Section III: Policyholder and beneficiary information and pricing

Contracting company

(name and legal form)

Name :

Address (of registered office and, if applicable, branch and name of Member State)

.......................................................

Information note

1° Commercial name of the contract.

2° Characteristics of the contract :

a) contractual definition of cover offered ;

b) duration of the contract ;

c) premium payment terms ;

d) time limit and conditions for cancelling the contract ;

e) formalities to be completed in the event of a claim;

f) Additional details relating to certain categories of contract:

-life assurance or capitalisation contracts: surrender charges and indemnities and other charges levied by the insurance undertaking, as mentioned in the first paragraph of article R. 132-3 ;

-other contracts with surrender values: charges levied in the event of surrender and other charges;

contracts with unit-linked guarantees: statement of the reference units of account and, for each unit of account selected by the policyholder or, in the case of a group contract with optional membership, by the member, indication of the main characteristics, which may be validly carried out by providing the key information document or the specific information document provided for in Regulation (EU) No 1286/2014 of the European Parliament and of the Council of 26 November 2014 and Commission Delegated Regulation (EU) No 2017/653 of 8 March 2017, and in the absence of insertion of the box referred to in Article L. 132-5-2 on the one hand, of the charges levied by the insurance undertaking on the mathematical provision or the guaranteed capital and, on the other hand, of the charges that may be borne by the unit of account as well as the arrangements for payment of the proceeds of the rights attached to the holding of the unit of account. If the key information document or specific information document is not provided, the subscriber is informed of how to obtain it and, where applicable, the e-mail address where these documents can be obtained;

-optional group contracts: name and address of the policyholder, cancellation and transfer formalities;

-optional group contracts with a transferability clause pursuant to article L. 132-23 or article 108 of law no. 2003-775 of 21 August 2003 on pension reform: transfer fees and compensation;

-people's retirement savings plans: indication in clear characters that the sums paid into a people's retirement savings plan give rise to benefits paid in the form of an annuity from the scheduled age of liquidation of rights, and that a plan may not be the subject of redemptions except in the cases provided for in article L. 132-23 of the Insurance Code and in the fourth paragraph of I of article L. 144-2; indication, where applicable, of the option available under the second paragraph of I of article L. 144-2; indication of the legislative and regulatory provisions governing the operation of the plan; name and registered office of the plan custodian; indication, where applicable, of the existence of the agreement on the representation of commitments referred to in VIII of article L. 144-2 ;

g) information on the premiums relating to the main and additional guarantees, where such information is appropriate;

h) details of the law applicable to the contract where this is not French law and general information about the tax system;

3° Minimum guaranteed return and participation:

a) guaranteed interest rate and duration of this guarantee ;

b) details of fidelity guarantees, reduction values, surrender values or, for optional group contracts with a transferability clause pursuant to article L. 132-23 or article 108 of law no. 2003-775 of 21 August 2003 on pension reform, transfer values; if these cannot be established at the time of subscription, article A. 132-4-1 applies;

c) procedures for calculating and allocating profit-sharing.

4° Dispute review procedure :

Procedures for examining claims that may be made regarding the contract.

Existence, where applicable, of a body specifically responsible for this review.

5° Where applicable, express reference to the report on the solvency and financial situation provided for in article L. 355-5, which gives the policyholder easy access to this information.