Roll Out Form 5

To be completed by Agent and submitted to Safaricom Site Acquisition Supervisor

Lease Completion, Rental Payment & Site Access Details

Site Name: Kezy Kawa and Gakuyu

Site Number: Option Letter: A

Site Type: Greenfield

Site Acquisition Agent: TECHMINDS TECHNOLOGIES LTD

Legal Documentation
(Please advise which of the following documents is provided by checking the box.)
Letter of Offer (LOO) signed by Owner.......................................................................... Yes No
Interim Agreement (IA – 2 copies) signed by Owner..................................................... Yes No
Copy of Draft Lease signed by Owner ...........................................................................Yes No
Copy of Title Deed in respect of the Owner’s Property.................................................. Yes No
Certificate of Official Title Search.................................................................................. Yes No
Registry Index Map ......................................................................................................... Yes No
Copies of Safaricom Final Construction Drawings
Signed/Approved by Property Owner ............................................................................. Yes No
Copies (not original) of relevant pages from Owner's As-Built "Council-Approved" Building
Plans (only rooftop sites - include rooftop drawing and all floor plans where we are taking
space plus drawings showing roof structure, building elevation and electrical source) ....... Yes No N/A
Copy of Certificate of Incorporation/Registration (if owner is a corporate body) ........ Yes No
Copy of Corporate body Search (if owner is a corporate body)..................................... Yes No N/A
Copy of Owner's I.D. (if owner is an individual) ........................................................... Yes No N/A
Copy of Ipage Updated Landlord’s Personal Identification Number (P.I.N.) Certificate… Yes No
ETR Invoice (where VAT is applicable) …………………………………………….……… Yes No N/A
Copy of Payee’s Ipage Updated Personal Identification Number (P.I.N.) Certificate. . . Yes No N/A
(Where the payee is different from the Landlord)
Rental Payment Details Form………………………………………………………….. Yes No
Original Land Rent Receipt and/or original Rent Clearance Certificate
for the current year (if Property is Leasehold)................................................................ Yes No N/A
Where the Owner is deceased;
 Certified copies of Grant of Letters of Administration Intestate/ Grant of Probate. . . Yes No N/A
 Family consent form.................................................................................................... Yes No N/A
Letter/Notification of the organisation’s authorised signatories..................................... Yes No N/A
(if owner is a corporate body)

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 Other Legal Documentation:
 Remarks on missing documentation:

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 Property Owner’s Details:
Private: Corporate:

Name(s): Madam Lucy Company:

Position: Contact person(s):

Position: Administrator
Address: Address:

Tel: Tel: -
Land line: Land line:
Mobile: 0720269608 Mobile:

Fax: Fax:
Email: Email:

Lease Payment Details:

Payee*:

Address of the payee:

*(Note: The Payee may be different from the Landlord i.e. a managing agent/company for Landlord etc.)

Term 1:

Lease Commencement Date:

Lease Expiry Date:

Any additional payments required to

Rental Payments - in KShs. * secure access:
NONE

*(Note: The rent shall be

inclusive of withholding tax at the rate of 10% or at such other rate as may be
prescribed by the Kenya Revenue Authority (KRA). Safaricom, as an authorised tax withholding agent,
will deduct such withholding tax and remit it to the KRA.)

Term 2: Applicable? Yes No

If applicable, state the following where applicable

Percentage increase from Term 1

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Site Number: Option Name:

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Negotiated at current market rates (Tick Box) Yes No

Other (Please describe)…………………………………………………………

Annual Rental Increment?

_____________________________________________________________________________________

Term 3: Applicable? Yes No

If applicable, state the following where applicable

Percentage increase from Term 2 5%

Negotiated at current market rates (Tick Box) Yes No

Other (Please describe)…………………………………………………………

Annual Rental Increment?

_____________________________________________________________________________________

ACCESS DETAILS

Contact details for Construction purposes

Contact person for agreeing Madam Lucy
Construction issues:
Address for receiving
Notice of Access Letter:

Telephone: 0720269608

Fax:

Email:

Contact details for Operations & Maintenance access

Does Safaricom have its own independent access? Yes No
If no, give the following details: -

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Site Number: Option Name:

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 Describe site access protocol during normal working hours (0800-1700hrs):-

Contact Person(s): N/A Position: N/A

Address: N/A Tel: - N/A
Land line: N/A
Mobile: N/A
Email: N/A Fax: N/A

Describe site access protocol outside normal working hours (1700-0800hrs): -

Contact Person(s): N/A Position: N/A

Address: N/A Tel: - N/A
Land line: N/A
Mobile: N/A

Email: N/A Fax: N/A

Submitted by: Jared Asiago Thomas

Signature: Date: 29th August, 2023

_____________________________________________________________________________________

Legal Services Unit (LSU) Approval

Submitted to LSU on ………………………………...

Approved by LSU on ………………………………… Name:

Signature: Date:

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Site Number: Option Name:

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