CIC GENERAL INSURANCE LTD

P.O BOX 59485 - 00200,

NAIROBI.
Phone : +254-703099120
Fax : +254-703099122
Email : info@cic.co.ke
Website : www.cic.co.ke

Motor Private Insurance Policy Schedule

Client Details
Insured Name: JOHN REMMI NJUGUNA Policy Number : 12/070/1/003983/2024/03
Previous Policy No.:
Postal Address: 16927-
NAIROBI

Business/Occupation: ENGINEER Broker/Agent Name: EUDAH INSURANCE

AGENCIES
Endorsement No.: Debit Note No. 2024032218
Period of Insurance:
From: 22/03/2024
(Both dates Inclusive)
To: 21/03/2025
Date of Issue: 22/03/2024
And any subsequent period for which the Insured shall pay and the Company shall agree to accept renewal
premium.

Premium KES 7,500.00

T/Levy KES 15.00
Motor Private PHCF KES 19.00
Stamp Duty KES 40.00
Total KES 7,574.00
Insurance Cover : Third Party Only

Vehicle Details:
Insured's
Year Estimate of Wind
Make/Body Seating Radio Vehicle
Reg. No. CC of Value Including Screen
Type Cap. Casette Colour
Mfg Accessories and Amount
Spare Parts
MITSUBISHI/
KCN
STATION 1790 2010 5 0.00 0.00 0.00 GREY
206T
WAGON
Chassis No. : GA3W-0011314
Engine No. : 4B10-GK5899

Condition : AS PER POLICY

Territorial Limits - East Africa (Subject to the Insured towing the vehicle to Kenya and abiding to usual COMESA
Card requirements for Third Party Liabilities)
Authorized Driver Any of the following:
a) Yourself
b) Any person driving on your order or with your permission
Provided the person driving holds a valid driving license to drive the motor vehicle or has held and is not disqualified
from holding or obtaining such license.

Policy No. : 12/070/1/003983/2024/03 Page 1 of 2

Limitations as to use

"Use only for social, domestic and pleasure purposes and for your business and profession"
The policy does not cover use for racing, competitions, rallies or trials ( or use for practice for any of them) or the
carriage of passengers for hire or reward.

Clauses :
Inexperienced drivers excess- Kshs 5,000/=
Provisional driving licence
Political Risks & Terrorism Exclusion Clause
Young Drivers - Kshs: 5,000/=

Cancellation Notice

Excess:
Third Party Property Fixed Value 7,500.00
Damage
Theft with tracking 2.50% of the claims amount Minimum 20,000.00
device from Our
Appointed Provider
Third Party Bodily Injury Fixed Value 0.00
Own Damage Excess 2.50%of the value MIN: 20,000.00
Theft with anti-theft 10.00% of the claims amount Minimum 20,000.00
device
Theft without anti-theft 20.00% of the claims amount Minimum 20,000.00
device
Young Drivers Fixed Value 5,000.00
Inexperienced Drivers Fixed Value 5,000.00
Total Loss 2.50% of the claims amount Minimum MIN: 20,000.00
Rare Models 5.00% of the claims amount Minimum 20,000.00

Risk ID :- 1
Reg. No. :- KCN 206T
Cover Description Sum Insured(KES)
Third Party Only 0.00

Prepared By : LOURINE KIPTIM Approved By : SYLVIAH NJERI MWANZIA

Dated at Nairobi This Friday the Twenty-Second of March 2024

Signed for and on behalf of CIC GENERAL INSURANCE LTD

Duly Authorized Signatory

Policy No. : 12/070/1/003983/2024/03 Page 2 of 2