Customer Statement

January 04, 2024

Bill To: BROKER ON 1468-66

LEENMARY SHERJI SHINE BILLYARD INSURANCE GROUP INC

142 POPLAR GROVE 39 LAKESHORE ROAD E
LONDON ON N6E 2X7 UNIT B100
MISSISSAUGA ON L5G 1C9
PHONE: (905) 667-7027
FAX: (866) 540-6870
contact@thebig.ca

Policy Information Statement of Account

Policy Holder LEENMARY SHERJI SHINE Premium $1201.00
Policy Type Private Passenger Auto $1201.00
Policy Number Y 79111294-6
Direct Bill Account 2902173
Billing Method Monthly Pay

Payment Due Date: January 25, 2024 Current Amount Due: $1,201.00
If you have already made payment for the amount due, please disregard this statement.

Payment may be made in one of the following ways:

Credit/Debit Card: Visit epayment.sgicanada.ca to submit payment. Visa, MasterCard, and American Express are accepted.
Internet Banking: Payee = SGI CANADA Ins Serv Ltd. Customer ID = 791112946
Cheque/Money Order: Please make payable to SGI CANADA and write your policy number on the front of the payment.
Return with this document to: SGI CANADA - Company Bill,
2260 11th Avenue, Regina, SK S4P 0J9

*10002902173000120100*
Broker: ON 1468-66 Amount: $1,201.00
Name: LEENMARY SHERJI SHINE Policy Number: Y 79111294-6 Due Date: January 25, 2024

BROKER COPY
GENERAL TERMS AND CONDITIONS
Payments are due by the date indicated on your statement. Failure to make payments by the due date will affect your insurance
coverage.
A $35.00 charge will be applied to payments not honoured by your financial institution.
Please contact your broker if you have any questions regarding this statement or if you require any changes to your insurance
coverage.

PAYMENT OPTIONS
Please mail payments to SGI CANADA Company Bill, 2260 11th Avenue, Regina, SK S4P 0J9.
A self-addressed envelope is provided for your convenience.

A Monthly Payment Plan is available by contacting your Broker.