Put a ( ) mark wherever applicable.

BANKERS BLANKET BOND

Proposal form

PLEASE NOTE: Every proposer or Assured, when seeking a quotation, taking out or renewing an Insurance Policy, has a legal obligation to reveal to the prospective Insurers any material fact or information which might affect the judgment of the Insurer in deciding whether to accept the insurance or assessing the conditions of that insurance. Failure to observe this obligation could avoid any contract entered into at inception.

SECTION A - PARTICULARS OF BANK / INSTITUTION

1. Title of the Bank including all Banking subsidiary Companies in which the Bank has a controlling interest

2. Principal Address 3. When established 4. Authorised Capital Paid up Capital Total Assets Total Deposits

Total Loans and Discounts

These should be as shown in the last Annual Statement or Report

5. a) Is your corporation a publicly owned or private corporation or a partnership

b) Does any individual or organisation own more than 10% of the equity? If so, who?

6. What percentage of revenues are derived from the following operations: a) Commercial Banking

b) Investment c) Trust Operations d) Retail Banking

e) Stock Brokerage Transactions

The Jubilee Insurance Company of Tanzania Ltd Head Office:

Amani Place, Ohio Street, 4th Floor, P.O. Box 20524 Dar es Salaam, Tanzania Tel: +255 22 2135121 - 4

Fax: +255 22 213 5166 Email: [email protected] www.jubileeinsurance.com/tz/

(The liability of the Company does not commence until this proposal has been accepted by the Company and the premium paid.)

• Put a (√ ) mark wherever applicable.

paper.

• Kindly answer all questions completely in order to help us to serve you better.

f) Foreign Exchange Dealing g) Factoring

h) Leasing

I) Mergers and acquisitions advice j) Fund management

k) Any other major activity

7. State number of

a) current cheque accounts

b) inactive accounts (being those with no movements in or out during the past 12 months). c) savings and deposit accounts

8. Name of Correspondent Bank or Agent in (i) USA (ii)London

SECTION B - STAFF AND LOCATIONS

9. State the number of Directors (Salaried and Permanent only): 10. State the numbers failing in each of the following

categories:-(a) Number of locations:

(b) Number of Employees and Officers (who are not Directors) but including Employees of all grades including messengers, guards, domestic employees and the like and divided as follows

i) Banking Duties ii) Non-Banking Duties

SECTION C - VALUES AT RISK

11. State MAXIMUM value

a) Head Office

b) Main Branches

c) Other locations

12. State MAXIMUM amount of cash including stock of unissued travellers cheques

(a) Head Office

13. State MAXIMUM amount of cash and bearer and negotiable securities in transit at any one time:-By Armoured Motor Vehicle

(a) Head Office (b) Main Branches (c) Other locations

Note 1* - This is covered by Insurance of the contractor or cash transportation.

SECTION D - PARTICULARS OF COVERAGE

14. Has any proposal for insurance of this nature been declined by any Insurance Company or Underwriter at Lloyd’s or has any policy been cancelled or renewal thereof refused?

If so, give the reason stated.

SECTION E - CLAIMS EXPERIENCE - BANKERS

15. Please give in the space provided below, brief details of any loss or losses you have sustained (whether Insured or uninsured), BEFORE the application of any deductible, which was sustained during the past FIVE YEARS

SECTION F - SECURITY

16. (a) Do you have a RULE BOOK or Books or WRITTEN INSTRUCTIONS covering all aspects of your business which will be maintained and operated and which clearly defines the duties of each Employee?

(b) Is the attention of each Employee drawn to these instructions and to their duty of compliance therewith?

(c) Are the duties of each Employee arranged so that no one Employee is permitted to control any transaction from commencement to completion.

17. (a) Have you designated an Officer or other Employee who is charged, subject to supervision by your Board of Directors, with responsibility for the

installation, maintenance and operation of security devices and for the development and administration of a security programme?

(b) Are Employees trained (and re-trained from time to time) in security procedures?

18. (a) Are unannounced and irregular changes made in the position of Employees within a particular job strata?

(b) Are all Employees required to take an uninterrupted holiday of at least two weeks in each calendar year during which they perform no duties and are

required to stay away from the bank premises?

19. (a) Is joint custody established and maintained for the safeguard (i) Property while in safes or vaults?

(iii) Codes, cyphers and test keys?

