AgriGuard Uganda

Parametric Crop Micro-Insurance · USSD *284#

Atine Labs™ · www.agriguard.one · partnerships@agriguard.one

AG-FO-001

Version 2.0 · Sep 2026

FARMER REGISTRATION FORM — FIELD COPY

Kamwenge District Pilot · Complete in BLOCK LETTERS using black or blue ink · All starred fields (*) are mandatory

COPY: Original — Office File Copy 2 — Farmer (give to farmer) Copy 3 — District Register

Field Agent Instructions: Complete this form at the farmer's location. Verify NIN against physical ID card. Record GPS from your device. Obtain consent before proceeding. Submit physical form to district office within 5 business days. USSD enrollment confirmation will be sent to farmer's registered number.

A — FARMER IDENTITY

Full Name (as on National ID) *

Farmer ID (assigned) *

National ID Number (NIN) — 14 characters *

Date of Birth (DD/MM/YYYY) *

Age

Gender *

Male Female Prefer not to say

Mobile Money Provider *

MTN Mobile Money Airtel Money

Phone Number (MTN/Airtel) *

Alternate Phone

Language Preference *

Runyankole Luganda Kiswahili Kinyarwanda Kirundi English

B — LOCATION & FARM DETAILS

District *

Kamwenge Kasese Kabarole Kyegegwa Kyenjojo Other: _______

Sub-county *

Bwizi Kahunge Kamwenge TC Kichwamba Mahyoro Nkoma Ntara Rwimi Other: ___

Village / LC1 Cell *

GPS Latitude (decimal °)

GPS Longitude (decimal °)

Farm Size (acres) *

No. of Plots

Land Ownership *

Owned (Title) Owned (Customary) Leased (Long-term) Leased (Seasonal) Family land

C — CROP & INSURANCE DETAILS

Primary Crop *

Maize Beans Banana/Matoke Sorghum Millet Cassava Groundnuts Sweet Potato Coffee Mixed Other: _______

Season *

2025A (Mar–Jun) 2025B (Aug–Nov) 2026A (Mar–Jun)

Coverage Type *

Drought + Flood (Combined) Drought Only Flood Only

Premium Payment Method *

USSD *284# (MTN) USSD *284# (Airtel) Mobile Money (Agent Collected) SACCO Deduction

Referring Agent ID

Insurer Name

Policy Number (if pre-issued)

D — NEXT OF KIN & CONSENT

Next of Kin — Full Name

Relationship

Phone

Consent Given *

Yes — Verbal (witnessed by agent) Yes — Written signature Yes — Thumbprint

Additional Notes / Remarks

Farmer Thumbprint / Signature

FIELD AGENT NAME & SIGNATURE

Agent ID: _____________ Date: _____________

FARMER SIGNATURE / THUMBPRINT

Date: _____________

SUPERVISING OFFICER

Date: _____________

OFFICE USE ONLY — DO NOT COMPLETE IN THE FIELD

USSD Registration No.

System Farmer ID

Verified By

Date Processed

Remarks

Status

Approved Pending verification Rejected — reason: __________

AgriGuard Uganda — Farmer Registration · AG-FO-001 v2.0 · Atine Labs™ CONFIDENTIAL — HANDLE WITH CARE · Page 1 of 1

AgriGuard Uganda

Parametric Crop Micro-Insurance

Atine Labs™ · www.agriguard.one

AG-CA-001

Crop Assessment · v2.0 · Sep 2026

CROP ASSESSMENT FORM — PRE-SEASON BASELINE

Complete at farm visit before first premium collection · All starred fields (*) mandatory · Use black/blue ink

A — IDENTIFICATION

Farmer ID (AG-XXX) *

Visit Date *

Next Review Date

Farmer Name (confirm)

Plot Reference

B — CROP & FIELD CONDITIONS

Crop Stage at Visit *

Pre-planting Germination Vegetative Flowering Grain fill Harvest

Soil Type *

Clay Sandy loam Loam Sandy Silt

Irrigation Access

None (rain-fed) Seasonal Year-round

NDVI Estimate (0–1)

