Quarterly Survey of Financial Statements - Segregated Funds (F3)

Reporting Entity - Question identifier:1.

Please indicate which accounting standards were used by the reporting entity to complete this questionnaire:

Reporting instructions

Continued.

ii) Capital Expenditures
- Purchases of used building and structures and machinery and equipment are itemized separately from the purchase of new capital assets.
- Capital expenditures include additions to the construction-in-progress accounts, not transfers from construction-in-progress to fixed assets accounts.
- Capital expenditures should be reported at gross values before deducting credits such as government assistance, grants, donations, investment tax credits, and flow through share credits, but net of GST input tax credits claimed.

iii) Retained Earnings
Prior period adjustments are to be included in item 38700 (Other additions (deductions)).

iv) Income Statement
- Expenses related to the amortization of deferred debits and deferred charges should be included in cell 52350 (Amortization - intangible assets and deferred charges).
- All unrealized losses, write-downs, and write-offs of assets, including adjustments to net realizable values, should be included in item 56420 (Derivative gains (losses) - unrealized), 56100 (Foreign currency gains (losses)), 56200 (Revaluations, (write-downs) and (write-offs)) or item 56500 (other comprehensive income (unrealized gains and (losses)).
- All realized gains and losses related to the disposal of investments, loans, and capital assets (except extraordinary items) should be included in item 56410 (Derivative gains (losses) - realized), 56300 (Realized gains (losses) on the sale of assets), 56100 (Foreign Currency gains (losses)) or 56600 (Other comprehensive income realized (gains) and losses).
- Profits or losses accruing to minority shareholders of consolidated subsidiaries should include the minority shareholders' portion of extraordinary gains and losses of the subsidiary. This means that the entire extraordinary gain or loss attributable to the subsidiary must be included in the extraordinary gain or loss line item of the consolidated income statement.

v) Discontinued Operations
Gains or losses from discontinued businesses related to operations should be disclosed as normal operations showing detailed revenues and expenses separately in the prescribed accounts in the income statement. As well, the balance sheet items related to discontinued operations should be shown separately in their respective accounts. Estimated gains or losses forecasted from a future disposal of assets of a discontinued operation are classified as an unrealized gain or loss and as such should be shown in the revaluation account (item 56200) - noted above.

• (1): International Financial Reporting Standards (IFRS)
• (2): Accounting standards for Private enterprises
• (3): Other (specify)

Reporting Entity - Question identifier:2.

Please explain any significant events, changes in accounting or basis of reporting, that have impacted operations since the prior period.

Reporting Entity - Question identifier:3.

This report covers the period from: Day, month, year to Day, month, year

I certify that the information herein is complete and correct to the best of my knowledge.

• 1: Name of company official (please print)
• 2: Name and position of person to contact if different from above (please print)
• 3: Telephone number and Extension
• 4: Position of company official
• 5: E-mail address
• 6: Facsimile number

Balance sheet date: Day, month, year

SECTION A - ASSETS - Question identifier:1.

Cash and deposits

• (a): Canadian currency

• (b): foreign currency

SECTION A - ASSETS - Question identifier:2.

Accounts receivable

SECTION A - ASSETS - Question identifier:3.

Allowance for doubtful accounts

SECTION A - ASSETS - Question identifier:4.

Canadian investments

• (a): Government of Canada treasury bills

• (b): bankers' acceptances, commercial and other short-term paper

• (c): Government of Canada debt

• (d): provincial and municipal government debt

• (e): corporate bonds and debentures

• (f): corporate shares and income trust units

• (g): segregated fund units

• (h): investment fund shares or units

• (i): other Canadian investments

SECTION A - ASSETS - Question identifier:5.

Foreign investments

• (a): money market instruments

• (b): debt instruments

• (c): corporate shares

• (d): investment fund units

• (e): other foreign investments

SECTION A - ASSETS - Question identifier:6.