(b) Is dual control established and maintained for the handling

of:-(I) All types of securities, negotiable and non-negotiable instruments and unissued blank forms of said items? 20. (a) Is there an internal audit department?

(b) If so,

(i) Is there an “audit and control procedures” manual?

(ii) How many people are employed in the internal audit department? (iii) How often are full internal audits made?

(iv) Are audits made regularly on a surprise basis?

(v) Are all premises, including computer centres and facilities included in the audit? (vi) Is the person responsible for the auditing forbidden to originate entries?

21. State the name of the independent firm of Chartered Accountants or professional Auditors or other competent Authority who full audit your Accounts annually

In addition, please state a) Frequency of audit

b) (i) Does the audit include all banking offices? (ii) If not, what extent does the audit take? c) Do the auditors visit all branches?

d) (i) Does the firm or Authority regularly review the system of internal control and furnish written reports? (ii) If so, do these reports go directly to the Board of Directors?

22. Please provide general description of security systems: safes, vaults etc in existence.

a) Vaults and Strongrooms b) Safes

c) Doors and Windows d) Alarms

e) Teller Positions f) Guards

g) Safe Deposit Boxes

23. Transit Head Office Main Branches Other Locations

b) In respect of all other transits:-(i) How many messengers accompanied by (ii) Police or armed guards?

(iii) Are trips scheduled at irregular intervals and over varying routes?

(iv) Is a private conveyance used? (v) Do you provide a messenger service for any

customers?

(vi) Do you make up payrolls for customers and deliver them to factories?

(vii) If so, does your responsibility cease immediately on arrival at customers premises?

24. OTHER PROJECTIONS Head Office Main Branches Other Locations

a) Please specify other protection devices such Camera systems

Electrical money traps

(or any other security measures not mentioned herein)

Period for which insurance is required

FOR & ON BEHALF OF NATIONAL MICROFINANCE BANK PLC

*NOTE:- This proposal form should be signed by the General Manager, Chief Accountant and Security Officer.

IMPORTANT NOTE

1. Specimen copy of the Policy Form and other terms applicable to risk is available, on request by the Proposer.

2. Please note that the above is for your general information only. For further details and specific information, please refer to the Policy whose terms and conditions, exceptions, clauses and warranties are applicable to this insurance.

3. The Policy holder shall keep a record of all information including copies of letters supplied to the insurers for the purpose of entering into the contract. A copy of the completed Proposal Form will be supplied to the Proposer on request after its completion.

Dated at Dar es Salaam this: day of 2012

Any Policy will be a contract of indemnity, designed to protect the insured from fortuitous loss directly and uninterruptedly resulting from defined happenings or conduct.

Manifestly it is not the intention of the insurers or the insured to cover the hazards of trading, to do so would be to translate the role of insurer into that of co-venture with the right to participate in trading profits. This is a statement of intent and shall not be construed to broaden the coverage provided by the policy terms and conditions.

We declare that the statements and particulars in this proposal are true and that we have not misstated or suppressed any material facts. We agree that this proposal, together with any other information supplied by us shall form the basis of any Contract of Insurance effected thereon and shall be incorporated therein. We undertake to inform Insurers of any material alteration to these facts whether occurring before or after completion of the Contract of Insurance. Signing this Proposal Form does not bind the Proposer to complete this insurance.

Chief Executive Officer’s Signature Date

Chief Finance Officer’s Signature Date

ANNEXURE A

FINANCIAL INSTITUTIONS PROFESSIONAL INDEMNITY PROPOSAL FORM

A. Answer all questions leaving no blank spaces.

B. If you have insufficient space to complete any of your answers, continue on your headed paper. C. This form must be dated and is to be signed by two Directors of the Proposer.

D. Please attach last Annual Statement and Report and any Interim Report issued since.

E. It is the intention of Underwriters that any contract of insurance with the Proposer shall be based upon the answers and information provided in this Proposal Form and any other additional information provided by the Proposer. If a quotation is offered it will be the intention of Underwriters to offer coverage only in respect of those entities named in answer to Question 1.

F. This Proposal is an application for insurance which shall be subject to the terms and conditions of Standard Jubilee Insurance Policy as varied by Underwriters.

1. a) Has the Proposer provided any new services to its clients during the last 3 years? If so, give details. b) Does the Proposer intend to offer any new services to its clients during the next 12 months? If so, give details.

