Deletion

yx!
T×eÃ mDN DRj#T

ETHIOPIAN INSURANCE
CORPORATION
ª“¨< S/u?ƒ ›Ç=e ›uv North Western ®wÃ p`”Ýõ
HEAD OFFICE ADDIS ABABA Main Branch/Branch
¾S.X.l eM¡ l. þ.X.l. 1124 eM¡ l. 011-5158597

P.O.Box 2545 Tel No. 512400
P.O.Box Tel. No.
ó¡e l. ó¡e l. 504000

517499
Fax No. Fax No.
›=-T@ÃM eic.mdxvs@ethionet.et «w dÃƒ http://www.eic.com.et

E-Mail Website
Endorsement No. 0924/09 attaching to and forming part of policy number NW/4/MTPV/6112/06
Issued in the Name of
M/S Desire Tours, Travel & Trade PLC
It is hereby declared and agreed that effective from 21/05/09 the vehicle with plate No.
3-49123 is deleted from the cover of this policy by the written request of the insured.
Subject otherwise to the terms, exceptions and conditions of the policy.
Signed for and on behalf of the corporation at Addis Ababa this 22nd day of June, 2009.
For and on behalf of

Ethiopian Insurance Corporation
North Western Main Branch
No. Make of Vehicle Plate No. Y.M. Sum Insured Net Premium
1 Nissan Diesel P/up 4-13363 2007 475,000.00 4,202.00
21 Truck 4-12593 2006 1,070,453.00 8,251.08
22 Trailer 4-00545 2006 615,000.00 4,182.00
23 Truck 4-12594 2006 1,070,453.00 8,251.08
24 Trailer 4-00546 2006 615,000.00 4,182.00
25 Truck 4-12595 2006 1,070,453.00 8,251.08
26 Trailer 4-00547 2006 615,000.00 4,182.00
27 Truck 4-12596 2006 1,070,453.00 8,251.08
28 Trailer 4-00527 2006 615,000.00 4,182.00
16,241,812.00 133,772.32
yx!T×eÃ mDN DRj#T
ETHIOPIAN INSURANCE
CORPORATION
ª“¨< S/u?ƒ ›Ç=e ›uv Centeral Addis ®wÃ p`”Ýõ
¾S.X.l eM¡ l. þ.X.l. 1124 eM¡ l. 011-5158597

P.O.Box 2545 Tel No. 512400
P.O.Box Tel. No.
ó¡e l. ó¡e l. 504000

517499
Fax No. Fax No.

E-Mail Website
Endorsement No. 7013034 attaching to and forming part of policy number 701121101216111
11
Issued in the Name of M/S ETHIO TELECOM
It is hereby declared and agreed that effective from the date of renewal i.e. 26/05/2011 to
25/05/2012 the sum insured adjusted from Birr 4,056,378,471.00 to Birr 4,051,837,737.11.
In consideration of the above a refund premium of Birr 2127.45 has been credited to the
insured in respect of Fire & Lightning insurance cover.
Signed for and on behalf of the corporation at Addis Ababa this 17th day of October 2011.

yx!T×eÃ mDN DRj#T
ETHIOPIAN INSURANCE
CORPORATION
¾S.X.l eM¡ l. þ.X.l. 1124 eM¡ l. 011-5158597

P.O.Box 2545 Tel No. 512400
P.O.Box Tel. No.
ó¡e l. ó¡e l. 504000

517499
Fax No. Fax No.

E-Mail Website
Endorsement No. 1301/09 attaching to and forming part of policy number NW/2/MTCM/7627/00
Issued in the Name of M/S Maritime & Transit Service Enterprise
It is hereby declared and agreed that effective from 30/07/09 the vehicle with plate No.
3-12721 is deleted from the schedule of this policy as per the written request of the
insured.
In consideration of the above a refund premium of Birr 2,214.22 has been credited to the
insured.
Signed for and on behalf of the corporation at Addis Ababa this 30th day of July, 2009.

