EQUITY INSURANCE AGENCY LTD

P. O. BOX 350 , 00202 - NAIROBI

TEL: +254-763026000 FAX: +254-20-2737276
EMAIL: E-mail:INSURANCE@EQUITYBANK.CO.KE WEBSITE:http://www.equitybank.co.ke

GROUP PERSONAL ACCIDENT RISK NOTE

INSURER: BRITAM GENERAL INSURANCE COMPANY (KENYA) LIMITED RISK NOTE NO: NBD0410370
POLICY NO: 590/093/1/000004/2009/01
POLICY: BIMA YA AJALI POLICY WITH MEDICAL EXPENSES CURRENCY KSH
CLIENT DETAILS:
CUST ID 21145204 MOBILE 0719627518
POLICY HOLDER MS. NEON MUTHONI TEL(OTHERS)
POSTAL ADDRESS: P.O. BOX 20 E- MAIL: neonmuthoni2@gmail.com
POSTAL CODE: 00900 KIAMBU KENYA BANK A/C NO.
ID NO.: 38864904 BRANCH CODE 064
PIN NO.: A016010566G
PERIOD OF INSURANCE
COVER FROM 14/01/2021 COVER TO 13/01/2022
TIME ON RISK COVER FROM 14/01/2021 COVER TO 13/01/2022

COVER BASED ON CAPITAL BENEFITS

Payment of Benefits as a result of accidental death or bodily injury to the
insured persons, including riots, strike and malicious assault but
excluding war, terrorism, civil war and kindred risks in accordance with
the benefits specified

SCHEDULE OF BENEFITS - AMOUNT OF COMPENSATION PAYABLE

RISK PERSONAL ACCIDENT

No. Name & Occupation Death PTD TTD Medical Funeral Year/Age
or Desc. of Categories
of Insured Persons
1 MUTHONI NEON 100000 100000 30000 50000 2000

APPLICABLE CLAUSES
24 Hour Cover
Age Limit - 18 - 70 Years
Air Travel As Passenger In Any Standard Type Licensed Aircraft
Disappearance Clause ? 12 Months
Duty Or Pleasure
Exposure Clause
Motor Cycling Upto 250cc
Premium Adjustment Clause
Riot, Strike & Civil Commotion
Trustee Clause
Worldwide Limits

EXCLUSION
Accidents Due To Influence Of Intoxicating Liquor Or Of Drugs
Aircrew Duties
Existing Physical Defect Or Infirmity
Power Boating
Racing Risks
Rugby/ Football (Except Amateur Soccer)
Scuba Diving/ Water Sports
Steeplechasing And Equestrian Competitions
Suicide & Attempted Suicide
War, Radioactivity And Kindred Risks

PREMIUM
COMPUTATION(KSHS)2
Premium 700.00 Time on Risk Premium: 700.00
Extensions:
LESS DEBITED PREMIUM 700.00
RISK: MUTHONI NEON
Medical Expenses
Permanent Total Disability
Temporary Total Disability
Policyholders Fund 2.00
Training Levy 1.00
Total Time on Risk Premium 703.00

2.00
Policyholders Fund
First Premium
Training Levy
First Premium

Premium are payable to Equity Insurance Agency Limited; A/C NO. 0180291028202; Community Corporate Branch, Equity Bank Limited.
CASH
CUSTOMER SIGNATURE: DATE:

ISSUING INSURANCE OFFICER: BEATRICE MKANJALA DATE: 14/01/2021

MONIKOMBO

VERIFIED OPERATIONS MANAGER BEATRICE MKANJALA DATE: 14/01/2021

MONIKOMBO

Print Date: 14 January 2021 Sch 1 of 2

Print Date: 14 January 2021 Sch 2 of 2