 655643 Single Option 1 QC / ON $ 50.12 $ 4.20 $ 0.00 $ 1.83 $ 56.15
Life Insurance Manulife 655643 $ 10,000 Basic QC / ON $ 2.82 $ 0.25 $ 0.00 $ 0.00 $ 3.07
Long Term Disability Insurance Manulife 655643 $ 543 option 1 QC / ON $ 46.58 $ 3.73 $ 0.00 $ 0.00 $ 50.31
Long Term Disability Insurance 2021/06/01 Manulife 655643 option 1 QC / ON $ (10.75) $ (0.86) $ 0.00 $ 0.00 $ (11.61)
Long Term Disability Insurance 2021/07/01 Manulife 655643 option 1 QC / ON $ (10.75) $ (0.86) $ 0.00 $ 0.00 $ (11.61)
Long Term Disability Insurance 2021/08/01 Manulife 655643 option 1 QC / ON $ (10.75) $ (0.86) $ 0.00 $ 0.00 $ (11.61)
Optional Life Insurance Manulife 655643 $0 Opt out QC / ON $ 0.00 $ 0.00 $ 0.00 $ 0.00 $ 0.00
Short Term Disability Insurance Manulife 655643 $ 435 Option 1 QC / ON $ 0.21 $ 0.02 $ 0.00 $ 0.00 $ 0.23
Total $ 45.80 $ 3.99 $ 0.00 $ 1.83 $ 51.62

Retro 77, Test, 1000001464, $ 67,677.00

Accidental Death & Dismemberment Insurance (AD&D) Manulife 655643 $ 67,677 option 1 QC / ON $ 3.86 $ 0.35 $ 0.00 $ 0.00 $ 4.21
Assurance salaire de longue durée 2021/06/01 Manulife 655643 option 1 QC / ON $ (19.31) $ (1.54) $ 0.00 $ 0.00 $ (20.85)
Assurance salaire de longue durée 2021/07/01 Manulife 655643 option 1 QC / ON $ (19.31) $ (1.54) $ 0.00 $ 0.00 $ (20.85)
Assurance salaire de longue durée 2021/08/01 Manulife 655643 option 1 QC / ON $ (19.31) $ (1.54) $ 0.00 $ 0.00 $ (20.85)
Critical Illness Insurance Manulife 655643 $ 10,000 10000 QC / ON $ 8.42 $ 0.76 $ 0.00 $ 0.00 $ 9.18
Health Care Insurance Manulife 655643 Single Option 1 QC / ON $ 50.12 $ 4.31 $ 0.00 $ 1.23 $ 55.66
Life Insurance Manulife 655643 $ 10,000 Basic QC / ON $ 2.82 $ 0.25 $ 0.00 $ 0.00 $ 3.07
Long Term Disability Insurance Manulife 655643 $ 976 option 1 QC / ON $ 83.67 $ 6.69 $ 0.00 $ 0.00 $ 90.36
Long Term Disability Insurance 2021/06/01 Manulife 655643 option 1 QC / ON $ (19.31) $ (1.54) $ 0.00 $ 0.00 $ (20.85)

Page 9 of 12
Long Term Disability Insurance 2021/07/01 Manulife 655643 option 1 QC / ON $ (19.31) $ (1.54) $ 0.00 $ 0.00 $ (20.85)
Long Term Disability Insurance 2021/08/01 Manulife 655643 option 1 QC / ON $ (19.31) $ (1.54) $ 0.00 $ 0.00 $ (20.85)
Optional Life Insurance Manulife 655643 $0 Opt out QC / ON $ 0.00 $ 0.00 $ 0.00 $ 0.00 $ 0.00
Short Term Disability Insurance Manulife 655643 $ 781 Option 1 QC / ON $ 0.21 $ 0.02 $ 0.00 $ 0.00 $ 0.23
Total $ 33.24 $ 3.14 $ 0.00 $ 1.23 $ 37.61

