CL 2019 Full Specimen

Policy Number:
Person Insured:
THE CANADA LIFE ASSURANCE COMPANY

HEAD OFFICE: 330 UNIVERSITY AVE.,
TORONTO, CANADA M5G 1R8
We, The Canada Life Assurance Company, agree to provide insurance and pay benefits as described in this
policy, subject to the provisions of the contract.
TERMS USED
References to "you" and "your" refer to the Person Insured unless the context requires otherwise, and references
to "we", "our", "us" and "Canada Life" refer to The Canada Life Assurance Company. In this policy, the singular
includes the plural.
TEN DAY RIGHT TO EXAMINE POLICY

Please read the policy carefully. Within ten days after receiving the policy (or where permitted by law within 60
days after its effective date if the policy has been issued but not received by the Owner), the Owner may cancel it.
If cancelled, the policy will be void from the start and all premium paid for the policy will be refunded. The same
right applies to any rider issued after the policy is in force from the date the rider is received. If a reinstated policy
or rider is cancelled, only the premium paid to effect the reinstatement will be refunded. Please return the policy
or rider if requesting a cancellation.
NON-CANCELLABLE TO AGE 65
If the premium for this policy is paid as required, we will renew the basic policy for successive years to the policy
anniversary date nearest your 65th birthday. Any additional benefit riders will be similarly renewed for the
Premium Period shown on the Policy Details page. While this policy is in force, we will not cancel the policy,
increase the premium shown on the Policy Details page, add a restrictive rider, or reduce the benefits if you
change to a more hazardous occupation.
LIFESTYLE PROTECTION PLAN

Yearly premium payable to Age 65.
Lifetime Conditional Renewal after Age 65.
16103 – 06/19 PAGE 1

TABLE OF CONTENTS
SECTION PAGE
POLICY DETAILS 3
DEFINITIONS 5
BENEFITS 8
Waiting Period 8
Benefit Period 8
Regular Occupation Period 8
Total Disability and Totally Disabled 8
Presumptive Disability and Presumptively Disabled 8
Catastrophic Disability and Catastrophically Disabled 9
Recurrent Disability 10
Concurrent Disability 10
Disability Benefit 10
Payment of Disability Benefit 11
Cooperation 11
Recovery Benefit 12
Extension of Benefit 12
Transplant Surgery Benefit 12
Survivorship Benefit 12
Waiver of Premium 13
Vocational Training Program 13
Exclusions 13
PREMIUM 14
Payment of Premium 14
Premium Refund 14
Additional Fees 14
Grace Period 14
Reinstatement 14
Non-Cancellable 15
Conditional Renewal 15
GENERAL PROVISIONS 16
Owner 16
Assignment 16
Incontestability 16
Misstatement of Age 16
Consideration 16
Currency and Place of Payment 16
Conformity with the Law 16
Payment of Benefits 16
STATUTORY CONDITIONS 17
The Contract 17
Waiver and Consent 17
Copy of Application 17
Material Facts 17
Notice and Proof of Claim 17
Failure to Give Notice or Proof 17
Company to Furnish Forms for Proof of Claim 17
Rights of Examination 17
When Loss of Time Benefits Payable 18
When Money Payable Other Than for Loss of Time 18
Limitation of Actions 18
ANY ADDITIONAL BENEFITS AND RIDERS

ISSUED TOGETHER WITH THIS POLICY
ARE INCLUDED AT THE END OF THIS POLICY
16103 – 06/19 PAGE 2

DEFINITIONS
Armed Forces Armed Forces means the armed forces of any country, political unit or any group formed
to engage in War, including any auxiliary or civilian unit serving with the armed forces.
Date of Issue The Date of Issue of this policy is shown on the Policy Details page. The Date of Issue is
used in the definition of time periods specified in the Incontestability provision.
Disability and Disability and Disabled are to be read as a reference to Total Disability if you are Totally
Disabled Disabled as defined under the Benefits provision.
Doctor Doctor means a licensed medical doctor, practising within the scope of the medical
doctor's licensed authority, who:
a) is not related by blood or marriage to you or the Owner;
b) is not in a business relationship with you or the Owner; and
c) is practising medicine in Canada, the United States or in such other jurisdiction as
we may approve.
Expiry Date The Expiry Date for this policy is shown on the Policy Details page. The Expiry Date
means the policy anniversary nearest your 65th birthday.
Full-time Full-time means you are working at least 30 hours per week at your normal place of
business, on a regular basis.
Gainful Gainful Occupation means any occupation for which you are reasonably fitted by reason
Occupation of your education, training or experience.
Injury Injury means accidental bodily injury which occurs on or after the Policy Date and while
this policy is in force. The signs and symptoms of the Injury must be assessed and
documented by a Doctor and supported by objective medical evidence.
Issue Age and The Issue Age for this policy is shown on the Policy Details page. The Issue Age means
Age your age on your birthday nearest to the Policy Date. For the purposes of this policy, your
Age, at any date, means your age on your birthday nearest to the applicable policy
anniversary, where policy anniversaries are determined annually from the Policy Date.
16205 - 06/19 PAGE 5

DEFINITIONS (continued)
Loss of Loss of Independent Existence means a condition that qualifies under the definition of
Independent Physical Impairment or Cognitive Impairment below and there is no reasonable chance of
Existence recovery based on the then current medical practice.
Physical Impairment
Physical Impairment means you are unable to perform, by yourself, whether with or
without the use of any equipment at least two of the following six activities of daily living.
a) bathing - the ability to wash oneself in a bathtub, shower or by sponge bath;
b) dressing - the ability to put on, remove, fasten and unfasten all necessary
clothing, braces, artificial limbs or other surgical appliances;
c) toileting - the ability to get to and from the toilet and complete related personal
hygiene;
d) bladder and bowel continence - the ability to manage bowel and bladder
functions, with or without any protective undergarments or surgical appliances, so
that a reasonable level of hygiene is maintained;
e) transferring - the ability to move into and out of a bed, chair or wheelchair; and
f) eating - the ability to consume food that has already been prepared and made
available.
The diagnosis for your condition must be made by a Doctor and accompanied by a
current physical assessment from an occupational therapist other than you.
Cognitive Impairment
Cognitive Impairment means mental deterioration and loss of intellectual ability,
evidenced by deterioration in memory, orientation and reasoning, which is measurable by
neuro-psychometric methods and results from demonstrable organic cause, and where
the severity is such that you are incapable of independent living and require a minimum of
8 hours of daily supervision.
For further clarification, any mental or nervous disorder without a demonstrable organic
cause, including but not limited to anxiety disorders, mood disorders, sleep disorders, pain
disorders, personality disorders and psychotic disorders, does not satisfy the definition of
Cognitive Impairment.
16205 - 06/19 PAGE 6

