Quarterly Survey of Financial Statements - Segregated Funds (F3)

Reporting entity

1. Indicate which type of corporation this report covers.

  • A single corporation
  • Part of a corporation
  • A consolidated family of corporations
  • Other (specify)

2. Is the reporting entity part of a Canadian consolidation?

  • Yes
  • No

3. Does this reporting entity have investments in partnerships or joint ventures?

  • Yes
  • No

4. Indicate the accounting standard used to complete this questionnaire.

  • International Financial Reporting Standards (IFRS)
  • Accounting Standards for Private Enterprises (ASPE)
  • United States Generally Accepted Accounting Principles (U.S. GAAP)
  • Other (specify)

5. Indicate the currency used to complete this survey.

  • Canadian dollars
  • U.S. dollars

6. What are the start and end dates of this enterprise's reporting period for the quarter ending:

  • From: YYYY-MM-DD to YYYY-MM-DD

Assets

7. Report your assets

  1. Cash and deposits – Canadian currency
  2. Cash and deposits – foreign currency
  3. Accounts receivable
  4. Allowance for credit losses on receivables
  5. Canadian investments in non-affiliates - debt securities issued by the Government of Canada
    1. Term-to-maturity of less than one year
    2. Term-to-maturity of one year or more
  6. Canadian investments in non-affiliates - debt securities issued by provincial and municipal governments
    1. Term-to-maturity of less than one year
    2. Term-to-maturity of one year or more
  7. Canadian investments in non-affiliates - debt securities issued by corporations, trusts or others
    1. Term-to-maturity of less than one year
    2. Term-to-maturity of one year or more
  8. Canadian investments in non-affiliates - corporate shares, fund or trust units and other equity
    1. Publicly traded
    2. Other equity
  9. Canadian investments in non-affiliates - other investments
  10. Foreign investments in non-affiliates - debt securities
    1. Term-to-maturity of less than one year
    2. Term-to-maturity of one year or more
  11. Foreign investments in non-affiliates - other investments
  12. Derivative assets
  13. Reverse repurchase agreements
  14. Mortgage loans to non-affiliates - secured by property in Canada
    1. Residential
    2. Non-Residential
  15. Mortgage loans to non-affiliates - secured by property outside Canada
  16. Mortgage loans to non-affiliates - accumulated allowance for credit losses
  17. Fixed assets
    1. Investment properties
    2. Accumulated depreciation
  18. All other assets
    • Specify all major items within other assets

Total assets

Liabilities and surplus

8. Report your liabilities.

  1. Accounts payable
  2. Derivative liabilities
  3. Obligations related to repurchase agreements
  4. All other liabilities
    • Specify all major items within other liabilities
  5. Liabilities to policyholders
    1. RRSP funds
    2. Other funds

Total liabilities

9. Report your surplus.

  1. Surplus
    1. Opening balance
    2. Net income (loss) for the current period
    3. Other additions (deductions)
      • Specify all major items within other additions (deductions)
    4. Allocation of net investment income to policyholder
  2. Total liabilities and surplus

Closing balance

Revenue, expenses and net income

10. What period does this income statement cover?

  • From: YYYY-MM-DD to YYYY-MM-DD

11. Report your revenue.

  1. Interest revenue from Canadian sources
    1. Debt securities
    2. Mortgages
    3. Other interest revenue
  2. Interest revenue from foreign sources
  3. Dividends
    1. From Canadian corporations
    2. From foreign corporations
  4. Rental revenue
  5. Gains and losses - fair value adjustments
    1. Realized
    2. Unrealized
  6. Gains and losses - foreign exchange
    1. Realized
    2. Unrealized
  7. All other revenues
    • Specify all major items within other revenues

Total revenue

12. Report your expenses.

  1. Management fees
  2. Dealer compensation expense
  3. Sales tax (HST) expense
  4. Software, research and development
  5. Depreciation
  6. Impairments
  7. All other expenses
    • Specify all major items within other expenses
  8. Net income

Total expenses

Disclosure of selected accounts

13. Allocate the changes to selected assets and liabilities.

  1. Canadian and foreign investments in non-affiliates - debt securities
    1. Initial balance
    2. Net (purchases-sales or issuances-repayments and other changes)
    3. Fair value adjustments and foreign exchange valuation adjustments
    4. Other adjustments
      • Closing balance
    5. Realized gains and losses
  2. Canadian and foreign investments in non-affiliates - corporate shares, fund or trust units and other equity
    1. Initial balance
    2. Net (purchases-sales or issuances-repayments and other changes)
    3. Fair value adjustments and foreign exchange valuation adjustments
    4. Other adjustments
      • Closing balance
    5. Realized gains and losses
  3. Canadian and foreign investments in non-affiliates - other investments in non-affiliates
    1. Initial balance
    2. Net (purchases-sales or issuances-repayments and other changes)
    3. Fair value adjustments and foreign exchange valuation adjustments
    4. Other adjustments
      • Closing balance
    5. Realized gains and losses
  4. Mortgage loans - to non-affiliates
    1. Initial balance
    2. Net (purchases-sales or issuances-repayments and other changes)
    3. Fair value adjustments and foreign exchange valuation adjustments
    4. Other adjustments
      • Closing balance
    5. Realized gains and losses
  5. Fixed assets - investment properties
    1. Initial balance
    2. Net (purchases-sales or issuances-repayments and other changes)
    3. Fair value adjustments and foreign exchange valuation adjustments
    4. Other adjustments
      • Closing balance
    5. Realized gains and losses
  6. Other assets
    1. Initial balance
    2. Net (purchases-sales or issuances-repayments and other changes)
    3. Fair value adjustments and foreign exchange valuation adjustments
    4. Other adjustments
      1. Closing balance
    5. Realized gains and losses
  7. Liabilities
    1. Initial balance
    2. Net (purchases-sales or issuances-repayments and other changes)
    3. Fair value adjustments and foreign exchange valuation adjustments
    4. Other adjustments
      • Closing balance
    5. Realized gains and losses
  8. Derivatives (assets and liabilities)
    1. Initial balance
    2. Net (purchases-sales or issuances-repayments and other changes)
    3. Fair value adjustments and foreign exchange valuation adjustments
    4. Other adjustments
      • Closing balance
    5. Realized gains and losses
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