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COMPLIANCE RETURN
Distribution without a representative
COMPLIANCE RETURN

Distribution without a representative

Name of insurer:

Name of guide:

File number of insurer (if any):

File number of the AMF (if known):

(02/08)
Instructions

This compliance return is intended for insurers who wish to offer insurance products through distribution
without a representative. This document must be completed at the time of the initial filing of a distribution
guide with the Autorit des marchs financiers (the AMF or the Authority), or at the time a significant
amendment is made. The AMF may, on a case-by-case basis, ask the insurer to file a new compliance
return.

The compliance return sets out certain requirements of the AMF with respect to form and content
specified in the Act respecting the distribution of financial products and services (R.S.Q. chapter D-9.2)
(hereinafter called the Act) and in the Regulation respecting distribution without a representative.
Insurers must also comply with the Act respecting insurance (R.S.Q. chapter A-32), the Regulation
respecting the application of the Act respecting insurance (chapter A-32, R. 1) and the Civil Code of
Qubec. This in no way limits the information to be provided with this return. The insurer must include any
additional information that would be necessary to properly understand the product being offered.

The AMF makes available on its website, www.lautorite.qc.ca, a Distribution Guide Drafting Manual
which, in conjunction with Regulation respecting distribution without a representative, provides all the
relevant information with respect to the presentation of a distribution guide.

The insurer is accountable for the compliance of its product and of any relevant document. This
compliance return constitutes a declaration of compliance. It must be signed by an authorized official of
the insurer who thus confirms, in the name of the insurer, the accuracy and quality of the information
declared.

The insurer may be asked to provide additional clarification when the information and the documents
submitted do not allow the determination of whether the compliance return has been duly completed, or
when the information provided in the compliance return is different from the information in the documents
submitted. To this end and for the purposes of examinations performed by the AMF, the insurer must
collect and retain all the relevant information that could eventually be required.

(02/08)
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QUESTION 1 Identification of the insurer.


To offer an insurance product through distribution without a representative, the insurer must hold a valid
licence in Qubec.

The insurer must indicate:

1.1 the name under which it operates in Qubec, as shown on its licence issued by the AMF;

1.2 the date of issuance of this licence by the AMF;

1.3 the name used by the insurer in regards to this product, pursuant to the Act respecting the legal
publicity of sole proprietorships, partnerships and legal persons (R.S.Q. chapter P-45).

This section must be completed in the same manner by any other insurer sharing the risk. This is not a
matter of reinsurance but rather of cases where the name of more than one insurer appears in the guide.

QUESTION 2 Identification of the contact person for the distribution guide.


The insurer must identify the person specifically designated as being the contact for all communications
with the AMF with respect to the distribution guide. This person may be an employee of the insurer or of a
consultant firm.

Name and address


Name Title Telephone E-mail
of the company

QUESTION 3 Identification of the administrator to whom the insurer outsourced


the management of the product.

3.1 Has the insurer outsourced all or any part of the management of the insurance product?

Yes No

3.2 What is the nature of the outsourced activities (e.g.: marketing, claims management, etc.)?
4

In the case of outsourcing of claims management and/or client services, indicate where in the
guide the consumer will be able to find the contact information of the legal person designated by
the insurer as the administrator to manage and act in its name with respect to the guide delivered
through distribution without a representative.

3.3 What is the administrators Qubec enterprise number (NEQ)?

QUESTION 4 Documents submitted pursuant to Title VIII of the Act respecting


the distribution of financial products and services (R.S.Q. chapter
D-9.2):
The examination of a distribution guide is done on the basis of the French version of the supporting
documents. French versions must therefore be submitted.

4.1 Has the French version of the following documents been included (based on the type of product
offered)?

Document Individual Insurance Group Insurance

Distribution guide?

Insurance policy and any relevant document?

Application?

Insurance certificate? N/A

Cheque in the amount of $1,000, drawn in


the name of the Autorit des marchs
financiers, covering the examination fees of
the distribution guide?

List of names and addresses of distributors


(Excel format)?

4.2 If an English version of the distribution guide is not included, please specify that no English version
will be distributed or that it will be filed with the AMF when available.
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Question 5 Description of the product and coverage offered


5.1 In the case of an insurance of persons policy, please indicate the principal and accessory
objects of the insurance contract:

Individual Insurance Group Insurance

Damage insurance N/A

Life insurance

Accident and sickness insurance

Please confirm whether the Qubec licence authorizes the insurer to offer the principal object
class specified above.