yx!T×eÃ mDN DRj#T
ETHIOPIAN INSURANCE
CORPORATION
¾S.X.l eM¡ l. þ.X.l. 1124 eM¡ l. 011-5158597

P.O.Box 2545 Tel No. 512400
P.O.Box Tel. No.
ó¡e l. ó¡e l. 504000

517499
Fax No. Fax No.

E-Mail Website
M/S Ministry of Health
It is hereby declared and agreed that effective from 07/10/08 the under listed vehicles are
deleted from the Schedule of this policy as per the written request of the insured.
Refund
No. Plate No. Premium
1 4-03019 597.80
2 4-03014 597.80
3 4-01998 463.23
4 4-02009 2,358.57
5 4-04176 2,358.57
6 4-01995 2,358.57
7 4-02848 2,358.57
8 4-02819 2,430.62
9 4-02834 1,084.40
10 4-01997 1,084.40
11 4-01989 887.07
12 4-02835 1,006.94
13 4-08941 704.77
14 4-08942 704.77
15 4-08943 704.77
16 4-02816 2,358.57
17 4-08954 945.52
23,004.93
insured.
Signed for and on behalf of the corporation at Addis Ababa this 2nd day of June, 2009.

yx!T×eÃ mDN DRj#T
ETHIOPIAN INSURANCE
CORPORATION
¾S.X.l eM¡ l. þ.X.l. 1124 eM¡ l. 011-5158597

P.O.Box 2545 Tel No. 512400
P.O.Box Tel. No.
ó¡e l. ó¡e l. 504000

517499
Fax No. Fax No.

E-Mail Website
Endorsement No. 664/09 attaching to and forming part of policy number NW/4/MTPB/0148/07
M/S Gissila S&M Public Transport Owners Ass.
It is hereby declared and agreed that effective from Various dates the under listed Vehicles
are deleted from the Schedule of this policy as per the written request of the insured.
Refund of Effective
S/No. Name of Insured Plate No. Basic Prem. Prem date
1 Hundura Goshu 3-01128 775.77 204.04 02/04/09
2 Abebech Tuffa 3-01199 887.04 233.30 02/04/09
3 Tadesse Mengistu 3-04195 673.65 203.02 19/03/09
4 Berhanu Assefa 3-13611 796.32 239.99 19/03/09
5 Workneh W/Michael 3-02724 883.87 266.37 19/03/09
6 Sisay Dawit 3-09079 798.88 166.34 22/04/09
7 Mohammed Teke 3-15257 665.18 138.50 22/04/09
8 Abinet Guta 3-03768 883.87 184.04 22/04/09
9 Kassaye Demis 3-06289 672.82 140.09 22/04/09
10 Murad Nasir 3-15191 880.08 282.11 12/03/09
11 Esuendale Abebaw 3-03306 883.87 283.32 12/03/09
12 Workabeba Abera 3-08884 798.88 256.08 12/03/09
13 Shiberu Bekele 3-02825 798.88 256.08 12/03/09
14 Ameha Beshah 3-01314 887.64 284.53 12/03/09
3,137.82
insured.
Signed for and on behalf of the corporation at Addis Ababa this 25th day of April, 2009.

yx!T×eÃ mDN DRj#T

ETHIOPIAN INSURANCE
CORPORATION
¾S.X.l eM¡ l. þ.X.l. 1124 eM¡ l. 011-5158597

P.O.Box 2545 Tel No. 512400
P.O.Box Tel. No.
ó¡e l. ó¡e l. 504000

517499
Fax No. Fax No.

E-Mail Website
M/S Horticulture Development Enterprise
It is hereby declared and agreed that effective from 25/01/08 the under listed Tractors are
deleted from the Schedule of this policy as per the written request of the insured.
Make of Veh. Engine No. Net Refund

Tractor 249071 26.59
Tractor 244503 26.59
Tractor 17519 26.59
Tractor 60154 26.59
insured.
Signed for and on behalf of the corporation at Addis Ababa this 04 th day of February,
2008.

yx!T×eÃ mDN DRj#T

ETHIOPIAN INSURANCE
CORPORATION
¾S.X.l eM¡ l. þ.X.l. 1124 eM¡ l. 011-5158597

P.O.Box 2545 Tel No. 512400
P.O.Box Tel. No.
ó¡e l. ó¡e l. 504000

517499
Fax No. Fax No.

E-Mail Website
Issued in the Name of M/S Odda Small & Medium Public Transport Owners Association
It is hereby declared and agreed that effective from 23/12/08 the under detailed vehicle is
deleted from the Schedule of this policy as per the request of the insured.
Owner Name Plate No.