Rainfall last 30 days (mm)

Pest / Disease Observed

None Mild Moderate (treatment needed) Severe

Expected Harvest (kg)

Baseline Photo Taken

Yes No

C — OBSERVATIONS & RECOMMENDATIONS

Field Agent Observations / Risk Notes

Recommended Follow-up Actions

FIELD AGENT NAME & SIGNATURE

ID: _________ Date: _________

FARMER ACKNOWLEDGMENT

Date: _________

OFFICE USE ONLY

Received By

Date

Assessment Code

Status

AgriGuard Uganda — Crop Assessment · AG-CA-001 v2.0 · Atine Labs™CONFIDENTIAL · Page 1 of 1

AgriGuard Uganda

Parametric Crop Micro-Insurance

Atine Labs™ · www.agriguard.one

AG-PV-001

Payout Verification · v2.0 · Sep 2026

PAYOUT VERIFICATION FORM

Complete after automatic payout trigger · SLA target: 48 hours from trigger to farmer receipt · Use black/blue ink

Note to Agent: This form confirms farmer receipt of an automatic satellite-triggered payout. All fields must be completed and returned to the district office within 24 hours of farm visit.

A — PAYOUT IDENTIFICATION

Payout Reference Number *

Farmer ID (AG-XXX) *

Policy Number

Farmer Full Name (confirm)

Phone Number (confirmed)

B — TRIGGER EVENT

Trigger Event Type *

Drought — NDVI below threshold Flood — Rainfall anomaly above threshold Combined Drought + Flood

Satellite Trigger Date *

Field Verification Date

Satellite Data Reference / NDVI Value

C — PAYOUT DETAILS & CONFIRMATION

Payout Amount (UGX) *

Hours Trigger → Payout

Mobile Money Sent *

Yes — System confirmed Pending Failed — retry required

Farmer Confirmed Receipt *

Yes — SMS confirmation received Yes — Agent verbal confirmation at farm No — Follow-up required

Farmer Satisfaction Rating

5 Very satisfied 4 Satisfied 3 Neutral 2 Dissatisfied 1 Very dissatisfied

Dispute Raised

No Yes — describe below

Notes / Dispute Details / Follow-up Actions

VERIFYING AGENT

ID: _________ Date: _________

FARMER SIGNATURE / THUMBPRINT

Date: _________

OFFICE USE ONLY

Processed By

Date

Reconciliation Reference

AgriGuard Uganda — Payout Verification · AG-PV-001 v2.0 · Atine Labs™CONFIDENTIAL · Page 1 of 1

AgriGuard Uganda

Parametric Crop Micro-Insurance

Atine Labs™ · www.agriguard.one

AG-AR-001

Agent Registration · v2.0 · Sep 2026

FIELD AGENT SELF-REGISTRATION FORM

Complete before receiving AgriGuard credentials · Submit to district supervisor · All starred fields (*) mandatory

Instructions: This form registers you as an authorized AgriGuard field agent. Your details will be verified against national ID records. Upon approval you will receive an Agent ID (FA-XXX), system login credentials, and access to the USSD enrollment toolkit.

A — PERSONAL DETAILS

Full Legal Name (as on NIN) *

Date of Birth

National ID Number (NIN) — 14 characters *

Phone Number *

Email Address

Residential Address

Next of Kin & Phone

B — OPERATIONAL DETAILS

District Assigned *

Kamwenge Kasese Kabarole Kyegegwa Kyenjojo

Sub-counties Covered (list all) *

Organization / SACCO Affiliation

Agricultural Experience

0–1 yr 2–5 yrs 6–10 yrs 10+ yrs

Smartphone Available

Yes (Android) Yes (iPhone) No — basic phone only

Supervising Admin ID *

Application Date *

C — DECLARATION

I, the undersigned, declare that the information provided in this form is true and accurate to the best of my knowledge. I understand that as an AgriGuard field agent I am bound by the AgriGuard Code of Conduct, data protection obligations, and the terms of the Field Agent Agreement. I consent to background verification and acknowledge that misrepresentation may result in immediate disqualification.