Derivatives

Report gross asset positions. Include derivative contracts, warrants, and options. Report liability positions at line 15.

SECTION A - ASSETS - Question identifier:7.

Reverse repurchase agreements

Report liabilities related to repurchase agreements at line 16.

SECTION A - ASSETS - Question identifier:8.

Mortgage loans to non-affiliates

Report provisions for losses at line 10.

• (a): secured by property in Canada
• (1): residential
• (2): non-residential

• (b): secured by property outside Canada

SECTION A - ASSETS - Question identifier:9.

Fixed assets

• (a): income properties

• (b): accumulated depreciation

SECTION A - ASSETS - Question identifier:10.

Other assets

Report assets not elsewhere specified. Include accumulated provisions for losses (credits) on investments and loans

SECTION A - ASSETS - Question identifier:11.

TOTAL ASSETS (at market value)

Report total assets at current market (fair) value. This entry must
balance with line 20.

SECTION A - ASSETS - Question identifier:12.

Unrealized appreciation of assets

Report the difference between the cost and market value of assets. Report accumulated unrealized gains as a positive, and accumulatedosses as a negative.

SECTION A - ASSETS - Question identifier:13.

Total assets (at cost)

Assets at cost value should equal line 11 less line 12.

Balance sheet date: Day, month, year

LIABILITIES - Question identifier:14.

Accounts payable

LIABILITIES - Question identifier:15.

Derivatives

Report gross liability positions. Report asset positions at line 6.

LIABILITIES - Question identifier:16.

Obligations related to repurchase agreements

Report reverse repurchase agreements at line 7.

LIABILITIES - Question identifier:17.

Other liabilities

Report liabilities not elsewhere specified.

LIABILITIES - Question identifier:18.

Liabilities to policyholders

• (a): RRSP funds

• (b): other funds

LIABILITIES - Question identifier:19.

SURPLUS

• (a): opening balance

• (b): net income (loss) for the current period

• (c): other additions (deductions)

• (d): allocation of net investment income to policyholder accounts

• (e): closing balance

LIABILITIES - Question identifier:20.

TOTAL LIABILITIES AND SURPLUS

This should be equal to line 11.

From: Day, month, year To: Day, month, year

REVENUE (net of sales taxes) - Question identifier:21.

Rental revenue

Report the gross amount before any expenses related to rental properties.

REVENUE (net of sales taxes) - Question identifier:22.

Interest revenue from Canadian sources

• (a): bonds and debentures
• (1): interest revenue
• (2): amortization of discounts and (premiums)

• (b): mortgages

• (c): other interest revenue

REVENUE (net of sales taxes) - Question identifier:23.

Interest revenue from foreign sources

Include amortization of discounts and (premiums) on foreign investments

REVENUE (net of sales taxes) - Question identifier:24.

Dividends

• (a): from Canadian corporations

• (b): from foreign corporations

REVENUE (net of sales taxes) - Question identifier:25.

Derivatives gains (losses)

• (a): realized

• (b): unrealized

REVENUE (net of sales taxes) - Question identifier:26.

Gains (losses) on the sale of assets

Report realized gains (losses) not reported at items 25 (a) or 33 (a). Also complete Section D (lines 35 to 40).

REVENUE (net of sales taxes) - Question identifier:27.

Other revenue

Report revenue from all other sources not disclosed above. Exclude other gains (losses) and report them at items 33 (a) or 33 (b).

REVENUE (net of sales taxes) - Question identifier:28.

TOTAL REVENUE

EXPENSES - Question identifier:29.

Depreciation

EXPENSES - Question identifier:30.

Management fees

EXPENSES - Question identifier:31.

Other expenses

EXPENSES - Question identifier:32.

TOTAL EXPENSES

EXPENSES - Question identifier:33.

Other gains (losses) and revaluations

• (a): Foreign currency gains (losses)

• (b): Revaluations, (write-downs) and (write-offs)

EXPENSES - Question identifier:34.

