MOTOR COVER NOTE

RISK NOTE NO : 885 STICKER NO : 23002-28596-13016

The policyholder described in the Certificate below having proposed for insurance in respect of the Motor Vehicle described in the Certificate and having
paid the sum of 354,000.00 TZS (Incl. VAT), THREE HUNDRED FIFTY-FOUR THOUSAND TANZANIAN SHILLINGS as premium.
The risk is hereby held covered in terms of the company's usual form of General Cartage TPO (More than 10 tones) Policy applicable thereto for the
period between the dates specified in the Certificate unless the cover be terminated by the Company by notice in writing in which case the insurance will
thereupon ceases and a proportionate part of the annual premium otherwise payable for such insurance will be charged for the time the Company has
been on risk. The Policyholder warrants that the Motor Vehicle is only used for the purpose of Commercial-General Cartage TPO (More.

Insured Name MATHAYO SITTA BUDEBA TIRA Cover Note 10623-28552-19516

Policy No P/306/1001/2022/001008

Account MATHAYO SITTA BUDEBA Customer Tax Invoice JICT92553

Address P.O BOX 56 KAHAMA Debit No 878 File No

TIN: 103-330-327,
Insurer Name Jubilee Allianz General Insurance Company of Intermediary : Microdots Insurance Agency
Tanzania Limited
Cover Period From 18-Oct-2023 12:00AM To 17-Oct-2024

THE MOTOR VEHICLES INSURANCE ACT,1961(CAP 169 R.E. 2002)(SECTION-7) VALIDITY OF THIS RISK NOTE IS SUBJECT TO RECEIPT OF Premium BY PRIOR
AND THE MOTOR VEHICLES (THIRD PARTY RISKS) DECREE 1953 (ZANZIBAR) - INSURER TO INCEPTION OF RISK & SUBJECT TO REALIZATION OF CHEQUE,
SECTION 6 WHEREVER APPLICABLE.

CERTIFICATE OF INSURANCE : We hereby certify that a Policy of Insurance covering the liabilities required to be covered by the above mentioned legislations has been
issued as follows:

Vehicle Make/Model Type/Color Engine No. Chassis No. Seating

Registration No. Capacity

T651DXK Iveco IVECO TIPPER TIPPER /White 26782 WJME2NNS00C10 2

4291
CC Year of Vehicle Sum Net Premium VAT Amount Premium (Incl.VAT)
Manufacture Insured (in TZS) (in TZS)

7790 2002 Third Party Only 300,000.00 54,000.00 354,000.00

Date of Issue : ISSUED BY, ALEX

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12-Oct-2023
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IMPORTANT: In the event of any change of vehicle or ownership, this certificate must be returned to the company within 7 days from the date of change.

P.O.Box 647 Kahama, Shinyanga, Tanzania, City: Shinyanga

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

Powered from Smart Policy Insurance System UIN # MCAG885 Receipt No: 98728 Alex-12-Oct-2023 04:15:44 PM Page 1 of 2
 P.O.Box 647 Kahama, Shinyanga, Tanzania, City: Shinyanga
Tel: +255 028 271 0157 Mob: +255 759 126 626

Powered from Smart Policy Insurance System UIN # MCAG885 Receipt No: 98728 Alex-12-Oct-2023 04:15:44 PM Page 2 of 2