Evaluation - calculate your new premium rates Date:   Jul-30-2010  Company Name :    Number of employees: Insurerers Name :    Division :    Class :    Policy no. : Type of insurance Amount claimed in the last (3) years Volume Current rate 2009 2008 2007 Life Insurance : $ Salary Volume Rate Death or Mutilaton by Accident(A.D.&D.) $ Salary Volume Rate Dependant Insurance Nombre de personnes Rate Short Term Disability Insurance(S.T.D.) $ Salary Volume Rate Long Term Disability Insurance(L.T.D.) $ Salary Volume Rate Health Insurance Number of Singles Number of Single Parents Number of Couples Number of Families Current Rate Sin S P Cou Fam Dental Insurance Number of Singles Number of Single Parents Number of Couples Number of Families Current Rate Sin S P Cou Fam Quebec (Law 33) Number of Singles Number of Families Current Rate Sin Fam Vision Insurance Number of Singles Number of Single Parents Number of Couples Number of Families Current Rate Sin S P Cou Fam Employe Benefit Program (E.B.P.) Number of Singles Number of Single Parents Number of Couples Number of Families Current Rate Sin S P Cou Fam Legal Insurance Number of Singles Number of Single Parents Number of Couples Number of Families Current Rate Sin S P Cou Fam Optional Life Insurance Number of Singles Number of Single Parents Number of Couples Number of Families Current Rate Sin S P Cou Fam

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