DEED OF RECEIPT AND WAIVER

THIS DEED OF RECEIPT AND WAIVER is made the day of Two Thousand and

BETWEEN:

(1) ………. represented by …. of Post Office Box Number ……., Nairobi, in the Republic of Kenya (the
“Employer”); and

(2) ……. (….) of care of Post Office Box Number in the Republic of Kenya
(the “Representative”).

WHEREAS:

(a) ….. (the “Deceased”) was employed as a cook by the Employer.

(b) The Deceased died on

(c) The Representative is one of the Deceased’s surviving widows and has been chosen by all the
surviving dependants of the Deceased, including his personal representatives, successors and
assigns, to represent them collectively in this matter.

(d) Following discussions between the Representative and the Employer, the parties have agreed and
accepted the terms of this Deed.

NOW THIS DEED WITNESSES:

IN CONSIDERATION of the terms of this Deed THE REPRESENTATIVE HEREBY ACKNOWLEDGES

RECEIPT of the sum of Kenya Shillings ………. from the Employer SUBJECT TO the conditions set out below
and:

(i). That the said sum is in full and final settlement of each and every claim of whatsoever nature and
howsoever arising that the Representative or any of the Deceased’s dependants may have against
the Employer.

(ii). That the said sum will be held by the Representative in trust for and on behalf of all the Deceased’s
dependants being entitled to share in the estate of the Deceased and will be paid in cash directly to
the dependants of the Deceased.

IN CONSIDERATION of the aforesaid payment (receipt of which is hereby acknowledged):

(1). The Representative hereby releases and forever discharges the Employer from all actions
proceedings liabilities claims and demands whether present or future actual or contingent and of
whatsoever nature and howsoever arising against the Employer from the death of the Deceased and
the Representative undertakes to indemnify the Employer against the same.

(2). The Representative hereby agrees to indemnify the Employer against all losses damages costs
charges and expenses suffered by the Employer by reason of this or any further claims of whatsoever
nature and howsoever arising out of any and all of the above as well before as after the date hereof.
(3). In this Deed where the context so admits the expressions “Employer” includes the State of Israel and
all officers and employees; and “Deceased” and “Representative” includes their respective personal
representatives, successors and assigns.

(4). By execution of this document the Representative has agreed and consented to the matters herein
contained.

(5). The Representative has had the opportunity to seek and obtain independent legal advice before
execution of this Deed.

(6). The Representative hereby warrants and confirms that she is entitled to sign this Deed on behalf of all
the underage children of the Deceased and other dependants of the Deceased being entitled to share
in his estate and agrees to indemnify the Employer and any and all employees of the Employer
against any claim from the said children or such dependants.

IN WITNESS WHEREOF this Deed has been duly executed by the Representative the day and year first
hereinbefore written:

SIGNED SEALED AND DELIVERED )

by the said …………….. )
in the presence of: )
)
)
)
)
Advocate )

Drawn by: