MPLE ID al; \NSURANCE BROKERS TEP a 1, Barracks, surulere, Lagos 4 48, Oyerokun cot the ed sega ker Feat temistoxe.cO™ SE/JA/TIB/05/18 315 May, 2018 The Medical Director MEDICAL ART CENTRE, 21, Mobolaji bank Anthony Way, Maryland, Ikeja, “ Lagos. Dear Sir/Madam, RE: GROUP LIFE ASSURANCE SCHEME POLICY NO: GL/4755 ASSURER: CAPITAL EXPRESS ASSURANCE LTD We refer to the above and have pleasure in forwarding Cost and Benefits Schedule along with Certificate of Group Life Term Assurance Scheme covering the peroid of 24% May, 2018 to 23x May, 2019 for your record and eve. While we appreciate your kind patronage, kindly acknowledge receipt. Yours Faithfully, For: TEMPLE INSURANCE BROKERS LTD Soyinka Emmanuel Bus. Dev. Officer Managgr [Iochnical] Directors: HRH Eze (Or) C.A.C. Eronini (Chalman), PA. Ajaguna (Managing Director/CE0), Reet EMS ee es eeeay, CAPITAL EXPRESS ASSURANCE LIMITED CERTIFI F GROU! -RM_ASSURi E SCHEME POLICY NO: GL/4755 NAME OF ASSURED : MEDICAL ART CENTRE ra NUMBER OF LIVES ; 45 PERIOD OF COVER : 24" MAY, 2018 - 23°° MAY, 2019 CAPITAL EXPRESS ASSURANCE LIMITED in compliance with section 4(5) of Pension “Reform Act 2014. The benefits and Costs under the scheme are governed by a Master Policy, copy of which is available for inspection by giving prior Notice to the employer. Managing Director ‘Authorized and Regulated by the National Insurance Commission ‘RIC No-006'ire CAPITAL EXPRESS ASSURANCE LIMITED [GROUP LIFE ASSURANCE SCHEME ASSURED : MEDICAL ART CENTRE ae. POUCY NO- GL@ARPITAL EXPRESS RENEWAL COSTING SCHEDULE PERIOD OF COVER : 24/5/2018 - 23/5/2019 " “ANNUAL yn_|.. surname | omernames | Dos ana _| Genber| Monty | aNnuatsatary | sum assure | PREMIUM 1 [Okeke (Ehizara. T5-lun-80]| 36 —|Female | 450.0000 '5,400,000.00 | 16:200.000.00, 9720000 2 _[Avehabwu [eyinwa: 2o-Mars4l 34 [Female 135,000.09 7,620,000.00| _ 4.860,000.00 79.16000 3 loyero, [Adebi 25-Jan-86) 32 |Female 735,00000, 7,60,000.00 | 4860,000.00 7916000, + [oleaime [Mort ‘SMar7e]| 2 [Male 780,000.09, 160,000.00 | 480,000.00 38,8800 5 Tmate [osumah 28-Mar-86| 32 [Female _| _135,00000 1,420,000.00 | 4840,000.00 3.16000 6 [loabachi [ebee T-Juna7| 31 [Female | 14400000 1,728,000.00 | 5,184000.00 31.1040 T_|adewns lAbiolo 2eSep-7i| 47 [Female | __405,00000 74.860,000.00 | 14.580.000.00 5.48000, Foes Fotuke 2-mar-8o] 38 [Female 160,200.00 1,9722,400.00 | 5767,200.00 3440320 3 lowkoya eninge: 29-Mor-80] 38 [Female 78,750.00 "945,000.00 | 835,000.00 7.01000 To [Okonkwo [Chineto 17-Sep-86] 32 [Female ‘63,000.00 754,000.00 | 2.268,000.00, 73,60800 Ti adogbon. Levee Bewayaal 26 [Female “7500.00 810,000.00] 2.480,600.00 14580000 12 |omidete Taina ToSep-8s] 33 [Female | 112,500.00 7;350,000.00 | 4050,000.00 243000 i [aderran ladeota ‘3o-mara7| —31__|Female 