EXCHANGE CONTROL DECLARATION

(To be signed only by non-residents of The Bahamas eligible for US$ denominated Policies)

Name of Proposer or Insured:

Driver’s License /Passport No.:

I/We declare that, The Central Bank of The Bahamas does not designate me/us as a resident(s) of the Commonwealth of The Bahamas for Exchange Control purposes.

I/We will immediately notify Insurance Management (Bahamas) Ltd. in writing in the event of any change of status.

I/We understand that payment of a claim under a Policy of Insurance in currency other than Bahamian currency is subject to approval by The Central Bank of The Bahamas.

I/We agree that an electronically transmitted signature affixed to this document shall have the force and effect of an original signature.

EXCHANGE CONTROL DECLARATION

(To be signed only by non-residents of The Bahamas eligible for US$ denominated Policies)

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