Abathun Demeke 3-08389
In consideration of the above a refund premium of Birr 430.80 is credited to the insured.
Signed for and on behalf of the corporation at Addis Ababa this 20 th day of February,
2009.

yx!T×eÃ mDN DRj#T

ETHIOPIAN INSURANCE
CORPORATION
¾S.X.l eM¡ l. þ.X.l. 1124 eM¡ l. 011-5158597

P.O.Box 2545 Tel No. 512400
P.O.Box Tel. No.
ó¡e l. ó¡e l. 504000

517499
Fax No. Fax No.

E-Mail Website
M/S Ethiopian Air Port Enterprise
deleted from the Schedule of this policy as per the request of the insured.
Make of Veh. Plate No.

GMC(Riv) F.F 4-06458
In consideration of the above a refund premium of Birr 5,690.34 is credited to the insured.
Signed for and on behalf of the corporation at Addis Ababa this 30th day of January, 2008.

yx!T×eÃ mDN DRj#T

ETHIOPIAN INSURANCE
CORPORATION
¾S.X.l eM¡ l. þ.X.l. 1124 eM¡ l. 011-5158597

P.O.Box 2545 Tel No. 512400
P.O.Box Tel. No.
ó¡e l. ó¡e l. 504000

517499
Fax No. Fax No.

E-Mail Website
Ato Alene G/selassie
It is hereby declared and agreed that effective from 19/06/06 the territorial Extension cover
in respect of vehicle plated 3-12595/3-03916 is deleted.
In consideration of the above a refund premium of Birr 119.80 has been paid to the insured
in respect of Motor Own damage Cover
Signed for and on behalf of the corporation at Addis Ababa this 01st day of October, 2007.

yx!T×eÃ mDN DRj#T

ETHIOPIAN INSURANCE
CORPORATION
¾S.X.l eM¡ l. þ.X.l. 1124 eM¡ l. 011-5158597

P.O.Box 2545 Tel No. 512400
P.O.Box Tel. No.
ó¡e l. ó¡e l. 504000

517499
Fax No. Fax No.

E-Mail Website
M/S Gissila Medium & Small Public Transport Owners Association
It is hereby declared and agreed that effective from Various dates the attached list of
Vehicles are deleted from the cover of this policy by the written request of the insured.
insured in respect of Motor third party Cover.
Signed for and on behalf of the corporation at Addis Ababa this 03rd day of March, 2008.

yx!T×eÃ mDN DRj#T

ETHIOPIAN INSURANCE
CORPORATION
¾S.X.l eM¡ l. þ.X.l. 1124 eM¡ l. 011-5158597

P.O.Box 2545 Tel No. 512400
P.O.Box Tel. No.
ó¡e l. ó¡e l. 504000

517499
Fax No. Fax No.

E-Mail Website
M/S Awraris Medium & Small Public Transport Owners Association
It is hereby declared and agreed that effective from 28/03/08 the following Vehicle are
deleted from the cover of this policy by the written request of the insured.
S/N. Plate No. Refund Of Premium
Owners Name
1
Ato Aberham G/Kidan 3-12915 171.69
2
Ato Seyefu Wolede 3-01119 191.59
Signed for and on behalf of the corporation at Addis Ababa this 05th day of December,
2007.