94,500.00 1.134,000.00 | 3.402,000.00 Bav700 ia [ova [Onyekoch 19-Sep-86] 30 [Male 45,000.00, "540,000.00 | 1.620,000.00 972000 iS [adebare Ten 27se5-83] 35 |Female 57,500.09, 7310,000.00 | 2.430,600.00 74380000 16 |Poyede lowe is-sep83] 38 [Female 0,750.00 729,000.00 | 2.187,000.00 7312200 17 [osvelu [adeots Oafayo | $-Now-81| 97 _|wale. 67,500.00 710,000.00 | 2.430,000.00 14580000 1a_[abdulih [Amine BMorsa] 36 [Female 20,250.00 243,000.00 729,000.00, 437400 1 Sieohen ames ‘S-lun86| 32 [Male 2475000 797.000.00 7.00000 534600, [Foo [Adebore Zaug-6é| 52 [Wale 18,000.00 216,000.00, 648,000.00 3.8000 a [Abdur Bi-Dec-63[ 35 [Male ¥8.000.00 716.000.00 648.0000, 3888.00, [Sonor [Okoje 77-Jan-87] 31 [Male 20,250.00, 243,000.00 79,000.00 437400 B_[kareom [Mohammed 14-Jun-87] 3 |Male 40,000.09, 480,000.00 | 1.440,000.00 3.54000, 24 [rode [Abiola Mary 12-Morss| 33 [Female 49,500.00 774,000.00 _1,782,000.00 1069200 rode [Rafat Oiolada: “£Aug-85| 33 [Female 724,750.00 "297,000.00 '871,00000, 5.34400 %4__[srotnos [Kazeem T9-May-79| 39 [wale 22.50000, "270,000.00 810,000.00) “46000, 7 Jousanie Moses 1s-Oct76] 40 [Male "270,000.00 3:240,000.00 | —9,720.000.00 Bema 2a [Mokewo [otwaseun 2s-Jan-79] 39 [male "270,000.00 3.240,000.00 | —9,7200000.00, 530000 33 _[awotole [Groce Té-Feb-54] 64 [Female 180,780.00 1,809,000.00 | 5,427,000.00 3255200 So_[acent [Agesuribo ‘urs 63 [Female Tza.70000 | 1.544,400.00 | 4.633.200.00, a7 5 opura lusting Adooti | aI-Apr-63] 65 [Female 119,250.00 1.431,000.00 | 4293,000.00 257580, 32 [ohukwe [Ghinyere Te:sur63] 85 |Femat 54,0005 648,000.00 | 1,744,000.00, 11,46400 5_[oimbo lOgochuiew Ts-Fe5-87| 36 [Female 4,000.00 648,000.00 | 1,944,0¢0.00 1.66400 34 Paeman [Kenechuewo ‘efeo-86] 30 [Male 78,750.00 945,000.00| 2.835,000.00 7.01000 15 |adeobte [Adeboia 2e-Apr92] 26 [Male 17,500.00 110,000.00,| 2.490,000.00- 14580000 36 "Tokeowo. Bukola 1s-Ocr-83] 33 _[remale 745,000.00 540,000.00 520,500.00, 9.72000, 7 aabyern [Domioia Dorcas | 25-May-86) 32 [Female 40,500.00 486,000.00,| —1.458,000.00 37800 is [Nemonoa Gemes 2emarss| 27 [Male 76,000.00 216,000.00 64800000, 3.55800 i raoy, [inuke Omotara | 13.Jun-8a| 36 |Fremare 39.500.00, T,474,000.00 | 5,072,000.00 30.15200. i, [belo [Etzobeth 20-Jun-90] 28 |Female 73,789.00 "685,468.00 | 2.656,404.00 15,998.42 i Josewe [Keninge. ‘=Augs6| 32 [Female 76,5000, 778,000.00 | 2754000.00 1452400 2 |Umeugochokawu_|Nonyelum 7-May-88| 30 [Female 54,0000, 648,000.00 | _1,944,000.00 11,6640 3 JOpae Winner Té-iun-90] 28 |Female 2.50000, 486,000.00 | —1.488,000.00 ‘874800 4 [Nwaoshar Rosemary 336-71] 27 _ Female 0,500.00 786,000.00 | _1.458,000.00 874800 S_|Oronwe Binyelum EABCHO| 28 |Female 5400000 4,000.00 944,00000, T6400 [rorat = 4414.499.00 | 52,973,268.00 | —168,719,80800 | 953,518.82