2. State names of all Executive and non Executive Directors, their length of service, specific responsibilities and professional qualification. Name Length of service Specific responsibilities Professional qualifications

Directors (including those of subsidiaries Employees)

b) State the total of salaries, including commissions, paid to Directors and Employees during the last financial year.

(c) Are any Directors or Employees compensated by bonus, Profit Commission, or similar performance related reward which is based upon their own performance or that of their department/division/ subsidiary (as distinguished from the Proposer as a whole)? If so, state in which departments/divisions/subsidiaries

Offeror

Total

Company

Total

3. a) What has been the percentage turnover in the following employment categories during the last twelve months?

Inward Outward

4. (a) List each takeover or merger situation in which the Proposer acted on behalf of clients in the last twelve months, indicating by asterisk, on behalf of whom the Proposer was acting, and the values involved.

If so:

a) Are all clients’ agreements reviewed annually?

b) Are all trust/discretionary transactions subject to the

same procedures and review as the Proposer’s own

account transactions.

If not, please describe. c) State:

i) The number of trust/discretionary accounts

ii) The asset value of the largest managed account

d) How often are financial reports rendered to clients? e) Does the Proposer have an “approved” list of securities

which can be recommended to clients?

6. a) Does the Proposer use or subscribe to any Electronic Funds Transfer Systems? List each one.

b) Does the Proposer use or subscribe to any Electronic Funds Transfer Systems which allow direct access to clients to the Proposer’s data base? List each one.

c) Does the Proposer use or subscribe to any Electronic Funds Transfer Systems which allow clients to directly execute a transfer of funds? List each one, indicating whether transfer can be made on a pre-format or free-format basis.

7. Does the Proposer permit the initiation of Funds Transfer by telephonic instruction from clients? If so,

a) Do all clients to whom this facility is available complete written agreements outlining legal Responsibilities, transfer limits and call back parameters for verification?

b) What are the call back parameters for verification?

c) Are all such instructions directed only to the Wire Transfer Room? d) Are all conversations including these instructions recorded? e) Is a written document produced in respect of each instruction, which

is date/time stamped, Logged and maintained for al least 90 days?

5. Does the Proposer undertake trust activities or discretionary account management?

8. Describe the procedures adopted when instructions are received by telephone:-

a) Within the Commodity Department b) Concerning the purchase/sale of stock. c) Within the Foreign Exchange Department.

9. a) State the name and address of Lawyers routinely acting for the Proposer.

b) Do the Lawyers supply written opinions as to the legality of any change in investment or Management policy in connection with Trusteeship activities?

c) Does the Proposer have an in-house Legal Department? (i) If so, how many legally qualified individuals does it consist of? (ii) What are the department’s responsibilities?

1. Preparing and managing Board & Shareholders Meetings; 2. Preparation of various contracts;

3. Security documentation and perfection;

4. Handling of court cases for and against the company; 5. Provision of legal opinion;

6. Follow up of compliance and regulatory matters; 7. Advising Management on legal issues, etc.

(iii) Does it offer its services to customers or other Third Parties? If so, please give details.

d) Does the Proposer use a standard form of contract, agreement of letter of appointment with regard to services performed?

(i) Are these regularly reviewed, and if so, by whom?

e) Are all publications issued by the Proposer reviewed by the in-house Legal Department and/or outside legal advisers?

10.

a) Does the Proposer have a Compliance Officer? b) If so, state his duties and to whom he reports. c) Attach his curriculum vitae

11.

(a) Does the Proposer have a written code of ethics encompassing all employees which includes a statement on the principles of acceptable conduct, and with guidelines for acceptable outside activities, conflict of interests, gifts from customers, and prohibition on other employment?

b) Are employees required to agree in writing that they have read the ethics code and are abiding by said code

c) Do you require all Directors and Employees to declare their outside business interests and specify relationships which could lead to possible conflicts of interest?

12.

a) Has any application made by the Proposer or its predecessors in business for Professional Indemnity Insurance ever been declined? If so, state the reasons.

b) Has any Professional Indemnity Policy in the name of the Proposer or its predecessors in business ever been cancelled?

If so, state the reasons.

13.

Has the Proposer any knowledge or information, after full enquiry, of any circumstances whatsoever which might give rise to claims being made against it, its subsidiaries or any branches to which this application applies?

14.