Retro 78, Test, 1000001465, $ 67,677.00

Accidental Death & Dismemberment Insurance (AD&D) Manulife 655643 $ 67,677 option 1 SK / ON $ 3.86 $ 0.00 $ 0.00 $ 0.00 $ 3.86
Assurance salaire de longue durée 2021/06/01 Manulife 655643 option 1 SK / ON $ (19.31) $ (1.54) $ 0.00 $ 0.00 $ (20.85)
Assurance salaire de longue durée 2021/07/01 Manulife 655643 option 1 SK / ON $ (19.31) $ (1.54) $ 0.00 $ 0.00 $ (20.85)
Assurance salaire de longue durée 2021/08/01 Manulife 655643 option 1 SK / ON $ (19.31) $ (1.54) $ 0.00 $ 0.00 $ (20.85)
Critical Illness Insurance Manulife 655643 $ 10,000 10000 SK / ON $ 8.42 $ 0.00 $ 0.00 $ 0.00 $ 8.42
Health Care Insurance Manulife 655643 Single Option 1 SK / ON $ 50.12 $ 1.64 $ 0.00 $ 1.23 $ 52.99
Life Insurance Manulife 655643 $ 10,000 Basic SK / ON $ 2.82 $ 0.00 $ 0.00 $ 0.00 $ 2.82
Long Term Disability Insurance Manulife 655643 $ 976 option 1 SK / ON $ 83.67 $ 6.69 $ 0.00 $ 0.00 $ 90.36
Long Term Disability Insurance 2021/06/01 Manulife 655643 option 1 SK / ON $ (19.31) $ (1.54) $ 0.00 $ 0.00 $ (20.85)
Long Term Disability Insurance 2021/07/01 Manulife 655643 option 1 SK / ON $ (19.31) $ (1.54) $ 0.00 $ 0.00 $ (20.85)
Long Term Disability Insurance 2021/08/01 Manulife 655643 option 1 SK / ON $ (19.31) $ (1.54) $ 0.00 $ 0.00 $ (20.85)
Optional Life Insurance Manulife 655643 $0 Opt out SK / ON $ 0.00 $ 0.00 $ 0.00 $ 0.00 $ 0.00
Short Term Disability Insurance Manulife 655643 $ 781 Option 1 SK / ON $ 0.21 $ 0.02 $ 0.00 $ 0.00 $ 0.23
Total $ 33.24 $ (0.89) $ 0.00 $ 1.23 $ 33.58

Retro 79, Test, 1000001467, $ 67,677.00

Accidental Death & Dismemberment Insurance (AD&D) Manulife 655643 $ 67,677 option 1 SK / ON $ 3.86 $ 0.00 $ 0.00 $ 0.00 $ 3.86
Assurance salaire de longue durée 2021/06/01 Manulife 655643 option 1 SK / ON $ (19.31) $ (1.54) $ 0.00 $ 0.00 $ (20.85)
Assurance salaire de longue durée 2021/07/01 Manulife 655643 option 1 SK / ON $ (19.31) $ (1.54) $ 0.00 $ 0.00 $ (20.85)
Assurance salaire de longue durée 2021/08/01 Manulife 655643 option 1 SK / ON $ (19.31) $ (1.54) $ 0.00 $ 0.00 $ (20.85)
Critical Illness Insurance Manulife 655643 $ 10,000 10000 SK / ON $ 8.42 $ 0.00 $ 0.00 $ 0.00 $ 8.42
Health Care Insurance Manulife 655643 Single Option 1 SK / ON $ 50.12 $ 1.64 $ 0.00 $ 1.23 $ 52.99
Life Insurance Manulife 655643 $ 10,000 Basic SK / ON $ 2.82 $ 0.00 $ 0.00 $ 0.00 $ 2.82
Long Term Disability Insurance Manulife 655643 $ 976 option 1 SK / ON $ 83.67 $ 6.69 $ 0.00 $ 0.00 $ 90.36
Long Term Disability Insurance 2021/06/01 Manulife 655643 option 1 SK / ON $ (19.31) $ (1.54) $ 0.00 $ 0.00 $ (20.85)
Long Term Disability Insurance 2021/07/01 Manulife 655643 option 1 SK / ON $ (19.31) $ (1.54) $ 0.00 $ 0.00 $ (20.85)
Long Term Disability Insurance 2021/08/01 Manulife 655643 option 1 SK / ON $ (19.31) $ (1.54) $ 0.00 $ 0.00 $ (20.85)
Optional Life Insurance Manulife 655643 $0 Opt out SK / ON $ 0.00 $ 0.00 $ 0.00 $ 0.00 $ 0.00
Short Term Disability Insurance Manulife 655643 $ 781 Option 1 SK / ON $ 0.21 $ 0.02 $ 0.00 $ 0.00 $ 0.23
Total $ 33.24 $ (0.89) $ 0.00 $ 1.23 $ 33.58