yx!T×eÃ mDN DRj#T

ETHIOPIAN INSURANCE
CORPORATION
¾S.X.l eM¡ l. þ.X.l. 1124 eM¡ l. 011-5158597

P.O.Box 2545 Tel No. 512400
P.O.Box Tel. No.
ó¡e l. ó¡e l. 504000

517499
Fax No. Fax No.

E-Mail Website
It is hereby declared and agreed that effective from various dates the attached list of
Vehicles are deleted from the cover of this policy by the written request of the insured.
In consideration of the above a refund premium of Birr 4,425.86has been credited to the
Signed for and on behalf of the corporation at Addis Ababa this 03rd day of March, 2008

yx!T×eÃ mDN DRj#T

ETHIOPIAN INSURANCE
CORPORATION
¾S.X.l eM¡ l. þ.X.l. 1124 eM¡ l. 011-5158597

P.O.Box 2545 Tel No. 512400
P.O.Box Tel. No.
ó¡e l. ó¡e l. 504000

517499
Fax No. Fax No.

E-Mail Website
It is hereby declared and agreed that effective from various dates the following Vehicles are
S/N. Refund Of Premium Effective date

¾vK”w[~ eU Plate No.
1 ›„ Åc Ÿ<UX 3-00052 469.87 15/11/07
2 ›„ SÑ`X Ñ<Å 3-02454OR 392.16 20/11/07
3 ¨/a S]T S<}“ 3-08960OR 264.97 20/11/07
Signed for and on behalf of the corporation at Addis Ababa this 05th day of December,
2007

yx!T×eÃ mDN DRj#T

ETHIOPIAN INSURANCE
CORPORATION
¾S.X.l eM¡ l. þ.X.l. 1124 eM¡ l. 011-5158597

P.O.Box 2545 Tel No. 512400
P.O.Box Tel. No.
ó¡e l. ó¡e l. 504000

517499
Fax No. Fax No.

E-Mail Website
Endorsement No. 757907 attaching to and forming part of policy number NW/1/MTCM/7817/00
M/S Ethiopian Agricultural Research Organization
It is hereby declared and agreed that effective from renewal date the following vehicle is
deleted from the cover of this policy as it was double insured.
Make of Veh. Plate No. Value

Toyota P/up 4-05287 215,000.00
In consideration of the above a refund premium of Birr 594.16has been credited to the
insured in respect of Motor Comprehensive Cover.
Signed for and on behalf of the corporation at Addis Ababa this 22nd day of October, 2007.

yx!T×eÃ mDN DRj#T

ETHIOPIAN INSURANCE
CORPORATION
¾S.X.l eM¡ l. þ.X.l. 1124 eM¡ l. 011-5158597

P.O.Box 2545 Tel No. 512400
P.O.Box Tel. No.
ó¡e l. ó¡e l. 504000

517499
Fax No. Fax No.

E-Mail Website
It is hereby declared and agreed that effective from 20/08/07 the following motor Cycles is
Motor Cycle 4-2027
insured in respect of Motor Comprehensive Cover
Signed for and on behalf of the corporation at Addis Ababa this 15th day of October, 2007.

yx!T×eÃ mDN DRj#T

ETHIOPIAN INSURANCE
CORPORATION
¾S.X.l eM¡ l. þ.X.l. 1124 eM¡ l. 011-5158597

P.O.Box 2545 Tel No. 512400
P.O.Box Tel. No.
ó¡e l. ó¡e l. 504000

517499
Fax No. Fax No.

E-Mail Website
Issued in the Name of M/S Gissila Medium & Small Public Transport Owners Association
It is hereby declared and agreed that effective from 14/08/07 the following name of owner
has been changed under the schedule of this policy.
Plate No. Previous Owner New Owner
3-12572 OR Ato Kebede Telila Ato Gebru Direta
Further more Plate No.3-17574ET is changed to 3-13384OR by the written request of the
insured.
Signed for and on behalf of the corporation at Addis Ababa this 20th day of August, 2007.

yx!T×eÃ mDN DRj#T

ETHIOPIAN INSURANCE
CORPORATION
¾S.X.l eM¡ l. þ.X.l. 1124 eM¡ l. 011-5158597

P.O.Box 2545 Tel No. 512400
P.O.Box Tel. No.
ó¡e l. ó¡e l. 504000

517499
Fax No. Fax No.

E-Mail Website
Issued in the Name of W/ro Meseret Goshou Tour Service
deleted from the Schedule of this policy by the written request of the insured.