1. Is your data processing organisation centralised or decentralised in the following areas.

a) Systems developments, software acquisition. b) Operation of major systems including telecommunications systems.

c) Acquisition and operation of small computers. d) Personal computing and decision support

systems.

2. Please list the approximate percentage of data processing performed according to the following source categories.

a) In-House Operations.

b) Arrangement with holding company. c) Arrangement with correspondent bank. d) Arrangement with joint venture.

e) Arrangement with service vendor (non-bank) f) Arrangement with subsidiary.

*1. Signing this Proposal Form does not bind the Proposer to complete this insurance.

2. If a policy is concluded it will be issued on a “CLAIMS MADE” basis i.e. to indemnify the Proposer for claims first made against it in the manner described in the policy during the Policy Period.

Chief Executive Officer’s Signature Date

Chief Financial Officer’s Signature Date

WE HEREBY DECLARE THAT the above statements and particulars are true and complete to the best of our knowledge and that we have not suppressed or misstated any material facts and we agree that this application shall be the basis of any contract* subsequently effected between the Proposer and the Underwriters.

ANNEXURE B

LLOYD’S ELECTRONIC AND COMPUTER CRIME POLICY PROPOSAL FORM

PLEASE NOTE: Every Proposer or Assured when seeking a quotation, taking out or renewing an Insurance Policy, has a legal obligation to reveal to the prospective Insurers any material fact or information which might affect the judgement of the Insurer in deciding whether to accept the insurance or assessing the conditions of that insurance. Failure to observe this obligation could avoid any contracts entered into at inception.

SECTION A - PARTICULARS OF COVERAGE

SECTION B - GENERAL PROCEDURES

3. DATA SECURITY OFFICER

a) Have you designated a Data Security Officer, who is charged with responsibility for the implementation and administration of data security?

b) To whom does the data Security Officer report.

c) Is there a written Data Security Manual outlining corporate policy and standards necessary to ensure security of data?

4. INTERNAL E.D.P. AUDIT

Is there an Internal E.D.P. audit department? If so:

a) Is there a written E.D.P. “audit and control procedures” manual? b) How many people are employed in the E.D.P. department?

c) Has the Internal E.D.P. auditor been specifically trained to fulfil his responsibilities in Data Processing?

d) Is there a full continuous audit programme in operation?

If not, state scope of the current audit. e) Are written audit reports made? If so, for whom?

5. EXTERNAL AUDIT

a) State the name of the outside firm of certified accountants who audit your accounts annually, other than government Bank examinations, Directors examinations and similar limited scope audits.

In addition please state: b) I) Frequency of outside audit

ii) Does the outside audit include all locations, including all data processing centres? If not, to what extent is the audit performed?

iii) Does the auditing firm regularly review your systems of internal controls and furnish written reports

iv) Has the auditing firm made any recommendations in the area of data adopted?

If so, state said recommendations and your reasons for not adopting them.

6. INPUT AND SYSTEM ACCESS

a) Are the passwords used to afford varying levels of entry to the computer system depending on the need and authorisation of the user?

b) Are passwords regularly changed when there is any turnover in knowledgeable personnel? If passwords are not used, describe the alternative method used. c) Are all the source documents secured to prevent unauthorised modification or use

of data before entering the computer system?

d) Do personnel inputting data either initial, sign or otherwise identify data they prepare? e) Is the use of terminals restricted only to authorised personnel?

f) Are unique passwords used to identify each terminal?

g) Are remote terminals kept in a physically secure location accessible to authorised personnel only? If not, please describe what steps are taken to prevent an unauthorised user from utilising a terminal.

h) Do you utilise any software security packages to control access to your computer systems (ACF2, RACF, SECURE)? If so, please specify package used.

7. COMMUNICATIONS

a) Are terminals restricted to the type of message that can be sent or received from it?

b) Are special log-on passwords (separate from an individual operations password) used when logging in a terminal to provide verification of the terminals identity?

c) Do you encrypt data? If so, please provide details.

d) Do you use a software system to monitor telecommunications (i.e. TCOM)? If so, please specify system used.

8. PHYSICAL SECURITY

a) Is the data processing centre specifically separated from other departments? b) Is the data processing centre specifically protected by the following: Burglar Alarm

ii) Camera System iii) Fire Suppression System iv) Guards

v) Access Control System vi) Other methods (please describe)

c) Are there positive entry control procedures used to restrict the entry of non-authorised personnel into your data processing centre utilising the following. i) Mantrap entry system

ii) Television recorder to a central guard area. iii) Personal identification by shift supervisors. iv) Minicomputer badge system?

d) Is at least one file generation stored and secured off-site from the main data centre in a restricted area?