DEFINITIONS (continued)
Monthly Disability The Monthly Disability Benefit for this policy is shown on the Policy Details page. The
Benefit Monthly Disability Benefit is the monthly benefit payable for Total Disability.
Occupation Class The Occupation Class and the Policy Class for this policy are shown on the Policy Details
and Policy Class page. The Occupation Class and the Policy Class are used for underwriting and pricing
purposes.
Period of Period of Disability means a period which starts when you become Disabled and
Disability continues as long as you are Disabled without interruption from the same or a related
cause, except as provided under the Recurrent Disability provision of this policy.
Policy Date The Policy Date for this policy means the later of the date shown on the Policy Details
page and the date this policy first takes effect as determined by the laws of the jurisdiction
that govern the contract. Policy years, months and policy anniversaries are measured
from the Policy Date.
Regular Regular Occupation means the occupation(s) in which you are regularly engaged at the
Occupation time you become Disabled except, if you regularly engage in any other Gainful
Occupation between successive Periods of Disability, that Gainful Occupation will be
considered your Regular Occupation.
Sickness Sickness means disease or illness which is first manifested on or after the Policy Date
and while this policy is in force. The signs and symptoms of the Sickness must be
assessed and documented by a Doctor and supported by objective medical evidence.
War War means an act or state of war, declared or not, and includes any armed conflict by or
against any country, political unit or any group formed to engage in war.
Written Request Written Request means a written request in a form satisfactory to us, together with such
evidence satisfactory to us as we may require, if any.
16205 - 06/19 PAGE 7

BENEFITS
Waiting Period The Waiting Period for this policy is shown on the Policy Details page. The Waiting
Period means the minimum number of days of Disability which must elapse during a
Period of Disability before any benefits are payable.
Non-consecutive Periods of Disability which result from the same or a related cause, and
which are separated by 24 months or less, will be accumulated and deemed continuous
for the purpose of satisfying the Waiting Period.
Benefit Period The Benefit Period for this policy is shown on the Policy Details page.
Regular Regular Occupation Period means the period starting on the date you become Disabled
Occupation Period and ending on the earliest of:
a) the date on which 24 months of Disability Benefits have been paid;
b) the date the Benefit Period ends; and
c) the Expiry Date.
Total Disability Total Disability and Totally Disabled mean you, due directly to Injury or Sickness, are
and Totally unable:
Disabled a) during the Regular Occupation Period, to perform the substantial duties of your
Regular Occupation and you are not engaged in any other Gainful Occupation;
and
b) thereafter, to work in any Gainful Occupation.
Presumptive Presumptive Disability and Presumptively Disabled mean the total and irreversible loss of
Disability and any of the following due directly to Injury or Sickness:
Presumptively a) speech;
Disabled b) the hearing of both ears;
c) the sight of both eyes;
d) the use of both hands or both feet; or
e) the use of one hand and one foot.
If you are Presumptively Disabled you will be considered to be Totally Disabled even if
you engage in any occupation
If you are considered to be Totally Disabled under this provision before the Monthly
Disability Benefit becomes payable:
a) you will not be required to satisfy the Waiting Period;
b) the Benefit Period will start on the date you become Totally Disabled and will
continue to the end of the Benefit Period;
c) the premium will be waived from the date you are considered to be Totally
Disabled;
d) the Monthly Disability Benefit shown on the Policy Details page will be increased
by 25% from the date you are considered to be Totally Disabled and will be
payable to the end of the Benefit Period; and
e) we will pay you a lump sum benefit equal to the lesser of:
i. 3 times the higher amount of Monthly Disability Benefit shown on the Policy
Details page as increased by 25% in d) above; and
ii. $15,000.
16205 - 06/19 PAGE 8

BENEFITS (continued)
Presumptive If you are considered to be Totally Disabled under this provision while the Monthly
Disability and Disability Benefit is payable:
Presumptively a) the premium will be waived from the date you are considered to be Totally
Disabled (cont.) Disabled under this provision, if it has not already been waived under the Waiver
of Premium provision;
b) the Monthly Disability Benefit shown on the Policy Details page will be increased
by 25% from the date you are considered to be Totally Disabled under this
provision and will be payable for the remainder of the Benefit Period; and
c) we will pay you a lump sum benefit equal to the lesser of:
Details page as increased by 25% in b) above; and
ii. $15,000.
If you are the Person Insured under more than one disability insurance policy, issued by
us and in force, the maximum lump sum benefit that we will pay you is $15,000.
If you are considered Totally Disabled under this provision, you will not be considered
Totally Disabled under the Catastrophic Disability provision.
Catastrophic Catastrophic Disability and Catastrophically Disabled mean you satisfy the definition of
Disability and Loss of Independent Existence.
Catastrophically
Disabled If you are Catastrophically Disabled you will be considered to be Totally Disabled even if
you engage in any occupation.
If you are considered to be Totally Disabled under this provision before the Monthly
Disability Benefit becomes payable:
a) you will not be required to satisfy the Waiting Period;
b) the Benefit Period will start on the date you become Catastrophically Disabled
and will continue to the end of the Benefit Period;
c) the premium will be waived from the date you are considered to be Totally
Disabled;
d) the Monthly Disability Benefit shown on the Policy Details page will be increased
by 25% from the date you are considered to be Totally Disabled and will be
payable to the end of the Benefit Period; and
e) we will pay you a lump sum benefit equal to the lesser of:
Details page as increased by 25% in d) above; and
ii. $15,000.
If you are considered to be Totally Disabled under this provision while the Monthly
Disability Benefit is payable:
a) the premium will be waived from the date you are considered to be Totally
Disabled under this provision, if it has not already been waived under the Waiver
of Premium provision;
b) the Monthly Disability Benefit shown on the Policy Details page will be increased
by 25% from the date you are considered to be Totally Disabled under this
provision and will be payable for the remainder of the Benefit Period; and
c) we will pay you a lump sum benefit equal to the lesser of:
Details page as increased by 25% in b) above; and
ii. $15,000.
16205 - 06/19 PAGE 9

Catastrophic If you are the Person Insured under more than one disability insurance policy, issued by
Disability and us and in force, the maximum lump sum benefit that we will pay you is $15,000.
Catastrophically
Disabled (cont.) If you are considered Totally Disabled under this provision, you will not be considered
Totally Disabled under the Presumptive Disability provision.
Recurrent After a Period of Disability for which Disability Benefit payments were paid, if within
Disability 12 months you again become Disabled from the same or a related cause and you have
worked continuously in a Full-time occupation away from your home between Periods of
Disability, we will consider the later Period of Disability to be a continuation of the previous
Period of Disability and Benefit Period. Disability Benefit payments will then become
payable in the manner described in the Payment of Disability Benefit provision, except
that you will not have to satisfy the Waiting Period.
If you have worked continuously in a Full-time occupation away from your home for at
least 12 months between the Periods of Disability, then a successive Period of Disability
will be considered a different Disability, regardless of the cause.
Concurrent Concurrent Disability means an unrelated Injury or Sickness that occurs during a Period of
Disability Disability. During a Period of Disability you will not receive payment for a Concurrent
Disability. The benefit payable each month will not increase as a result of any Concurrent
Disability.
Disability Benefit The Disability Benefit payable at the end of a particular calendar month during a Period of
Disability is the Monthly Disability Benefit shown on the Policy Details page, if you have
been Totally Disabled without interruption during the calendar month.
The Monthly Disability Benefit will be increased by 25% if you are Presumptively Disabled
or Catastrophically Disabled.
The Disability Benefit will be payable in accordance with the Payment of Disability Benefit
provision if you are Disabled.
16205 - 06/19 PAGE 10