retro pro, test, 1000001950, $ 887,987.00

Accidental Death & Dismemberment Insurance (AD&D) Manulife 655643 $ 250,000 option 1 MB / ON $ 0.00 $ 0.00 $ 0.00 $ 0.00 $ 0.00
Critical Illness Insurance Manulife 655643 $ 10,000 10000 MB / ON $ 0.00 $ 0.00 $ 0.00 $ 0.00 $ 0.00
Health Care Insurance Manulife 655643 Single option 2 MB / ON $ 0.00 $ 0.00 $ 0.00 $ 0.00 $ 0.00
Life Insurance Manulife 655643 $ 10,000 Basic MB / ON $ 0.00 $ 0.00 $ 0.00 $ 0.00 $ 0.00
Long Term Disability Insurance Manulife 655643 $ 10,000 option 1 MB / ON $ 0.00 $ 0.00 $ 0.00 $ 0.00 $ 0.00
Optional Life Insurance Manulife 655643 $0 Opt out MB / ON $ 0.00 $ 0.00 $ 0.00 $ 0.00 $ 0.00
Short Term Disability Insurance Manulife 655643 $ 1,500 Option 1 MB / ON $ 0.00 $ 0.00 $ 0.00 $ 0.00 $ 0.00
Total $ 0.00 $ 0.00 $ 0.00 $ 0.00 $ 0.00

CLASS TOTAL $ 15,495.97 $ 886.63 $ 106.77 $ 95.78 $ 16,585.15

DIVISION TOTAL $ 15,495.97 $ 886.63 $ 106.77 $ 95.78 $ 16,585.15

GRAND TOTAL $ 15,495.97 $ 886.63 $ 106.77 $ 95.78 $ 16,585.15

Page 10 of 12
 Summary by division
Period of 2021/09/01 - 2021/09/30

Client Billing Test_Retro

Contract All
Insurer All
Division All
Class All

Number of Total Insurance GST QST Total Premium

Benefits Protection Volume
Employees Premium Tax HST PST Including taxes
Accidental Death & Dismemberment Insurance
All 43 $ 6,309,848 $ 123.14 $ (5.12) $ 0.00 $ 0.00 $ 118.02
(AD&D)
Assurance salaire de longue durée All 43 $ 446,261 $ 10,650.84 $ 684.43 $ 0.00 $ 0.00 $ 11,335.27
Assurance soins médicaux 4 $0 $ 444.60 $ 0.00 $ 14.82 $ 0.00 $ 459.42
Assurance soins médicaux Couple 7 $0 $ 917.08 $ 53.51 $ 22.23 $ 40.13 $ 1,032.95
Assurance soins médicaux Family 3 $0 $ 109.24 $ (1.65) $ 14.82 $ (1.24) $ 121.17
Assurance soins médicaux Single 27 $0 $ 1,499.40 $ 74.44 $ 36.86 $ 46.07 $ 1,656.77
Assurance soins médicaux Single Parent 4 $0 $ 360.60 $ 14.42 $ 18.04 $ 10.82 $ 403.88
Assurance vie facultative All 42 $ 980,000 $ 1,126.00 $ 60.98 $ 0.00 $ 0.00 $ 1,186.98
Critical Illness Insurance All 43 $ 440,000 $ 143.14 $ 1.91 $ 0.00 $ 0.00 $ 145.05
Dependent Life Insurance All 18 $ 100,000 $ 30.77 $ 1.37 $ 0.00 $ 0.00 $ 32.14
Health Care Insurance 4 $0 $ 444.60 $ 0.00 $ 14.82 $ 0.00 $ 459.42
Health Care Insurance Couple 7 $0 $ 917.08 $ 53.51 $ 22.23 $ 40.13 $ 1,032.95
Health Care Insurance Family 3 $0 $ 109.24 $ (1.65) $ 14.82 $ (1.24) $ 121.17
Health Care Insurance Single 27 $0 $ 1,499.40 $ 74.44 $ 36.86 $ 46.07 $ 1,656.77
Health Care Insurance Single Parent 4 $0 $ 360.60 $ 14.42 $ 18.04 $ 10.82 $ 403.88
Life Insurance All 43 $ 580,626 $ 87.59 $ 2.22 $ 0.00 $ 0.00 $ 89.81
Long Term Disability Insurance All 43 $ 446,261 $ 10,650.84 $ 684.43 $ 0.00 $ 0.00 $ 11,335.27
Optional Life Insurance All 3 $0 $ 0.00 $ 0.00 $ 0.00 $ 0.00 $ 0.00
Optional Life Insurance All 42 $ 980,000 $ 1,126.00 $ 60.98 $ 0.00 $ 0.00 $ 1,186.98
Short Term Disability Insurance All 43 $ 45,777 $ 3.57 $ 0.12 $ 0.00 $ 0.00 $ 3.69
Total $ 15,495.97 $ 886.63 $ 106.77 $ 95.78 $ 16,585.15

