e-MOTOR COVER NOTE

COVER NOTE NO: 10122-00660-61217 STICKER NO: 22001-00640-68117

The policyholder description in the certificate below having proposed for insurance in respect of the Motor Vehicle described in the Certificate and
having paid sum of 495,600.00 TZS as premium. The risk is hereby applicable for the period between the dates specified in the Certificate unless the
cover be terminated by the Company notice in writing in which case the insurance will thereupon ceases and a proportionate part of the annual
premium otherwise payable for such insurance will be charged for the time the Company has been on risk. The Policyholder warrants that the Motor
Vehicle is only used for the purpose of MOTOR Private Vehicles-Comprehensive claim free Vehicle.

Limit of liability third party property damage : 30,000,000 TZS

Excess 5% of Claim - Minimum TZS 350,000

Insured Name KHADIJA OMARY RAJABU Phone Number 255657658040

Owner Name KHADIJA OMARI RAJABU Owner Category Corporate

Insured Region Dar es Salaam Insured District Kinondoni

Insurer Sanlam General Insurance Tanzania Limited Cover Period From: Jan 06, 2022 To: Jan 05, 2023

Agent Name Goldstone Insurance Agency Agent Phone Number 255713792792

Payment Method Mobile Channel TIGOPESATZ

Reference Number 0445420479 Payment Date January 06, 2022

THE MOTOR VEHICLE INSURANCE ACT 1961 (CAP 169 VALIDITY OF THIS RISK NOTE IS SUBJECT TO
RE 2002) (SECTION-7) AND THE MOTOR VEHICLES RECEIPT OF PREMIUM BY INSURER PRIOR TO
THIRD PARTY RISKS DECREE 1953 (ZANZIBAR) - INCEPTION OF RISK & SUBJECT TO REALIZATION OF
SECTION 6 CHEQUE, WHEREVER APPLICABLE

CERTIFICATE OF INSURANCE: We hereby certify that a policy of Insurance covering the liabilities required to be covered by the above
mentioned legislations has been issued as follows:

Customer ID Type ID Number Date Of Birth Body Type Model Number

National Identification
19890303141070000318 1989-03-03 Saloon (closed top) 40999
Number(NIN)

Motor Registration No. Make Color Model Chassis No.

T570DVC Toyota Gold UA-NCP60 NCP600079121

Seating Capacity Engine No. Engine Capacity Fuel Used Motor Usage

5 2NZ2634099 1290 Petrol Private

Year of Manufacture Vehicle Sum Premium (Exc VAT) VAT Amount Premium (Inc VAT)

2003 12,000,000.00 420,000.00 75,600.00 495,600.00

Created Date ISSUED BY: Joshua Ndege

January 06, 2022 17:19:43 PM AUTHORIZED SIGNATORY