Payment of The Disability Benefit will be payable during a Period of Disability as long as you:
Disability Benefit a) have satisfied the Waiting Period, or the Waiting Period has been waived under
the Presumptive Disability provision, the Catastrophic Disability provision, or
elsewhere under this policy;
b) are receiving medical care from a Doctor that is of an appropriate nature and
frequency for the Disability;
c) agree to be examined by a Doctor or other person determined by us, if and when
we reasonably require; and
d) comply with requirements outlined in this Policy.
Payments will continue during your Disability until the earliest of:
a) the date you are no longer Disabled;
b) the end of the Benefit Period;
c) the date of your death; or
d) the date the claim is terminated by us for failure to comply with requirements
outlined in this Policy.
The first Disability Benefit payment will become payable at the end of the calendar month
in which you have satisfied the above conditions. Subsequent payments due will be made
at monthly intervals in arrears. For Disability Benefit payments due for less than a
calendar month, the benefit for each day of Disability will be 1/30th of the applicable
Disability Benefit.
You must notify us immediately upon any attempt to return to work.
Any lump sum benefit payable under the Presumptive Disability or Catastrophic Disability
provision will become payable at the end of the calendar month in which you have
satisfied the conditions set out in the applicable provision.
Cooperation The payment of any benefits will be subject to receiving any information that we may
request for the adjudication, investigation and verification of your claim. You are
responsible for any cost associated in obtaining this information.
16205 - 06/19 PAGE 11

Recovery Benefit A Recovery Benefit will be payable for 2 months after you return to work following a
Period of Disability as long as you:
a) have satisfied the Waiting Period and have been Disabled during such Period of
Disability for at least 3 months; and
b) remain at work Full-time in your Regular Occupation, immediately following such
Period of Disability.
The Recovery Benefit amount following a Period of Disability will be:

a) for the first month, 50% of the Disability Benefit; and
b) for the second month, 25% of the Disability Benefit.
The Recovery Benefit will not be paid:

a) if any other benefits are payable under this policy, including any subsequent
Recovery Benefit;
b) after the earlier of the end of the Benefit Period and the Expiry Date; or
c) more than once for a Period of Disability.
For further clarification, any remaining balance of the Recovery Benefit will be payable
following a Recurrent Disability if you return to work Full-time in your Regular Occupation
and the Recovery Benefit was not paid in full for the Period of Disability to which the
Recurrent Disability relates.
Extension of If you are Disabled on the Expiry Date, and fewer than 24 months of Disability Benefit
Benefit payments have been made during your current Period of Disability, then the Disability
Benefit will continue for any remaining balance of the 24 months, during your Disability.
Payments will then end even if your Disability continues.
Transplant After this policy or any amendment relevant to this provision has been in force for
Surgery Benefit 6 months following the Policy Date or last date of reinstatement of this policy, if any, we
will consider you to be Disabled due to Sickness, if you become Disabled as a result of
surgery to transplant an organ or other part of your body to the body of another person.
Survivorship If you die while Disabled, after Disability Benefit payments have begun and before the
Benefit Expiry Date, we will pay to your estate, a lump sum equal to 3 times the Disability Benefit.
The Survivorship Benefit will be payable at the time of your death.
16205 - 06/19 PAGE 12

Waiver of If you are Disabled, the Owner must continue to pay premium when due, except where
Premium waived under the Presumptive Disability or Catastrophic Disability provision or as
provided below.
We will waive the payment of any premium which becomes due under this policy on or
after the 91st day of a Period of Disability while you continue to be Disabled. We will then
refund any premium paid by the Owner for the first 90 days of that period. For the
purposes of this provision, the premium will be pro rated on a per diem basis. If non-
consecutive days are used to satisfy the Waiting Period, the amount of premium paid that
will be refunded will be calculated as if the days of Disability had been consecutive.
Proof of Disability which is satisfactory to us must be submitted for premium to be waived.
The Owner must pay pro rata premium from the date the premium is no longer waived, for
the remainder of the then current premium frequency period. We will notify the Owner of
the amount of premium due.
Vocational Vocational Training Program means a government sponsored or other professionally

Training Program planned vocational program we have approved in writing in advance of your participation
in the program. In considering whether to approve a Vocational Training Program we will
assess such factors as the expected duration of your Total Disability and the level of
activity required to facilitate the earliest possible return to work.
The Disability Benefit will be payable while you are Totally Disabled and participate in a
Vocational Training Program.
We may pay the cost of a program provided in connection with the Vocational Training
Program, as long as:
a) the program will assist you in working in a Gainful Occupation;
b) the program is not covered by any other program or plan;
c) the program has been approved in advance by us; and
d) we receive evidence satisfactory to us of the cost of the program.
Reasonable expenses associated with the program may be paid by us at our discretion.
If approved by us, payment will be made to the supplier of the program or to you if we
receive satisfactory proof that the supplier has been paid.
Exclusions No benefits will be payable and no premium will be waived under this policy:
a) if your Disability results, directly or indirectly, from any of the causes described
below:
i. normal pregnancy. However, we will not exclude a Disability which results
from a complication of pregnancy;
ii. War and any hazard arising from War;
iii. active duty in any Armed Forces, whether or not at War;
iv. surgery to transplant an organ or other part of your body to the body of
another person, except as provided under the Transplant Surgery Benefit
provision; or
b) during any period of time you are incarcerated or under a court ordered restriction
that prevents you from performing your Regular Occupation.
16205 - 06/19 PAGE 13

PREMIUM
Payment of The Policy Date, Yearly Premium and Premium Period are shown on the Policy Details
Premium page. The first premium is payable on the Policy Date and must be paid before this policy
may take effect. If we consent, the premium payment frequency can be changed to other
than yearly, except while you are Disabled. The premium amount payable on a frequency
other than yearly will be recalculated based on the requested premium frequency and
method of payment. Each premium after the first is payable in advance on its due date,
which is the first day of each applicable premium frequency period as measured from the
Policy Date. Premium is payable at any of our offices in Canada, while you are living and
this policy is in force during the Premium Period and while no Waiver of Premium is in
effect.
Premium Refund This policy will terminate on the date of your death or commencement of active duty with
any Armed Forces. If this policy is terminated for either of these reasons, we will refund
any premium which is paid for a period beyond the monthly anniversary following the date
of termination.
Additional Fees We may charge a fee for services requested by the Owner and for any payment
transaction which is denied for reason of non-sufficient funds (NSF) in accordance with
our then current fee schedule. We will notify the Owner of any such fee and its due date.
Grace Period A grace period of 31 days is allowed for payment in full of any premium or additional fees
due, except the first. This policy remains in force during any grace period. If the premium
or any additional fees due are not paid by the end of the grace period, this policy will then
terminate.
Reinstatement If this policy has terminated the Owner may by Written Request apply for reinstatement of
this policy, subject to the following:
a) If termination was the result of non-payment of premium or additional fees, we
must receive:
i. the Written Request within 1 year after termination;
ii. evidence satisfactory to us of your insurability, if requested; and
iii. payment of all premium and any additional fees that would have been payable
had this policy remained in force, together with any interest then due at a rate
determined by us.
b) If you were in the Armed Forces for less than 5 years, and if termination was a
result of your commencement of active duty with any Armed Forces, we must
receive:
i. the Written Request within 90 days after your discharge from the Armed
Forces;
ii. evidence satisfactory to us of your insurability, if requested; and
iii. payment of the then current premium.
The reinstatement is effective on the date on which we have approved the application for
reinstatement and the preceding terms of this provision have been satisfied.
After a reinstatement, benefits will only be paid for Disability which results from Injury
sustained after the date of that reinstatement or from Sickness which is first manifested
more than ten days after the date of that reinstatement.
If the application for reinstatement is not approved by us, any premium paid for
reinstatement and any additional fees for services not rendered will be refunded.
16205 - 06/19 PAGE 14