Toyota L/Crusier 3-50780
In consideration of the above a refund premium of Birr 718.85 is paid to the insured.
Signed for and on behalf of the corporation at Addis Ababa this 11th day of May, 2009.

yx!T×eÃ mDN DRj#T

ETHIOPIAN INSURANCE
CORPORATION

¾S.X.l eM¡ l. þ.X.l. 1124 eM¡ l. 011-5158597
P.O.Box 2545 Tel No. 512400
P.O.Box Tel. No.
ó¡e l. ó¡e l. 504000

517499
Fax No. Fax No.

E-Mail Website
Issued in the Name of M/S Water Works Design & Supervision Enterprise

Nissan 4-07800
Signed for and on behalf of the corporation at Addis Ababa this 19th day of August, 2007.

yx!T×eÃ mDN DRj#T

ETHIOPIAN INSURANCE
CORPORATION
¾S.X.l eM¡ l. þ.X.l. 1124 eM¡ l. 011-5158597

P.O.Box 2545 Tel No. 512400
P.O.Box Tel. No.
ó¡e l. ó¡e l. 504000

517499
Fax No. Fax No.

E-Mail Website
Issued in the Name of M/S Ministry Of National Defense
Make of Veh. Plate No. Refund Prem

Toyota p/up Army -00868 275.12
Signed for and on behalf of the corporation at Addis Ababa this 12th day of June, 2007.

yx!T×eÃ mDN DRj#T

ETHIOPIAN INSURANCE
CORPORATION
¾S.X.l eM¡ l. þ.X.l. 1124 eM¡ l. 011-5158597

P.O.Box 2545 Tel No. 512400
P.O.Box Tel. No.
ó¡e l. ó¡e l. 504000

517499
Fax No. Fax No.

E-Mail Website
Issued in the Name of M/s Hormat Engineering Complex Project
It is hereby declared and agreed that effective from 11/04/06 the vehicles with Plate no. 3-
05369, 4-00644 & 4-01783 (New Army. 04274) is deleted from the cover of this policy.
Signed for and on behalf of the corporation at Addis Ababa this 12th day of April 2006.

yx!T×eÃ mDN DRj#T

ETHIOPIAN INSURANCE
CORPORATION
¾S.X.l eM¡ l. þ.X.l. 1124 eM¡ l. 011-5158597

P.O.Box 2545 Tel No. 512400
P.O.Box Tel. No.
ó¡e l. ó¡e l. 504000

517499
Fax No. Fax No.

E-Mail Website
Issued in the Name of M/S DBE & Ato Alemayehu Mekonnen
It is hereby declared and agreed that effective from 31/08/06 the policy is cancelled by the
written request of the insured.
In consideration of the above a refund premium of Birr 3,982.56 is credited to the insured
in respect of Motor Comprehensive cover.
Signed for and on behalf of the corporation at Addis Ababa this 5th Day of October, 2006.
yx!T×eÃ mDN DRj#T

ETHIOPIAN INSURANCE
CORPORATION
¾S.X.l eM¡ l. þ.X.l. 1124 eM¡ l. 011-5158597

P.O.Box 2545 Tel No. 512400
P.O.Box Tel. No.
ó¡e l. ó¡e l. 504000

517499
Fax No. Fax No.

E-Mail Website
M/S Addis Ababa City Government

Toyota Automobile 4-00812
Signed for and on behalf of the corporation at Addis Ababa this 15th day of October, 2007.
yx!T×eÃ mDN DRj#T

