AMANI PLACE, 4" Floor, Ohio Street; 1 #285 22 2120193; E-mail: infoCsanlamgeneralinsurance.co.tz Website: wrww.saniam.co.tz CLAIM NO: C/02/2021/1002/000030 INSURED: BENJAMIN MASHIMBA BUNGULWA, POLICY NO: P/02/2021/1002/000471, PERIOD OF INSURANCE: 28/04/2021 TO 27/04/2022 ADJUSTED CLAIM AMOUNT: _TSHS. 9,097,117.50/: (In Words) ‘TSHS Nine Million Ninety Seven Thousand One Hundred Seventeen Fifty Cents Only. In consideration of SANLAM GENERAL INSURANCE COMPANY TANZANIA LIMITED having paid/agreed to pay the above-mentioned amount in relation to, or on account of Motor Vehicle T 831 BET Which happened/commenced on or about the 08” Day of December 2021 I/We hereby certify that such payment is to my/our Tull satisfaction and-is in discharge for all claims past, present, or prospective against the Company under its above-mentioned policy in respect of this, occurrence. 1/We therefore hereby subrogate all my/our rights in favour of Sanlam General Insurance (T) Limited. * I/We further confirm that it is in order for the cheque / Bank Transfer to be issued in favour of: - Name of the Account holder...Zesanie. Manone, PuslsLiwa ‘Address of Account holder...,.../0MA020. i Name of Bank... AAA... Branch: BKM. Z Bank Account Number: TSHS... 2441060. Insured Name andStamp = ZEMIAMIM pfasHiMba BurGdly A Insured Signed Hig Date 27/0) /2022 Witness Name & Signature/Stamp.. TULURASA -C > MRL GER