PREMIUM (continued)
Non-Cancellable Non-Cancellable Period means the period starting on the Policy Date and ending on the
Expiry Date.
While this policy is in force, during the Non-Cancellable Period, we will not:
a) terminate this policy other than in accordance with its terms;
b) change its provisions; or
c) change the premium set out under Description of Benefits and Premium as shown
on the Policy Details page, other than:
i. a change in premium made in accordance with the Rider Premium and
Premium Adjustment provision of any rider included in this policy; or
ii. as a result of policy changes requested by the Owner.
Conditional This policy will terminate on the Expiry Date unless it is renewed in accordance with the
Renewal terms of this provision.
If this policy is in force at the Expiry Date, the Owner may elect to renew this policy for
successive policy years, as long as:
a) the Owner provides a Written Request 30 days before the Expiry Date and each
subsequent annual renewal period;
b) you are not Disabled;
c) you are engaged in a Full-time occupation for regular remuneration; and
d) all premium and any additional fees are paid as required.
Any additional benefit riders included in this policy will terminate on the Expiry Date.
If this policy has been renewed as described above, coverage under this policy will,
unless you are Totally Disabled, immediately terminate should you cease to be engaged
in a Full-time occupation for regular remuneration. We will refund any premium which is
paid for a period beyond the monthly anniversary following the date of such termination.
If this policy is renewed in accordance with this provision, the following conditions will
apply:
a) the premium payable for each policy year will be determined on the basis of our
rates in effect on the first day of such policy year for this Disability Insurance Plan;
b) the Benefit Period will be 24 months if the date you become Totally Disabled is
before Age 75 and 12 months if the date you become Totally Disabled is on or
after your Age 75;
c) Disability Benefit payments will be payable only for Total Disability; and
d) the expiry date will be extended to the end of the policy year in which this policy is
renewed ("Extended Expiry Date").
If you are Totally Disabled at the Extended Expiry Date, Disability Benefit payments are
payable beyond the Extended Expiry Date for the remainder of the Benefit Period
described above, while you continue to be Totally Disabled.
16205 - 06/19 PAGE 15

GENERAL PROVISIONS
Owner The Owner is the person identified as Owner on the Policy Details page. The Owner has
the rights granted by this policy, subject to the rights of any irrevocably designated
beneficiary where permitted by law.
Assignment The Owner can assign this policy as permitted by law. An assignment of this policy or of
an interest in it will not be binding on us until the assignment or a certified copy of it is filed
with our Head Office. We are not responsible for the validity or effect of any assignment.
Incontestability You, and the Owner if other than yourself, are required to disclose to us in any
application, on any medical examination and in any written statements or answers
furnished as evidence of insurability for this policy, every fact that is material to the
insurance and is known to either of you. A failure to disclose, or a misrepresentation of
such a fact, will render the contract voidable by us.
We will not contest the validity of this policy after it has been in force continuously, during
your lifetime, for 2 years from the latest of the Policy Date, Date of Issue and the date of
the last reinstatement of this policy, except in the case of fraud, or a claim for a Disability
which began before the end of this 2 year period.
We reserve the right to contest the validity of this policy with respect to any amendment to
the contract or addition of a rider which increases the insurance coverage or makes the
Policy Class more favourable to the Owner, but not after the amendment or rider has
been in force continuously, during your lifetime, for 2 years from the later of the date the
amendment or rider first takes effect or the date of the last reinstatement of this policy.
However, we may still contest the validity of such an amendment or rider in the event of
any fraud, or a claim for a Disability which began before the end of this 2 year period.
This provision does not apply to any misstatement of your age.
Misstatement of If your date of birth has been misstated, we may, at our option adjust the benefits payable
Age under this policy or the premium as of the Policy Date, in accordance with the correct age.
However, where your age affects the commencement or termination of any insurance
under this policy, your correct age governs.
Consideration This policy is issued in consideration of the application for it, and in return for payment, on
or before delivery of this policy, of the premium for the initial premium frequency period.
Currency and All amounts payable to us or by us under this policy are payable in Canada in Canadian
Place of Payment currency.
Conformity with If any provision in this policy conflicts with the laws under which the contract is made as at
the Law the Policy Date, then the provision is deemed amended to meet the minimum
requirements of such laws.
Payment of Any benefit payable under this policy during your lifetime is payable to you, if living,
Benefits otherwise to your estate, except as may be provided below or elsewhere in this policy.
If any benefits due under this policy are payable to your estate, we may pay up to $2,000
of these benefits, or such other amount as may be permitted by law, to a person who is
related to you by blood or marriage, or whom we consider to be equitably entitled to such
benefits. We will be discharged to the extent of any such payment made in good faith.
This provision is subject to any prior assignment of the policy.
16205 - 06/19 PAGE 16

STATUTORY CONDITIONS
The Contract The application, this policy, any document attached to this policy when issued, and any
amendment to the contract agreed upon in writing after this policy is issued, constitute the
entire contract, and no agent has authority to change the contract or waive any of its
provisions.
Waiver and We will be deemed not to have waived any condition of the contract, or given our consent,
Consent either in whole or in part, unless the waiver or consent is clearly expressed in writing
signed by one of our authorized officers.
Copy of We will, upon request, furnish to you, the Owner or to a claimant under the contract a
Application copy of the application.
Material Facts No statement made by you or the Owner at the time of any application for the contract will
be used in defence of a claim under or to avoid the contract, unless it is contained in any
application or any other written statements or answers furnished as evidence of
insurability.
Notice and Proof You or the Owner, or a beneficiary entitled to make a claim, or the agent of any of them,
of Claim must:
a) give written notice of claim to us, within 30 days from the date a claim arises
under the contract on account of an Injury, Sickness or Disability,
i. by delivery of the written notice of claim, or by sending it by registered mail, to
our Head Office or an office of ours in the Province, or
ii. by delivery of the written notice of claim to an authorized agent of ours, if any,
in the Province;
b) within 90 days from the date a claim arises under the contract on account of an
Injury, Sickness or Disability, furnish to us such proof of claim as is reasonably
possible in the circumstances of the happening of the Injury or commencement of
the Sickness or Disability, and the loss occasioned thereby, the right of the
claimant to receive payment, and his or her age, and the age of the beneficiary, if
relevant; and
c) if so required by us, furnish a satisfactory certificate as to the cause or nature of
the Injury, Sickness, or Disability for which the claim may be made under the
contract and its duration.
Failure to Give Failure to give notice of claim or furnish proof of claim within the time prescribed by the
Notice or Proof statutory condition above does not invalidate the claim if the notice or proof is given or
furnished as soon as reasonably possible, and in no event later than 1 year from the date
of the Injury or the date a claim arises under the contract on account of Sickness or
Disability, if it is shown that it was not reasonably possible to give notice or furnish proof
within the time so prescribed.
Company to We will furnish forms for proof of claim within 15 days after receiving notice of claim, but
Furnish Forms for where the claimant has not received the forms within that time, he or she may submit his
Proof of Claim or her proof of claim in the form of a written statement of the cause or nature of the Injury,
Sickness or Disability giving rise to the claim and of the extent of the loss.
Rights of As a condition precedent to recovery of insurance money under the contract, you must
Examination allow us an opportunity to examine you when and so often as we reasonably require while
the claim under this policy is pending.
16205 - 06/19 PAGE 17

