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                                                                      PROSPECTUS AND PROPOSAL FORM

                 REal InsuRancE company lImITED
Royal ngao House, Hospital Road p.o. Box 40001 00100 nairobi, Kenya
       Tel: +254 (20) 2712620 Fax: +254 (20) 2717888/2713831
                             real insurance cOMPany liMiTeD

                                    BURGLARY INSURANCE - PROSPECTUS

The insurers’ policy provides indemnity in respect of loss or destruction of or damage to the property
insured caused by THEFT involving entry to or exit from a building by forcible and violent means.

Damage to the premises consequent upon such Theft is also covered if the Insured is liable for the

The policy does not cover

(1) the risk of theft without forcible entry or exit

(2) property more specifically insured

(3) loss destruction or damage

     (a)   where any member of the Insured’s household or of his business staff is concerned as a
           principal or accessory
     (b)   resulting from any act committed by any person lawfully in the premises
     (c)   caused by fire or explosion
     (d)   which can be insured against by a Glass Insurance Policy
     (e)   resulting from a safe or strongroom being opened by a key obtained through its having
           been left on the premises whilst closed for business purposes
     (f)   arising while the Premises are in the occupation of a sub-tenant
     (g)   directly or indirectly caused by or contributed to by or arising from volcanic eruption
           subterranean fire earthquake or other convulsion of nature war invasion act of foreign
           enemy hostilities (whether war be declared or not) civil war rebellion revolution
           insurrection military or usurped power riot or civil commotion looting detention seizure or
           confiscation radioactive contamination or nuclear weapons material

(4) Unless specially mentioned loss or destruction of or damage to deeds bonds bills of exchange
    promissory notes cash bank notes cheques securities for money stamps stamp collection documents
    of any kind books of account manuscripts medals coins live-stock or motor vehicles and accessories
    whilst thereon.

nb   The sum insured by each item of this policy will be separately subject to Average in accordance with the following

     Each and every item specified in the Schedule is separately but similarly subject to Average that is to say if the Property
     insured shall at the time of any loss or damage be collectively of greater value than the Sum Insured thereon then the
     Insured shall be considered to be his own insurer for the difference and shall bear a rateable share of the loss or damage

                  a Quotation will be given on receipt of completed Proposal Form

                               real insurance cOMPany liMiTeD

                                    BURGLARY INSURANCE PROPOSAL FORM

                                       Please Use CaPital letters

Full Name of Proposer

Postal Address                                                                         Tel. No:

Profession or Occupation

Period of Insurance                      From                                          To

Physical address of the
Premises at which the
Insurance is required

             all qUestions mUst be answered fUlly by the ProPoser. if yoU have tiCked a shaded box Please give fUll details
1  (a) State all addresses at which property is contained                        (a)
   (b) Description of premises, e.g. Shop, Office, Warehouse, Factory,           (b)
   (c) State how long occupied by you                                            (c)
2 (a) i) Do the premises form part of a building otherwise tenanted
                                                                                  YES       NO
            and if so, how?
   (b) ii) Are the premises occupied by you at night and if not, is here
                                                                                  YES       NO
            a Watchman or other person on the premises?
3 Are full and reliable records of stock and sales kept and if not, state
                                                                                  YES       NO
   how you would be able to prove a claim
4. How are the following secured and protected?
   (a) outer doors on ground floor and basement                                  (a)
   (b) Front windows on ground floor and basement                                (b)
   (c) Back or side windows on ground floor and basement                         (c)
   (d) Trap Door and Skylights?                                                  (d)
5. Do you wish to insure Cash and Notes in locked safe? If so, please
                                                                                  YES       NO
   give the following information regarding your safe(s):
   (a) Name of Maker                                                             (a)
   (b) Number of Safe                                                            (b)
   (c) Dimensions of Safe                                                        (c)
   (d) Is safe                                                                   (d)
       i) built into wall or                                                      YES       NO
       ii) secured to floor                                                       YES       NO
   (e) Is safe marked Thief Resisting                                             YES       NO
   (f) What is the total value of cash and Notes Kept in the safe(s)             (f)
       when locked?
6. Are the keys of the safe(s) removed from the premises when the
   premises are closed for business?
7 (a) Have thieves ever entered or attempted to enter your premises
                                                                                  YES       NO
       and if so, when?
   (b) If entry was made, please state:
       i) how access was gained?                                                 i)
       ii) what precautions have been adopted to prevent a                       ii)
  (c) Have any other premises occupied by you been so entered and
                                                                                  YES       NO
       if so, please give full details.
  (d) Have you ever claimed upon any Insurer for loss by theft and if
                                                                                  YES       NO
       so please give particulars of each claim.
8. Has any Company or Insurer in respect of any of the contingencies
    to which this proposal applies:
    a) declined to insured you?                                                               YES        NO
    b) required special terms to insure you?                                                  YES        NO
    c) cancelled or refused to renew you insurance?                                           YES        NO
    d) increased your Premium at Renewal?                                                     YES        NO
9. State:
    a) The approximate total value of the Stock in Trade including                           (a)
        Goods in Trust or on Commission for which you are responsible
    b) the amount for which the above property is insured against Fire                       (b)
    c) the name of the Fire insurer                                                          (c)
10. Does the stock include the following and, if so, what is the value?
    a) tobacco, cigars, cigarettes                                                            YES        NO
    b) wines and spirits                                                                      YES        NO
    c) metals (brass, copper, lead etc.)                                                      YES        NO
    d) gold, silver or Jewellery                                                              YES        NO
    e) furs or silks                                                                          YES        NO
    f) radio, television sets or parts, record players, hi-fi equipment,                      YES        NO
        cameras or binoculars

                                          ParTiculars OF PrOPerTy TO be insureD

                                                                                                                             Sum Insured being
                                                                                                                                Full Value

1. Stock-in-Trade belonging to Proposer consisting of:

2. Goods in Trust or on Commission for which Proposer is responsible consisting of:

3. Furniture, Fixtures, Fittings and Utensils in Trade

4. Cash and Notes secured in locked safe

5. Household Goods and Personal Effects

    The total value of articles of Gold Silver or other precious metal jewellery and furs insured
    under item (5) shall be deemed not to exceed one-third of the Sum Insured by this item
    unless the value thereof is stated and additional premium paid.

    No one curio picture or other work of art or article of gold silver or other precious metal
    jewellery or furs insured under item (5) shall be deemed of greater value that 5% of the Sum
    Insured by this item unless such article is specifically insured in a separate item.

                                                                                                   Total Value at Risk


I declare that the above answers are true to the best of my knowledge and belief and that the sum to be insured
represents the full value of the property proposed for insurance. I have disclosed all particulars affecting the
assessment of the risk and I undertake to exercise all ordinary and reasonable precautions for the safety of the
property. I agree that this proposal and declaration shall form the basis of the contract between me and the

Date .................................................................   Signature of Proposer .......................................................

     The Liability of the Company does not commence until the proposal has been accepted and the first premium paid.

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