QUOTATION

Client Name
STEPHEN HARRISON MANEMA Quotation No
962

Mobile No +255757846312 Issue Date 06-Oct-2023

Email ID Branch Kahama Branch
Address P.O BOX 20 MUSOMA Intermediary Name Microdots Insurance Agency
TIN Insurance Company
117184684 Jubilee Allianz General Insurance Company of Tanz
VRN Cover Period
06-Oct-2023 - to - 05-Oct-2024

Insurance Type Motor First Loss Payee

Insured Name Taxation Gross Premium

S/N Cover Description Sum Insured Net Premium
(in TZS)

Third Party Only

1 STEPHEN HARRISON Cover Type : Third Party Only Sum Insured : 0.00 100,000.00 VAT : 18,000.00 118,000.00
MANEMA Reg No : T729ADA Other Fees : 0.00 Levy : 0.00
Make : Toyota Stamp Duty : 0.00
Model : Landcruiser Policy Fund : 0.00
Chasis No : LJ95RGKMNS
Body Type : STATION WAGON
Colour : Green Metallic
Reg Year : 1999

Tanzanian Shillings Total : 118,000.00

Admin Fee : 0.00
Total Receivable: 118,000.00
TZS, ONE HUNDRED EIGHTEEN THOUSAND ONLY

ISSUED BY, ALEX

For, Microdots Insurance Agency

Bank Details Digital Payment

Bank name: NMB Bank Plc

Account no: TZS 24110006485
Account Name Imatic Technology Limited

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Printed Date 10/6/2023 Printed Time 2:25:43PM Printed By: Alex
 Customer Declaration

1. I/We declare that the above quote is given to me/us on the information provided by me/us.
2. I/We declare to the best of my/our knowledge and belief that the information given on this quote is true in every respect.
3. I/We agree that this proposal and declaration shall be the basis of the contract between me/us and the Insurer.
4. I/We confirm to have been given adequate pre-sale and post-sale advice relating to coverage, terms and conditions of this
insurance product.

Signature Date

P.O.Box 647 Kahama,

Tel: +255 028 271 0157
Mob: +255 759 126 626

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Printed Date 10/6/2023 Printed Time 2:25:43PM Printed By: Alex