STATUTORY CONDITIONS (continued)
When Loss of The initial benefits for loss of time will be paid by us within 30 days after we have received
Time Benefits proof of claim. Payment will be made thereafter in accordance with the terms of the
Payable contract, if you, when required to do so, furnish proof of continuing Disability before
payment.
When Money All money payable under the contract, other than benefits for loss of time, will be paid by
Payable Other us within 60 days after we have received proof of claim.
Than for Loss of
Time
Limitation of An action or proceeding against us for the recovery of a claim under the contract may not
Actions be commenced more than 1 year after the date the insurance money became payable or
would have become payable if it had been a valid claim, or such longer period as may be
required by law.
16205 - 06/19 PAGE 18

REGULAR OCCUPATION PERIOD EXTENDER RIDER
Terms Used This rider is issued by us as part of the policy to which it is attached and is subject to the
provisions of the policy, except as may be modified or amended by this rider. Any
modification or amendment made by this rider is only in effect while this rider is in force.
The terms used in this rider have the same meaning as indicated in the policy, unless
otherwise specified or required in the context of the following rider provisions.
Rider Date The Rider Date will be the same as the Policy Date, if this rider is included in the policy
when it is first issued by us. Otherwise, the Rider Date will be such later date as
established by the amendment to the contract to include this rider. The Rider Date is used
to determine duration, premium due dates, anniversaries and your age with respect to this
rider.
Regular Despite anything to the contrary, under the definition of Regular Occupation Period in the
Occupation Period Benefits provision of the basic policy, the Regular Occupation Period will end on the
earlier of:
a) the date the Benefit Period ends; and
b) the Expiry Date.
Rider Premium This rider is included in the policy in consideration for the payment of the Yearly Premium
for this rider shown on the Policy Details page. The premium for this rider is payable at the
same time and in the same manner and in addition to the premium for the basic policy.
The premium is payable on the same terms and conditions as the premium for the basic
policy and for the Premium Period for this rider shown on the Policy Details page.
Rider Termination Subject to the provisions of the basic policy and any riders and benefits included in the
contract, this rider will terminate on the earliest of the following dates:
a) the monthly anniversary following the date on which we receive the Owner’s
Written Request for termination of this rider;
b) the Expiry Date;
c) the date of your death; and
d) the date on which the policy terminates for any other reason.
R. L. McFeetors, S. A. Wagar,
President and Chief Executive Officer Secretary
This rider should be kept with the policy.

17200 – 10/05
RESIDUAL DISABILITY RIDER
rider.
Disability and Despite anything to the contrary, Disability and Disabled, as defined under the Definitions
Disabled provision of the basic policy, are to be read as a reference to:
a) Total Disability if you are Totally Disabled;
b) Partial Disability if you are Partially Disabled; or
c) Residual Disability if you are Residually Disabled.
Partial Disability Partial Disability and Partially Disabled mean you are not Totally Disabled and are
and Partially working Full-time or part-time in any Gainful Occupation but, due directly to Injury or
Disabled Sickness:
a) are unable to perform one or more of the important daily duties of your Gainful
Occupation; or
b) suffer the necessary and continuous loss of at least one-half of the time normally
spent in the daily performance of your Gainful Occupation.
Residual Disability Residual Disability and Residually Disabled mean you are not Totally Disabled and are
and Residually working Full-time or part-time in any Gainful Occupation but, due directly to Injury or
Disabled Sickness the percentage loss of Earned Income as determined under the Earned Income
Loss provision of this rider is 20% or more.
Regular Despite anything to the contrary, Regular Occupation means the occupation(s) in which
Occupation you are regularly engaged at the time you become Disabled except, if you regularly
engage in any other Gainful Occupation:
a) during a period of Partial Disability;
b) during a period of Residual Disability; or
c) between successive Periods of Disability,
that Gainful Occupation will be considered your Regular Occupation.
(Continued on the back.)

17170 – 10/05
RESIDUAL DISABILITY RIDER (continued)
Disability Benefit If you have been Partially Disabled without interruption during a particular calendar month
and the Option to Elect the Residual Disability Benefit has not been exercised for the
Period of Disability, the Disability Benefit payable at the end of the calendar month is:
a) for the first 24 months of Partial Disability, 50% of the Monthly Disability Benefit
shown on the Policy Details page; and
b) thereafter, 25% of the Monthly Disability Benefit shown on the Policy Details
page.
If you have been Residually Disabled without interruption during a particular calendar
month and the Option to Elect the Residual Disability Benefit has been exercised during
the Period of Disability, the Disability Benefit payable at the end of the calendar month is:
a) the Monthly Disability Benefit shown on the Policy Details page if the Earned
Income Loss is 80% or more; or
b) the Earned Income Loss multiplied by the Monthly Disability Benefit shown on the
Policy Details Page if the Earned Income Loss is 20% or more, but less than 80%.
No Disability Benefit is payable if the Earned Income Loss is less than 20%.
provision while you are Partially Disabled or Residually Disabled.
Option to Elect During a Period of Disability, if you are Residually Disabled, the Owner will have the
The Residual option to make a one-time election to allow your Disability Benefit to be based on your
Disability Benefit Earned Income Loss, as defined below. Once the election is made, it cannot later be
revoked during that Period of Disability.
The election is made by providing written evidence, satisfactory to us, of your Earned
Income Loss during the period of Partial Disability immediately before the date of the
election. This evidence may include, but is not limited to, a true copy of one or more of the
following:
a) income tax returns;
b) audited income and expense statements; and
c) employer’s salary statements.
An election under this option does not take effect until the date the election is approved by
us.
If the election is made, we will pay the amount, if any, by which:

a) the Disability Benefit payments for Residual Disability that would have been
payable during the 12 months immediately before the making of this election,
exceeds
b) the Disability Benefit payments for Partial Disability that were paid during the
12 months immediately before the making of this election.
(Continued on the next page.)

17170 – 10/05
Recovery Benefit Despite anything to the contrary, the Recovery Benefit will not be payable following a
Exclusion period of Residual Disability if the Option to Elect the Residual Disability Benefit was
exercised during the Period of Disability.
Earned Income Earned Income means, for a particular calendar month, the sum of all income earned
during that month as set out below:
a) your share of annual pre-tax corporate profits from an incorporated business
which you partly or wholly owned and in which you were working Full-time or
part-time;
b) your share of business income, less your share of business expenses that are
deductible from income under the Income Tax Act (Canada), as amended from
time to time, from an unincorporated business which you partly or wholly owned
and in which you were working Full-time or part-time; and
c) income you earn from any occupation or employment including, but not limited to:
i. the total of your salary, wages, commissions, fees and any other
remuneration from employment, less any employment expenses that are
deductible from income under the Income Tax Act (Canada), as amended
from time to time;
ii. the equivalent monthly amount of any annual or periodic bonus paid to you;
and
iii. the equivalent monthly amount of any annual or periodic contributions to a
pension plan, retirement plan, profit sharing plan or stock savings plan made
on your behalf.
Earned Income does not include:

a) income from pension plans, retirement plans, profit-sharing plans, stock savings
plans, deferred compensation plans, insurance policies and annuities;
b) interest, rents, royalties and investment income not included above; and
c) any other forms of income which do not depend on your engagement in any
occupation or employment.
Prior Earned Prior Earned Income means, for a particular calendar month, the amount of your highest
Income average monthly Earned Income for which written evidence is provided, determined over:
a) the taxation year immediately before the date your Disability began, or, if Earned
Income includes income from an incorporated business, the last complete fiscal
period before the date your Disability began; or
b) the 6 consecutive calendar months immediately before your Disability began.
If Earned Income includes income from an incorporated business the 6 consecutive

calendar months from b) above must fall within one fiscal period.
Fiscal period has the meaning provided in the Income Tax Act (Canada), as amended
from time to time.
Method of Prior Earned Income from a business may be calculated using the cash or accrual method
Accounting of accounting. However, the same method must be used to calculate Earned Income.