ETHIOPIAN INSURANCE
CORPORATION
¾S.X.l eM¡ l. þ.X.l. 1124 eM¡ l. 011-5158597

P.O.Box 2545 Tel No. 512400
P.O.Box Tel. No.
ó¡e l. ó¡e l. 504000

517499
Fax No. Fax No.

E-Mail Website
M/S Upper Awash Agro Industry Enterpeise

Bylarus Tractor Trailer 6102-54-012

yx!T×eÃ mDN DRj#T

ETHIOPIAN INSURANCE
CORPORATION
¾S.X.l eM¡ l. þ.X.l. 1124 eM¡ l. 011-5158597

P.O.Box 2545 Tel No. 512400
P.O.Box Tel. No.
ó¡e l. ó¡e l. 504000

517499
Fax No. Fax No.

E-Mail Website
It is hereby declared and agreed that effective from renewal date the following vehicle is
deleted from the cover of this policy as it was double insured.
Make of Veh. Plate No. Value
Nissan 4-02188 400,000.00
insured in respect of Motor Comprehensive Cover

yx!T×eÃ mDN DRj#T

ETHIOPIAN INSURANCE
CORPORATION
¾S.X.l eM¡ l. þ.X.l. 1124 eM¡ l. 011-5158597

P.O.Box 2545 Tel No. 512400
P.O.Box Tel. No.
ó¡e l. ó¡e l. 504000

517499
Fax No. Fax No.

E-Mail Website
Issued in the Name of M/S Ethiopian Air Port Enterprise
It is hereby declared and agreed that effective from renewal date the under detailed vehicle
is deleted from the Schedule of this policy as make of the vehicle is changed.
Make of Veh. Plate No. Chassis No. Engine No.

Nissan 4-12458 IN1LG4E25Z0705114 ZD30074574K
Signed for and on behalf of the corporation at Addis Ababa this 28th day of November,
2007.

yx!T×eÃ mDN DRj#T

ETHIOPIAN INSURANCE
CORPORATION
¾S.X.l eM¡ l. þ.X.l. 1124 eM¡ l. 011-5158597

P.O.Box 2545 Tel No. 512400
P.O.Box Tel. No.
ó¡e l. ó¡e l. 504000

517499
Fax No. Fax No.

E-Mail Website
It is hereby declared and agreed that effective from various dates the following Vehicles
are deleted from the cover of this policy by the written request of the insured.
Plate Basic Refund of Effective

S/No. Name of Insured No. Prem. Prem date
1 Abeba Ayalew 3-03571 982.08 204.49 22/04/09
2 Abrham Lemma 3-02287 883.87 283.32 12/03/09
3 Mentamer Admassu 3-07608 624.13 200.06 12/03/09
4 Tenker Kassa 3-02465 887.64 284.53 12/03/09
5 Tesfaye Dadi 3-03680 798.88 256.08 12/03/09
6 Girma Bekuretsion 3-05531 502.41 161.05 12/03/09
7 Fosiya Zenabu 3-22225 792.07 253.90 12/03/09
8 Shimeles Teklu 3-04315 792.07 253.90 12/03/09
9 Leben Bashetu 3-16803 454.53 145.70 12/03/09
10 Jemal Hule 3-31002 814.98 261.24 12/03/09
11 Gezachew Negash 3-03693 883.76 283.29 12/03/09
12 Fitsum Asmamaw 3-37178 718.32 230.26 12/03/09
13 Dawit Gizaw 3-12195 880.08 282.11 12/03/09
14 Erguftu Wakene 3-12921 649.78 537.63 08/09/08
15 Atnafu Zewdie 3-14544 880.08 236.30 31/03/09
16 Saleh Kelefa 3-00229 538.06 141.52 02/04/09
4,015.35
Signed for and on behalf of the corporation at Addis Ababa this 25th day of April, 2009


Deletion

Uploaded by

Document Information

Copyright

Available Formats

Share this document

Share or Embed Document

Sharing Options

Did you find this document useful?

Is this content inappropriate?

Copyright:

Available Formats

Deletion

Uploaded by

Copyright:

Available Formats

yx!

