oe Fidelity INSURANCE FIDLEITY SHIELD INSURANCE COMPANY LIMITED MOTOR VEHICLE STATUTORY DECLARATION DECLARATION AS TO USE ) f « 00S Of XI cop Weekton 1 Aimert lt | F.OTA. the owner of Motor Vehicle Reg. No. ADA... SHH awake). AHHH Ge the subject of a contract of Insurance between me and FIDELITY SHIELD INSURANCE COMPANY LIMITED, do hereby solemnly declare as follows:- (@) That the above Motor Vehicle is used solely for social, domestic purposes only. (b) That under no cireumstances will the said Motor Vehicle be used as “Taxi”, “Matatu” ot in any way for the carriage of fare paying passengers. (© That in the event of the said Motor Vehicle mentioned above being used for carriage of fare paying passengers as a “Taxi”, “Matatu”or any other use other than for social, domestic, pleasure and for the insured’s business only as described above with my knowledge or otherwise, the cover granted by this insurance shall be null and void ab initio, And 1 make this Declaration conscientiously believing the same to be true and according to the oaths and Statutory Declaration Ordinance (Kenya) -: threneths Signed: ‘Taken and acknowledged this: Before me: NB: The Declaration must be made before a Magistrate, Justice of the peace, Commissioner for oaths, Registrar of the Supreme Court, Deputy Registrar or District Registrar,