SECURITY BOOK REQUISITION FORM

TO: FROM: DATE: FINANCE DEPARTMENT ..

AUTHORISED BY:

Please supply Cover Note / Receipt books as detailed below (delete the inapplicable) RETURNED SERIAL NUMBERS .

NUMBER OF BOOKS REQUIRED.. ISSUED SERIAL NUMBERS: ISSUED BY... Name & Signature DATE/2012.

Terms and Conditions 1. The issued cover note remains property the Credsure Zimbabwe Ltd. 2. You are not permitted to subcontract its usage to anyone without being authorized by the company. 3. You may be required to return the book on the companys request without prior notice for audit or any other purpose the company deems fit. 4. Carbon copies on the cover note should be legible and all sections must be completed. 5. In the even that a cover note is lost or stolen you are required to pay standard third party minimum premium per outstanding cover note. You will be required to pay advertising cost for the lost or stolen cover note for at least two days in two daily papers. 6. Once the cover note book has been used up it should be immediately returned to the company for audit and replacement. I have read and understood the terms and condition of cover note book(s) issuance.

RECEIVED BY

... DATE/2012. Name & Signature