T×eÃ mDN DRj#T

HEAD OFFICE ADDIS ABABA Main Branch/Branch

¾S.X.l eM¡ l. þ.X.l. 1124 eM¡ l. 011-5158597

ó¡e l. ó¡e l. 504000

›=-T@ÃM eic.mdxvs@ethionet.et «w dÃƒ http://www.eic.com.et

Subject otherwise to the terms, exceptions and conditions of the policy.

For and on behalf of

HEAD OFFICE ADDIS ABABA Main Branch/Branch

¾S.X.l eM¡ l. þ.X.l. 1124 eM¡ l. 011-5158597

ó¡e l. ó¡e l. 504000

›=-T@ÃM eic.mdxvs@ethionet.et «w dÃƒ http://www.eic.com.et

Subject otherwise to the terms, exceptions and conditions of the policy.

For and on behalf of

HEAD OFFICE ADDIS ABABA Main Branch/Branch

¾S.X.l eM¡ l. þ.X.l. 1124 eM¡ l. 011-5158597

ó¡e l. ó¡e l. 504000

›=-T@ÃM eic.mdxvs@ethionet.et «w dÃƒ http://www.eic.com.et

Subject otherwise to the terms, exceptions and conditions of the policy.

For and on behalf of

HEAD OFFICE ADDIS ABABA Main Branch/Branch

¾S.X.l eM¡ l. þ.X.l. 1124 eM¡ l. 011-5158597

ó¡e l. ó¡e l. 504000

›=-T@ÃM eic.mdxvs@ethionet.et «w dÃƒ http://www.eic.com.et

Subject otherwise to the terms, exceptions and conditions of the policy.

For and on behalf of

HEAD OFFICE ADDIS ABABA Main Branch/Branch

¾S.X.l eM¡ l. þ.X.l. 1124 eM¡ l. 011-5158597

ó¡e l. ó¡e l. 504000

›=-T@ÃM eic.mdxvs@ethionet.et «w dÃƒ http://www.eic.com.et

Subject otherwise to the terms, exceptions and conditions of the policy.

For and on behalf of

yx!T×eÃ mDN DRj#T

HEAD OFFICE ADDIS ABABA Main Branch/Branch

¾S.X.l eM¡ l. þ.X.l. 1124 eM¡ l. 011-5158597

ó¡e l. ó¡e l. 504000

›=-T@ÃM eic.mdxvs@ethionet.et «w dÃƒ http://www.eic.com.et

Make of Veh. Engine No. Net Refund

Subject otherwise to the terms, exceptions and conditions of the policy.

For and on behalf of

yx!T×eÃ mDN DRj#T

HEAD OFFICE ADDIS ABABA Main Branch/Branch

¾S.X.l eM¡ l. þ.X.l. 1124 eM¡ l. 011-5158597

ó¡e l. ó¡e l. 504000

›=-T@ÃM eic.mdxvs@ethionet.et «w dÃƒ http://www.eic.com.et

Owner Name Plate No.

Subject otherwise to the terms, exceptions and conditions of the policy.

For and on behalf of

yx!T×eÃ mDN DRj#T

HEAD OFFICE ADDIS ABABA Main Branch/Branch

¾S.X.l eM¡ l. þ.X.l. 1124 eM¡ l. 011-5158597

ó¡e l. ó¡e l. 504000

›=-T@ÃM eic.mdxvs@ethionet.et «w dÃƒ http://www.eic.com.et

Make of Veh. Plate No.

Subject otherwise to the terms, exceptions and conditions of the policy.

For and on behalf of

yx!T×eÃ mDN DRj#T

HEAD OFFICE ADDIS ABABA Main Branch/Branch

¾S.X.l eM¡ l. þ.X.l. 1124 eM¡ l. 011-5158597

ó¡e l. ó¡e l. 504000

›=-T@ÃM eic.mdxvs@ethionet.et «w dÃƒ http://www.eic.com.et

For and on behalf of

yx!T×eÃ mDN DRj#T

HEAD OFFICE ADDIS ABABA Main Branch/Branch