9. ASSURED COMPUTER SYSTEMS

As required by the policy wording, please identify all your computer systems to be insured hereunder, by providing details of:-a) Manufacturer/Vendor

b) CPU Model/Description

c) Operating System/Software description

10. AUTOMATED TELLER MACHINES

a) State the number of automated teller machines operated by the bank. (Note: this does not include shared networks)

b) Do you participate in an automated teller machine System shared or operated by another organisation?

If so, identify the same and provide full details of the network. c) Are the automated teller machines on-line to a central computer.

11. SERVICE BUREAU COMPUTER SYSTEM

a) Do you utilise any person, partnership or organisation (other than the Assured) to convert source data to electronic data? If so, please identify:

i) The name of the service bureau. ii) The service class provided.

b) Have all service bureau been authorised by written agreement?

c) Do you require all service bureau utilised to obtain separate fidelity insurance? If so, for what minimum amount?

12. INDEPENDENT CONTRACTORS

a) Do you utilise independent contractors to prepare Electronic computer instructions? b) Do you obtain a written agreement from the independent contractors outlining their

responsibilities?

c) Do you require all independent contractors to obtain a separate fidelity policy? If so, for what minimum amount?

13. ELECTRONIC DATA PROCESSING MEDIA

Do you store electronic data on: a) Magnetic tape

b) Punched tape c) Magnetic disc d) Punched cards e) Others please specify

SECTION C - CHARACTERISTICS

SECTION D - LOSS EXPERIENCE - COMPUTER CRIME

14. Please give in the space provided below, brief details of any losses which you have sustained during the past five years, that involved any use of

computer operations or computer related operations, and/or any circumstances likely to give rise to a loss or losses whether insured or uninsured.

Unless the information has been provided above, please attach full details of corrective measures taken to avoid recurrence of the said losses. Date

SECTION E - GENERAL DESCRIPTION OF DATA PROCESSING

15.

Service Class

(as applicable) of daily transactionsApprox number or BatchOn Line or Service BureauIn House electronicallyAccessed

by non employees a) Demand Deposit b) Commercial Deposit c) Time Deposit d) Retail Loans e) Commercial Loans f) Letters of Credit g) Personal Trust h) Corporate Trust i) Funds Transfer

j) Foreign Exchange Dealing k) Automated Clearing l) Securities Transfer m) Securities Custody n) Cash Management o) Miscellaneous/Other

16. AUTOMATED CLEARING HOUSE

a) Do you engage in a system of clearing debits and credits electronically through an Automated Clearing House?

b) Do you use such a system to direct deposits of recurring payments? c) Are you on-line to the Automated Clearing House?

d) Identify the Automated Clearing System to which you belong?

17. ELECTRONIC COMMUNICATONS SYSTEM

Please identify all forms of automated interbank Electronic communications systems used: a) FEDWIRE b) CHIPS c) SWIFT d) BANKWIRE e) BANKWIRE f) TELEX g) TWX h) TELENET i) TYMNET

Other networks Please specify

17. CUSTOMER COMMUNICATIONS SYSTEMS

a) Do you have any on-line cash management systems with corporate customers? If so, please

provide:-i) the name of the systems.

ii) brief description of the services offered. iii) brief description of the system configuration.

iv) approximate number of clients - copy of the agreement between the Bank and

customers and/or a Handbook.

b) Do you allow any customers electronic access to your computer system through:-i) Bank at Home.

ii) Point of Sale. iii) Cash Dispensers iv) Telex Interface

Dated this day of 2012

For and on behalf of Bank

DECLARATION

I/We declare that the statements and particulars in this Proposal Form are true to the best of my/our knowledge and belief and that we have not misstated or suppressed any material facts. We agree that this Proposal Form together with any other information supplied by us shall form the basis of any contract if Insurance effected thereon and shall be incorporated therein. We undertake to inform Insurers of any material alteration of these facts whether occurring before or after completion of the Contract of Insurance. Signing this Proposal Form does not bind the Proposer to complete this insurance.

Chief Executive Officer’s Signature Date

Chief Finance Officer’s Signature Date

Data Processing Manager or