17170 – 10/05
Index Index means the Consumer Price Index for Canada, All Items (Not Seasonally Adjusted)
last published by Statistics Canada under the authority of the Minister designated
responsibility for Statistics Canada.
If the base period of the Index is changed and, as a result, a percentage change is made
to the Index, we will change all of the previous values of the Index by the same
percentage. If the Consumer Price Index is discontinued or its method of determination is
altered in a way considered material by us or is otherwise unavailable, we have the right
to use another published index which we determine to be a suitable measure of the cost
of living for individuals in Canada. If a substitute index is used, we will recalculate the
previous values during the Period of Disability.
Earned Income Earned Income Loss for a particular calendar month, means the percentage determined
Loss by performing the following calculation:
Earned Income Loss = A – B x 100
A
In the above calculation:
A = is the Prior Earned Income adjusted in accordance with the Index as set out below.
Starting on the first anniversary of the date your Disability began and on each
subsequent anniversary while you are Residually Disabled, the value of the Index will
be compared with the value of the Index one year earlier. For this purpose, we will
use the values of the Index 2 months and 14 months before the month of the
applicable adjustment. The amount of your Prior Earned Income will be changed in
the proportion that the more recent value bears to the earlier value. However, your
Prior Earned Income will never be reduced to less than that used in the first 12
months of the applicable Period of Disability as a result of any Index change.
B = is the Earned Income for the particular calendar month.
for this rider shown on the Policy Details page. The premium for this rider is payable at
the same time and in the same manner and in addition to the premium for the basic
policy. The premium is payable on the same terms and conditions as the premium for the
basic policy and for the Premium Period for this rider shown on the Policy Details page.
b) the Expiry Date;

17170 – 10/05
COST OF LIVING (maximum 8% per year) RIDER
rider.
New Policy New Policy refers to a policy issued in accordance with the provisions of this rider.
Index Index means the Consumer Price Index for Canada, All Items (Not Seasonally Adjusted),
last published by Statistics Canada under the authority of the Minister designated
responsibility for Statistics Canada.
During a Period of Disability, if the base period of the Index is changed, we will recalculate
the previous values needed for the applicable adjustment calculation using the same
percentage change that was made to the Index. If the Index is discontinued, is otherwise
unavailable or its method of determination is altered in a way considered material by us,
we have the right to use another published index which we determine to be a suitable
measure of the cost of living for individuals in Canada. If another index is substituted for
the Index, we will recalculate the previous values needed for the applicable adjustment
calculation based on the substitute index for that Period of Disability.
Cost of Living If you are receiving Disability Benefit payments then, starting on the first anniversary of
Benefit the date on which you became Disabled and continuing at 12-month intervals while the
Period of Disability continues until the policy anniversary nearest your 65th birthday, we
will adjust the amount of the Monthly Disability Benefit shown on the Policy Details page
for the policy as set out below.
Every 12 months, the value of the Index will be compared with the value of the Index
1 year earlier. For this purpose, we will use the values of the Index 2 months and
14 months before the month of the applicable adjustment. The amount of the Monthly
Disability Benefit will be changed in the proportion that the more recent value bears to the
earlier value. However, the amount of the Monthly Disability Benefit will not be:
a) greater than that which would have been payable currently had the Index
increased at 8% compounded annually from the date on which you became
Disabled to the applicable adjustment date during the Period of Disability;
b) less than 102% of the amount which was payable after the Monthly Disability
Benefit was last changed.
Application for After the end of a Period of Disability during which Monthly Disability Benefit payments
New Policy have been adjusted under the provisions of this rider and while this rider is in force, the
Owner may apply for a New Policy on the life of the Person Insured to purchase additional
coverage, without providing medical evidence of the insurability of the Person Insured.

17031 – 5/07
COST OF LIVING (maximum 8% per year) RIDER (continued)
Approval of New Approval of the application for a New Policy will be subject to the following conditions
Policy which must be met within 90 days after the date of the final Disability Benefit payment for
the most recent Period of Disability:
a) we must receive the application for the New Policy, in a form satisfactory to us;
b) the first premium for the New Policy must be received by us;
c) your Age must then be 60 or less; and
d) you must be actively engaged in a Full-time occupation away from your home.
If the application is approved by us, the New Policy will take effect on the date the
application and the first premium for the New Policy are received by us. Any evidence of
your insurability which is part of the contract to which this rider is attached will also be
deemed to be part of any New Policy.
Maximum The Maximum Disability Benefit that will be provided under a New Policy will be the lesser
Disability Benefit of:
a) the amount of the increase in the Monthly Disability Benefit payment provided
under the provisions of this rider, based on the amount by which the last monthly
payment for a complete month for the most recent Period of Disability exceeds
the first monthly payment for a complete month for such Period of Disability; and
b) the maximum amount of Monthly Disability Benefit, if any, which we would
normally then issue for your age and class of risk, according to our published
issue and participation limits then in effect.
Conditions The following conditions will apply to any New Policy:

a) the benefit period will be the same as shown on the Policy Details page for the
policy, if then available, otherwise the next shorter benefit period then available;
b) the waiting period will be the same as shown on the Policy Details page for the
policy, if then available, otherwise the next longer waiting period then available;
c) the plan will be the same as shown on the Policy Details page for this policy, if
then available, otherwise the most similar plan we then issue, if any, or subject to
our consent, may be any other type of plan or coverage we then offer;
d) the premium will be based on our rates in effect on the date on which the New
Policy takes effect, using your age at that date and the Occupation Class and
Policy Class for the policy. However, if your occupation class on the date the New
Policy takes effect would produce a lower premium rate, that premium rate will be
used by us to determine the premium for the New Policy; and
e) at the Owner’s request, any rider included in the policy may be added to the New
Policy, except any rider which provides the option to purchase additional
coverage without providing medical evidence of your insurability, if such rider is
then available, otherwise the most similar rider that we then issue, if any may be
added. No other additional benefit riders will be included in the New Policy without
our consent.
No Monthly Disability Benefit will be paid under the New Policy with respect to any Period
of Disability which began before the date the New Policy takes effect.
Exclusions Any Exclusion Rider attached to the policy will form a part of any New Policy.

17031 – 5/07
COST OF LIVING (maximum 8% per year) RIDER (continued)
b) the Expiry Date;
However, if you are Disabled at the Expiry Date, and Disability Benefits for Total Disability
are payable beyond the Expiry Date under the terms of a provision or rider included in the
policy, then this rider will continue in force until the earlier of the date you cease to be
Totally Disabled for that Period of Disability, and the date the policy terminates.