Page 11 of 12
Client Billing Test_Retro
Contract 655643
Insurer Manulife
Division All Eligible
Class bill

Number of Total Insurance GST QST Total Premium

Benefits Protection Volume
Employees Premium Tax HST PST Including taxes
Accidental Death & Dismemberment Insurance
All 43 $ 6,309,848 $ 123.14 $ (5.12) $ 0.00 $ 0.00 $ 118.02
(AD&D)
Assurance salaire de longue durée All 43 $ 446,261 $ 10,650.84 $ 684.43 $ 0.00 $ 0.00 $ 11,335.27
Assurance soins médicaux 4 $0 $ 444.60 $ 0.00 $ 14.82 $ 0.00 $ 459.42
Assurance soins médicaux Couple 7 $0 $ 917.08 $ 53.51 $ 22.23 $ 40.13 $ 1,032.95
Assurance soins médicaux Family 3 $0 $ 109.24 $ (1.65) $ 14.82 $ (1.24) $ 121.17
Assurance soins médicaux Single 27 $0 $ 1,499.40 $ 74.44 $ 36.86 $ 46.07 $ 1,656.77
Assurance soins médicaux Single Parent 4 $0 $ 360.60 $ 14.42 $ 18.04 $ 10.82 $ 403.88
Assurance vie facultative All 42 $ 980,000 $ 1,126.00 $ 60.98 $ 0.00 $ 0.00 $ 1,186.98
Critical Illness Insurance All 43 $ 440,000 $ 143.14 $ 1.91 $ 0.00 $ 0.00 $ 145.05
Dependent Life Insurance All 18 $ 100,000 $ 30.77 $ 1.37 $ 0.00 $ 0.00 $ 32.14
Health Care Insurance 4 $0 $ 444.60 $ 0.00 $ 14.82 $ 0.00 $ 459.42
Health Care Insurance Couple 7 $0 $ 917.08 $ 53.51 $ 22.23 $ 40.13 $ 1,032.95
Health Care Insurance Family 3 $0 $ 109.24 $ (1.65) $ 14.82 $ (1.24) $ 121.17
Health Care Insurance Single 27 $0 $ 1,499.40 $ 74.44 $ 36.86 $ 46.07 $ 1,656.77
Health Care Insurance Single Parent 4 $0 $ 360.60 $ 14.42 $ 18.04 $ 10.82 $ 403.88
Life Insurance All 43 $ 580,626 $ 87.59 $ 2.22 $ 0.00 $ 0.00 $ 89.81
Long Term Disability Insurance All 43 $ 446,261 $ 10,650.84 $ 684.43 $ 0.00 $ 0.00 $ 11,335.27
Optional Life Insurance All 3 $0 $ 0.00 $ 0.00 $ 0.00 $ 0.00 $ 0.00
Optional Life Insurance All 42 $ 980,000 $ 1,126.00 $ 60.98 $ 0.00 $ 0.00 $ 1,186.98
Short Term Disability Insurance All 43 $ 45,777 $ 3.57 $ 0.12 $ 0.00 $ 0.00 $ 3.69
Total $ 15,495.97 $ 886.63 $ 106.77 $ 95.78 $ 16,585.15

Page 12 of 12