Moloko Jacky Ramatsui Po Box 7089 Pretoria 0001

PERSONAL INSURANCE QUOTE

27-JAN-12 Mr Moloko Jacky Ramatsui Quotation no Proposer 1003838850 Mr Moloko Jacky Ramatsui

Thank you for requesting a personal insurance quotation from iWYZE. Attached is a summary of your quote. This quote is based on information and disclosures that you provided us with.Please check that the quote contains all the correct information. It is valid for 7 days from the date shown above. Should you, after 7 days, still wish to take out insurance with us, please contact us for a new quote. Should you decide to accept this quotation, iWYZE may require that your valuables or the motor vehicle you wish to insure be inspected. We will contact you within 7 days of issuing your policy documents to follow up on any necessary inspections. iWYZE reserves the right to amend the terms or cancel cover with immediate effect based on the outcome of the inspection. Any iWYZE Policy Portfolio will include the following benefits: A No-Claim Reward - 10% of premiums paid after 3 years of claim-free insurance An Excess Waiver on the first claim made after 3 claim-free years; available to clients on the lowest Excess option A Retrenchment Premium Waiver which pays your insurance premiums for up to 6 months if you happen to be retrenched Free iALERT Road and Home Emergency Service To accept this quote or if you have any questions regarding this quote , please contact us on 0860 93 94 93. Kindly keep your quote number handy when you make this call. Alternatively, email us at sales@iwyze.co.za and include your quote number and contact details. Once we have your confirmation, we will issue your policy documents containing detailed Terms and Conditions. Yours sincerely

For: iWYZE

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SCHEDULE SUMMARY
Policy holder Quotation no Version Moloko Jacky Ramatsui 1003838850 9

Reason Quotation

Start Date 27-JAN-2012

End Date 03-FEB-2012

Section Selected Vehicle-MERCEDES-BENZ-C230K COUPE A/T [8/2002 4/2004]-NPZ804GP Sasria-Sasria Cover Sub-total Admin fee Initiation fee Total premium

First/Add/Ref Premium R 786.81 R R R R R 2.00 788.81 50.00 .00 838.81

Monthly Premium R 786.81 R R R R R 2.00 788.81 50.00 .00 838.81

This schedule becomes a tax invoice after inception of the cover when payment due has been made. VAT is included at 14.0%. iWYZE VAT vendor no: 4460101019 In the event of you not claiming between the date of this schedule and 27-JAN-2015, you are entitled to no claim rewards. The illustrative value of the no claim reward is R2832.52. Please note the stated value is an illustration and the ultimate amount (should you qualify) may be different. iWYZE will not be bound by the stated amount of the no claim reward.

iAlert : 0800 123 000 24 Hours a day, 7 Days a week, 365 Days a year Services Provided: Road : Emergency Roadside Assistance Home : Household Emergencies

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DECLARATION
Declaration Have you or any member of your household had any application for insurance declined or insurance cancelled or renewal refused or not invited or had special terms imposed in the last 3 years Have you or any member of your household been involved in a motor accident or suffered any losses during the past 3 years Loss Date 01-SEP-10 01-OCT-10 Loss Type Vehicle Collision Vehicle Collision

No Yes

Loss Value R62000 R600

Financial information Have you been placed under administration order Have you been declared insolvent in the last 5 years Do you have any judgments or defaults against your name Do you give iWYZE permission to do a financial and insurance background check on you

No No No Yes

Terms and Conditions SASRIA i.e. unrest, riot, strike, or public disorder cover as described in the South African Special Risks Insurance Association (SASRIA) Policy, (the terms and conditions of which are available on request) is included in respect of property insured by this policy. INFORMATION SHARING I acknowledge that the sharing of insurance information for underwriting and claims purposes (including credit information) between insurers is in the public interest as it enables insurers to underwrite policies and assess risks fairly and to reduce the incidence of fraudulent claims with view to limiting premiums. On my own behalf and on behalf of any person I represent herein, I hereby waive my right to privacy with regard to underwriting or claims information (including credit information) that I provide or that is provided by another person on my behalf in respect of any insurance policy or claim made or lodged by me. I acknowledge that the insurance information provided by me may be stored in the shared database and used as set out above as well as for any decision pertaining to the continuance of my policy or the meeting of any claim I may submit. I consent to such information being disclosed to any other insurance company or its agents. I acknowledge that the information may be verified against legally recognised sources or databases. Confirmation I confirm that the information supplied by me is correct in every respect

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VEHICLE
Name Make Model Manufacture year Regular driver - ID Age Gender Registered in SA Taxi use Car status Road use Reg no Vin no Engine no Insured type Modified Financed Finance house Description of use Tracking Gearlock Immobiliser Approved Immobiliser Anti Hijack Licence Type Licence date Licence endorsed Licence code Tracking device Endorsements Disabilities Birth date Night address Night structure Night security Day address Day structure Day security Day situation Item 1 MERCEDES-BENZ C230K COUPE A/T [8/2002 - 4/2004] 2002 Moloko Jacky Ramatsui7810285364084 33 Male Yes No Second Hand Yes NPZ804GP VINNUMTOBEADVISED N/A Retail Price No Yes MFC Domestic No No Yes Yes No 01-JUN-96 No B-Motor vehicle that does not exceed 3500kgs. Unconfirmed N/A No 28-OCT-78 659 Tom Clareridge avenue Pretoria Gauteng 0001 Carport Access Control No Security Guard 00 Tom Clareridge Pretoria Gauteng 0001 In the Open Access Control No Security Guard Residential Item 2 N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A

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Night situation Registered owner Registered owner name Named driver Total Item premium Cover - Excess Car Hire Excess

Residential Yes Moloko Jacky Ramatsui7810285364084 No R 786.81 Comprehensive - R2750 Included R2750

N/A N/A N/A N/A

N/A

Loss Collision Collision

Loss Date 01-SEP-10 01-OCT-10

Loss Value R62000 R600

Loss Detail Scratch windscreen

Specified Excesses Windscreen (if cover is applicable)

R 500

Clauses Item 1 VEHICLE INSPECTION The inspection of my vehicle must happen within 7 days of adding my vehicle to my policy. Should my vehicle not be inspected within 7 days, cover for my vehicle will be automatically cancelled.iWYZE reserves the right to amend the terms or cancel cover with immediate effect based on the outcome of the inspection. Item 1 CAR HIRE Where my vehicle is stolen and remains unrecovered or is damaged and cannot be driven because it requires repairs, iWYZE will pay the actual car hire charges for a temporary vehicle up to 30 days on an unlimited kilometre basis.

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SASRIA
Name Non-Motor (Sum Insured) Watercraft (Sum Insured) Motor (No. of Vehicles) Sum insured R0 R0 1 Monthly Premium R0 R0 R2

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