Group insurance plan for
Le Superclub Vidéotron franchisees

1. Franchisee number
   
    
2. Present insurer
   
    
3. Plan renewal date
   Month January February March April May June July August September October November December Year 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015
    
4. Name of the person in charge of the insurance
   plan within your franchise.
   
    
5. Telephone number of the person in charge.
   - Ext.

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