NET INCOME (LOSS)

Transfer value to item 19 (b).

MATCHING OF INCOME STATEMENT GAINS AND (LOSSES) WITH RELATED ASSETS AND LIABILITIES - Question identifier:35.

Canadian investments

• (c): Government of Canada debt

• (d): provincial and municipal government debt

• (e): corporate bonds and debentures

• (f): corporate shares and income trust units

• (g): segregated fund units

• (h): investment fund shares or units

• (i): other Canadian investments

MATCHING OF INCOME STATEMENT GAINS AND (LOSSES) WITH RELATED ASSETS AND LIABILITIES - Question identifier:36.

Foreign investments

• (a): money market instruments

• (b): debt instruments

• (c): corporate shares

• (d): investment fund units

• (e): other foreign investments

MATCHING OF INCOME STATEMENT GAINS AND (LOSSES) WITH RELATED ASSETS AND LIABILITIES - Question identifier:37.

Mortgage loans - Non-affiliates

• (a): secured by property in Canada
• (1): residential
• (2): non-residential

• (b): secured by property outside Canada

MATCHING OF INCOME STATEMENT GAINS AND (LOSSES) WITH RELATED ASSETS AND LIABILITIES - Question identifier:38.

Fixed assets

• (a): income properties

MATCHING OF INCOME STATEMENT GAINS AND (LOSSES) WITH RELATED ASSETS AND LIABILITIES - Question identifier:39.

Other assets and liabilities

Please specify major items and their values:

MATCHING OF INCOME STATEMENT GAINS AND (LOSSES) WITH RELATED ASSETS AND LIABILITIES - Question identifier:40.

TOTAL

Sum of lines 35 to 39. This should equal the sum of items 25 (a), 25 (b), 26, 33 (a) and 33 (b).

OTHER DISCLOSURE - Question identifier:41.

Hours spent completing questionnaire

Is this your first quarterly report completed for the Quarterly Survey of Financial Statements after adopting a new set of acounting standards?

• (1): YES If yes, please complete sections below.
• (2): NO

Total assets - Canadian GAAP

Total assets - New accounting standards

Total liabilities - Canadian GAAP

Total liabilities - New accounting standards

Total equity - Canadian GAAP

Total equity - New accounting standards

Explanation of differences between figures under prior Canadian GAAP and under the new accounting standards.

Total revenue - Canadian GAAP

Total revenue - New accounting standards

Total expenses - Canadian GAAP

Total expenses - New accounting standards

Net income (loss) - Canadian GAAP

Net income (loss) - New accounting standards

Comprehensive income (loss) - Canadian GAAP

Comprehensive income (loss) - New accounting standards

Explanation of differences between figures under prior Canadian GAAP and under the new accounting standards.

Please use this section to report any comments you may have.

Report all amounts in thousands of Canadian dollars - "$ 000s"

Use parentheses to report negative values.

If actual data are not available, estimates may be used.

Returning your questionnaire:

Return the completed questionnaire in the enclosed envelope or fax it to Statistics Canada at (800) 552-4428 within 30 days of quarter end. Fax or other electronic transmission disclosure: Statistics Canada advises you there could be risk of disclosure during facsimile or other electronic transmission. However, upon receipt of your information, Statistics Canada will provide the guaranteed level of protection afforded all information collected under the authority of the Statistics Act.

For further information, definitions of terms used, or questions concerning this survey, please consult the "Quarterly Survey of Financial Statements Reporting Guide" (available at www.statcan.gc.ca/imdb-bmdi/2501-eng.htm), and/or contact Statistics Canada at:

Telephone: (877) 898-6686 Fax: (800) 552-4428 E-mail: QSFS-RTEF@statcan.gc.ca Statistics Canada Business Survey Section/Central Region 2nd Floor, Jean Talon Building 150 Tunney's Pasture Driveway Ottawa, Canada, K1A 0T6