gw

GATE WAY INSURANCE COMPANY LIMITED

131 REGIMANUEL ESTATE
P.O.BOX 164 SPINTEX ROAD
ACCRA-GHANA

CERTIFICATE OF DEPOSIT
SECURITY CODE :

TRANSACTION CODE :

CERTIFICATE OF DEPOSIT CODE :

DEPOSIT CODE :

SERIAL NO. :

ITEM(S) :

DATE OF DEPOSIT :

PURPOSE OF DEPOSIT :

NAME OF DEPOSITOR :

NAME OF BENEFICIARY :

Remarks in the absence of the Depositor only the next of Kin or the Beneficiary has the
mandate to claim the consignment with at least two (2) days notification prior to the
collection and the balance would be calculated and pay on the date of collection.

Received with full proof of ownership.

Demurrage charges attract a fee of
GATEWAY INS. CO. LTD US $10.00 per DAY
P.O.BOX 164 SPINTEX ROAD
ACCRA-GHANA

SIGN/DATE:…………………… ………………………
REV. JOSEPH DONKOR MR. DAVID MORGAN MENSAH
(DIRECTOR) (DEPOSITOR)