17031 – 5/07
RETURN OF PREMIUM (50%) RIDER
rider.
Eligible Premium Eligible Premium means the sum of premium for the basic policy and any additional
benefit riders included in the policy, except the Accidental Death and Dismemberment
Rider or the Death by Accidental Means Rider.
For further clarification, Eligible Premium will include the additional cost associated with
paying the premium by a premium frequency other than yearly and will not include any
interest or additional fees.
Yearly Eligible Yearly Eligible Premium means Eligible Premium calculated based on the yearly premium
Premium frequency. For further clarification, Yearly Eligible Premium will not include the additional
cost associated with paying the premium by a premium frequency other than yearly.
Benefits Paid Benefits Paid means any benefits paid other than under the Accidental Death and
Dismemberment Rider or the Death by Accidental Means Rider.
Conditions for A Return of Premium Benefit will be payable if:

Payment a) you are not Disabled at the end of the applicable Return Period; and
b) the total amount of any Benefits Paid and any Eligible Premium waived or
refunded under the policy during the applicable Return Period has not exceeded
20% of the total amount of Eligible Premium that was paid or waived under the
policy during the applicable Return Period.
Return Periods Return Periods are determined as any 7 consecutive policy years during which the
Conditions for Payment provision of this rider is satisfied for that period, commencing on
the later of:
a) the Rider Date; and
b) the end of a prior Return Period.
th
If the Conditions for Payment provision is not satisfied on the 7 anniversary following the
Rider Date or end of a prior Return Period, we will notify the Owner of the anniversary, if
any, upon which the Conditions for Payment provision has been satisfied for the
immediately preceding 7 consecutive policy years.
A Return Period will also be determined on the date of your death or on the Expiry Date
as the number of complete consecutive policy years and months, not to exceed 7 years,
during which the Conditions for Payment provision of this rider is satisfied and beginning
on or after the later of the Rider Date and the date the last Return of Premium Benefit was
payable and ending on the date of your death or the Expiry Date, as applicable.

17222 - 11/15
RETURN OF PREMIUM (50%) RIDER (continued)
Return of A Return of Premium Benefit will be payable at the end of any Return Period. The amount
Premium Benefit of the Return of Premium Benefit will be equal to the excess, if any, of:
a) 50% of the sum of the Yearly Eligible Premium paid or waived during the
applicable Return Period, less
b) the sum of any Benefits Paid and any Eligible Premium waived or refunded under
the policy during that Return Period.
The amount of Yearly Eligible Premium included in the Return of Premium Benefit will be
reduced as of the effective date of the approval by us of any of the following changes
made at the Owner's request during that Return Period:
a) a reduction in the Monthly Disability Benefit;
b) a lengthening of the Waiting Period;
c) a shortening of the Benefit Period;
d) a reduction in a benefit under any rider; or
e) a termination of any rider.
The amount of the Yearly Eligible Premium used in the calculation for the period of time
prior to the effective date of the change will be multiplied by the proportion that the Yearly
Eligible Premium on the effective date of the change bears to the Yearly Eligible Premium
immediately prior to the effective date of the change. This calculation will result in a
reduction in the Return of Premium Benefit otherwise payable. The reduction will apply
from the beginning of the Return Period as though this change had taken place on the
date the applicable Return Period commenced.
Application of Each Return of Premium Benefit which is payable under this rider will, at the Owner's
Return of Written Request, either be:
Premium Benefit a) paid to you in cash; or
b) applied to reduce future yearly premium under the policy, subject to the following
conditions:
i. application of a Return of Premium Benefit to pay premium will be subject to
our rules with respect to such payments which are in effect on the date the
Return of Premium Benefit is payable;
ii. if a Return of Premium Benefit is applied in payment of a premium and the
premium is waived or would otherwise be refunded under the terms of the
basic policy, the Return of Premium Benefit will be treated as if it has not
been so applied and will instead, be applied in payment of the next unpaid
yearly premium under the policy;
iii. no Return of Premium Benefit may be applied in payment of a premium if the
due date of the premium is on or after the Expiry Date; and
iv. any part of a Return of Premium Benefit which cannot be applied to pay future
yearly premium under the policy will be payable to you in cash.
The Owner's Written Request to elect to have a Return of Premium Benefit applied to
reduce future yearly premium, as described above, must be received by us no less than
30 days before the date on which the Return of Premium Benefit is payable, otherwise the
Return of Premium Benefit will be paid to you in cash.

17222 - 11/15
RETURN OF PREMIUM (50%) RIDER (continued)
shown for this rider on the Policy Details page. The premium for this rider is payable at the
a) the monthly anniversary following the date on which we receive the Owner's
request to terminate this rider;
b) the Expiry Date;

17222 - 11/15
LIFETIME BENEFIT – ACCIDENT & GRADED SICKNESS RIDER
rider.
Lifetime Benefit The Lifetime Benefit for Total Disability payable at the end of a particular calendar month
for Total Disability following your 65th birthday while a Period of Disability continues is:
a) the Lifetime Benefit for Total Disability shown for this rider on the Policy Details
page if Total Disability is caused by:
i. Injury before your 65th birthday; or
ii. Sickness first manifested before your 55th birthday; or
b) the Lifetime Benefit for Total Disability shown for this rider on the Policy Details
page multiplied by the applicable percentage shown in the table below if Total
Disability is contributed to or caused by Sickness first manifested after your
55th birthday, or by medical or dental treatment, including surgery, for the
Sickness.
Your Age on the date
you become Disabled Percentage
56 90%
57 80%
58 70%
59 60%
60 50%
61 40%
62 30%
63 20%
64 10%
If the Cost of Living (maximum 3% per year) Rider or Cost of Living (maximum 8% per
year) Rider is included in your policy, the Lifetime Benefit for Total Disability determined
above will be adjusted in the same manner as was the Monthly Disability Benefit under
the Cost of Living Benefit provision of the rider.
The Lifetime Benefit for Total Disability will be payable in accordance with the Payment of
Lifetime Benefit for Total Disability provision below.

17230 – 5/07
LIFETIME BENEFIT – ACCIDENT & GRADED SICKNESS RIDER (continued)
Payment of The Lifetime Benefit for Total Disability will be payable if you:
Lifetime Benefit a) are Totally Disabled on your 65th birthday;
for Total Disability
b) have satisfied the Waiting Period, or the Waiting Period has been waived under
the Presumptive Disability provision, the Catastrophic Disability provision, or
elsewhere under the policy;
c) are receiving medical care from a Doctor that is of an appropriate nature and
frequency for the Disability; and
d) agree to be examined by a Doctor or other person determined by us, if and when
we reasonably require.
Payments will continue during your Disability until the earlier of:
a) the date you are no longer Totally Disabled; and
b) the date of your death.
The Lifetime Benefit for Total Disability will become payable at the end of the calendar
month in which you have satisfied the above conditions. Subsequent payments due will
be made at monthly intervals in arrears. For Lifetime Benefit for Total Disability payments
due for less than a calendar month, the benefit for each day of Disability will be 1/30th of
the applicable Lifetime Benefit for Total Disability.
The Lifetime Benefit for Total Disability during a period of Concurrent Disability will be
payable for only one cause of Disability at any time.
Presumptive If you are considered Totally Disabled under the Presumptive Disability or Catastrophic
Disability and Disability provision:
Catastrophic a) before your 65th birthday, the Lifetime Benefit for Total Disability will be increased
Disability by 25%; or
b) after your 65th birthday, the Lifetime Benefit for Total Disability will not be
increased by 25%.
A lump sum benefit will not be payable under this rider.
Survivorship Despite anything to the contrary, the Survivorship Benefit will not be payable if you die
Benefit Exclusion while the Lifetime Benefit for Total Disability Benefit is payable.
shown for this rider on the Policy Details page. The premium for this rider is payable at the

17230 – 5/07
LIFETIME BENEFIT – ACCIDENT & GRADED SICKNESS RIDER (continued)
b) your 65th birthday if you are not Totally Disabled;
c) if you are Totally Disabled on your 65th birthday, the date you are no longer
Totally Disabled;
d) the date of your death; and
e) the date on which the policy terminates for any other reason.
Despite anything to the contrary, if you are Totally Disabled on the Expiry Date, the policy
will not terminate before the date you are no longer Totally Disabled. However, any riders
with the exception of this rider and the Cost of Living (maximum 3% per year) Rider or
Cost of Living (maximum 8% per year) Rider if included in the policy, will terminate on the
Expiry Date.