Yes No
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5.2 Does the distribution guide comply with the Act respecting the distribution of financial products
and services (R.S.Q. chapter D-9.2) (the Act), particularly:

Page(s) of the
Yes
guide
Do you describe the product offered? (s. 411 of the Act)
Do you state the nature of the guarantee? (s. 411 of the Act)
Do you specify the time and the means (insurance certificate or
other document) to confirm coverage to the consumer? S. 444
of the Act states that: A distributor that, on granting a loan,
solicits the adhesion of a client to debtor life, health or job loss
insurance must provide the client with confirmation of insurance
from the insurer within 30 days of the application for adhesion.
Do you clearly state all exclusions from the guarantee? (s. 411
of the Act)
Do you specify the way in which eventual claims are to be
presented, and the time for presenting them? (s. 411 of the Act)
Do you indicate the lapse of time available to the insurer, in case
of a claim, to pay the amounts insured?
(s. 411 of the Act)
Do you specify the manner by which the insured can appeal the
insurers decision? (s. 411 of the Act)
Where applicable, does the distribution guide mention that the
insurer is aware that other insurance products offering
guarantees similar to those of the product offered are available
on the market? (s. 412 of the Act)
Is the distribution guide drafted and presented in accordance
with the rules determined by the AMF? N/A
(s. 413 of the Act)
Is the text of the distribution guide drafted in accordance with the
requirements of the Regulation respecting distribution without a
representative, including Schedule 4, with respect to, among
other items:
a) the plan and the drafting grid?
N/A

b) clear and simple language writing techniques?


N/A

c) grammar and spelling rules?


N/A

d) exclusions?
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Page(s) of
Yes No
the guide
The Regulation respecting distribution without a representative
(the Regulation) provides for three notices. Do these notices
apply to this guide and, if so, on which pages of the guide are
they mentioned?

a) Notice of Cancellation of an Insurance Contract (s. 2 of the


Regulation and s. 440 of the Act respecting the distribution
of financial products and services (R.S.Q. chapter D-9.2)

b) Notice of Free Choice of Insurer or Representative (s. 3 of


the Regulation and s. 443 of the Act respecting the
distribution of financial products and services (R.S.Q.
chapter D-9.2)

c) Notice of Specific Consent (s. 4 of the Regulation and ss.


92 and 437 of the Act respecting the distribution of
financial products and services (R.S.Q. chapter D-9.2)

5.3 To what type of goods does the insurance product offered as an accessory by the distributor relate,
pursuant to sections 408, 424, 425 and 426 of the Act?

5.3.1 Please describe briefly the context in which the insurance product is offered?
E.g.: - in which circumstances is the insurance offered;
- by whom;
- when is the distribution guide given to the consumer;
- etc.

5.4 If the insurance product is distributed in accordance with an order-in-council, please indicate the
number of this order.

5.4.1 Does the product comply totally with the order-in-council?

Yes No
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Question 6 Consultation service

What is the contact information of the consultation service maintained by the insurer to answer any
inquiries from a distributor or a consumer concerning the distribution guide, pursuant to section 421 of the
Act respecting the distribution of financial products and services (R.S.Q. chapter D-9.2)?

QUESTION 7 Steps taken by the insurer with respect to its distributors, pursuant
to the Act respecting the distribution of financial products and
services (R.S.Q. chapter D-9.2)
7.1 As provided in section 420 of the Act, and considering the complexity of the product
referred to in the guide, what are the steps taken by the insurer to ensure that its
distributors are sufficiently familiar with the product?

QUESTION 8 Signature of authorized official of the insurer who performed the


compliance audit
We, the insurer, declare that we have verified the compliance of the attached guide with respect to the
applicable legislation in Qubec, namely the Act respecting the distribution of financial products and
services (R.S.Q. chapter D-9.2) and the Regulation respecting distribution without a representative and
declare that all the above information is accurate and true and that the documents provided comply with
the applicable legislation.

Date the compliance audit was performed:

You must print the form in order to sign it and return it to us


Signature and date :
(Authorized official of the insurer)

Name (please print):