17230 – 5/07
HEALTH CARE PROFESSION RIDER
rider.
Infected Condition Infected Condition means that you are infective with one or more of:
a) Human Immunodeficiency Virus (HIV);
b) Hepatitis B virus; or
c) Hepatitis C virus.
Medical/Dental Medical/Dental Licensing Body means a Canadian organization or association with the
Licensing Body authority to issue a license or certificate permitting you to practice your Regular
Occupation in the province or territory in which you conduct your practice.
Medical/Dental Medical/Dental Regulatory Body means a Canadian organization or association which

Regulatory Body regulates the professional conduct of its membership and for which membership is a
prerequisite to obtaining a license or certificate permitting you to practice the duties of
your Regular Occupation.
Law Law means any statute or regulation of the federal, a provincial or a territorial government
of Canada pertaining to the provision of health care services.
Total Disability For the purposes of this rider, we will consider you Totally Disabled due to Sickness while,
as a direct result of an Infected Condition, you are and remain prohibited from performing
the substantial duties of your Regular Occupation by Law or by a written policy of general
application of a Medical/Dental Regulatory Body or Medical/Dental Licensing Body.
Residual Disability While the Residual Disability Rider is in force, we will for the purposes of this rider,
and Residually consider you Residually Disabled due to Sickness if, as a direct result of an Infected
Disabled Condition, you are and remain:
a) prohibited from performing one or more of the substantial duties of your Regular
Occupation; or
b) required to disclose an Infected Condition to patients,
by Law or by written policy of general application of a Medical/Dental Regulatory Body or
Medical/Dental Licensing Body.
Disability Benefit During a Period of Disability resulting directly from an Infected Condition, the Disability
Benefit payable at the end of the calendar month, is:
a) the Disability Benefit as set out under the Disability Benefit provision of the basic
policy, if you have been Totally Disabled without interruption during the calendar
month; or
b) the Disability Benefit for Residual Disability as set out under the Disability Benefit
provision of the Residual Disability Rider, if you have been Residually Disabled
without interruption during the calendar month.

17080 – 10/05
HEALTH CARE PROFESSION RIDER (continued)
Payment of The Disability Benefit will become payable from the later of:
Disability Benefit a) the date you are considered to be Totally Disabled or Residually Disabled under
the provisions of this rider due directly to an Infected Condition; and
b) the date we receive notice of claim for Disability due directly to an Infected
Condition.
provision in the basic policy, except:
a) you will not be required to satisfy the Waiting Period; and
b) you will not be required to be receiving medical care from a Doctor that is of an
appropriate nature and frequency for the Disability.
Despite anything to the contrary, the Disability Benefit will not be payable beyond the
Expiry Date.
Rider Premium We reserve the right to increase the Yearly Premium for this rider on any policy
and Premium anniversary on which the previous Yearly Premium was zero. After any such increase, the
Adjustment Yearly Premium may only be increased at the end of each successive 5 year period. The
premium is guaranteed to remain level during each such
5 year period.
Any premium for this rider is payable at the same time and in the same manner and in
addition to the premium for the basic policy. Any premium is payable on the same terms
and conditions as the premium for the basic policy and for the Premium Period for this
rider shown on the Policy Details page.
b) the Expiry Date;

17080 – 10/05
OWN OCCUPATION RIDER
rider.
Regular Despite anything to the contrary, under the definition of Regular Occupation Period in the
Occupation Period Benefits provision of the basic policy, the Regular Occupation Period will end on the
earlier of:
a) the date the Benefit Period ends; and
b) the Expiry Date.
Own Occupation Despite anything to the contrary, under the definition of Total Disability and Totally
Protection Disabled in the Benefits provision of the basic policy, you will be considered to be Totally
Disabled even if you engage in any other Gainful Occupation.
b) the Expiry Date;

17121 – 5/07

CL 2019 Full Specimen

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CL 2019 Full Specimen

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Policy Number:

THE CANADA LIFE ASSURANCE COMPANY

TEN DAY RIGHT TO EXAMINE POLICY

LIFESTYLE PROTECTION PLAN

16103 – 06/19 PAGE 1

ANY ADDITIONAL BENEFITS AND RIDERS

16103 – 06/19 PAGE 2

16205 - 06/19 PAGE 5

16205 - 06/19 PAGE 6

16205 - 06/19 PAGE 7

16205 - 06/19 PAGE 8

16205 - 06/19 PAGE 9

16205 - 06/19 PAGE 10

You must notify us immediately upon any attempt to return to work.

16205 - 06/19 PAGE 11

The Recovery Benefit amount following a Period of Disability will be:

The Recovery Benefit will not be paid:

Payments will then end even if your Disability continues.

16205 - 06/19 PAGE 12

Proof of Disability which is satisfactory to us must be submitted for premium to be waived.

Vocational Vocational Training Program means a government sponsored or other professionally

16205 - 06/19 PAGE 13

16205 - 06/19 PAGE 14

16205 - 06/19 PAGE 15

This provision does not apply to any misstatement of your age.

16205 - 06/19 PAGE 16

16205 - 06/19 PAGE 17

THE CANADA LIFE ASSURANCE COMPANY

16205 - 06/19 PAGE 18

THE CANADA LIFE ASSURANCE COMPANY

This rider should be kept with the policy.

(Continued on the back.)

This rider should be kept with the policy.

If the election is made, we will pay the amount, if any, by which:

(Continued on the next page.)

This rider should be kept with the policy.

Earned Income does not include:

If Earned Income includes income from an incorporated business the 6 consecutive

(Continued on the back.)

This rider should be kept with the policy.

THE CANADA LIFE ASSURANCE COMPANY

This rider should be kept with the policy.

(Continued on the back.)

This rider should be kept with the policy.

Conditions The following conditions will apply to any New Policy:

(Continued on the next page.)

This rider should be kept with the policy.

THE CANADA LIFE ASSURANCE COMPANY

This rider should be kept with the policy.

Conditions for A Return of Premium Benefit will be payable if:

(Continued on the back.)

This rider should be kept with the policy.

(Continued on the next page.)

This rider should be kept with the policy.

THE CANADA LIFE ASSURANCE COMPANY

This rider should be kept with the policy.

(Continued on the back.)

This rider should be kept with the policy.

A lump sum benefit will not be payable under this rider.

(Continued on the next page.)

This rider should be kept with the policy.

THE CANADA LIFE ASSURANCE COMPANY