Highest Education Level

Primary O-Level A-Level Diploma Degree+

Preferred Training Language

English Runyankole Luganda

APPLICANT SIGNATURE

Date: _____________

SUPERVISING OFFICER

ID: ________ Date: _________

OFFICE USE ONLY — AGENT APPROVAL

Assigned Agent ID (FA-XXX)

NIN Verified

Yes No

Approved By

Date

AgriGuard Uganda — Agent Registration · AG-AR-001 v2.0 · Atine Labs™CONFIDENTIAL · Page 1 of 1

AgriGuard Uganda

Parametric Crop Micro-Insurance Platform

Atine Labs™ · www.agriguard.one · commercial@agriguard.one

AG-IR-001

Insurer Registration · v1.0 · Sep 2026

INSURER REGISTRATION & PLATFORM ONBOARDING FORM

AgriGate Uganda Partner Registration · IRA-Licensed Insurers Only · Complete in BLOCK CAPITALS · Submit to commercial@agriguard.one

Instructions: This form registers your organization as an insurer-partner on the AgriGate Uganda platform. Completion constitutes formal expression of interest to access the platform's farmer database, USSD enrollment infrastructure, and satellite-trigger payout network. A commercial team representative will contact the authorized signatory within 3 business days of receipt. Attach a copy of your current IRA license and Certificate of Incorporation.

A — ORGANIZATION DETAILS

Full Registered Organization Name *

IRA License Number *

License Expiry Date

Regulatory Status *

Fully Licensed Provisional

Organization Type *

Commercial Insurer Microinsurer Reinsurer Development Finance Institution Other: __________

Website / LinkedIn

Physical Address *

Postal Address

B — PRIMARY CONTACT DETAILS

Contact Person Full Name *

Title / Designation *

Email Address *

Phone Number *

WhatsApp Number

Technical/IT Contact Email (for API & USSD integration)

Technical Contact Phone

C — COVERAGE SCOPE & SCALE

Districts of Operation (list all) *

Estimated Farmer Pool *

Estimated Total Acreage *

Crop Types to Insure

Preferred Payout Channel *

MTN Mobile Money Airtel Money Bank Transfer Mixed

Target Pilot Season

D — PLATFORM SERVICE FEE ACKNOWLEDGMENT

Platform Fee: USD 1.00 per verified insured farmer-acre per calendar year, payable by the insurer to AgriGate Uganda Limited. This fee is charged annually (1 January invoice), is separate from the farmer's insurance premium, and applies to all verified enrolled farmer-acres. Deduplication key: (farmer_id, district_block, calendar_year).

Acknowledgment * — tick the box to confirm acceptance:

I acknowledge and accept the USD 1.00 per verified insured farmer-acre per calendar year platform service fee payable to AgriGate Uganda Limited, invoiced annually on 1 January.

E — AUTHORIZED SIGNATORY

Authorized Signatory Full Name *

Title / Designation *

Email Address *

Phone

Application Date *

Additional Notes / Special Requirements

AUTHORIZED SIGNATORY — NAME & SIGNATURE

Date: _____________

COMPANY STAMP / SEAL

AGRIGATE UGANDA — RECEIVED BY

Date: _____________ Ref: _____________

AGRIGATE UGANDA — OFFICE USE ONLY

Insurer ID Assigned

API Key Issued

Yes No

MOU Signed

Yes Pending

Onboarded By

AgriGuard Uganda — Insurer Registration · AG-IR-001 v1.0 · Atine Labs™ CONFIDENTIAL — COMMERCIAL DOCUMENT · Page 1 of 1

AgriGate Uganda

Plot 14 Kampala Road, Kampala, Uganda · platform@agriguard.one · +256 700 000 000

AG-IO-001

v1.0 · September 2026

PLATFORM ACCESS & SERVICES AGREEMENT — INSURER ONBOARDING CONTRACT

This agreement is entered into between AgriGate Uganda (Atine Labs Limited) and the Insurer named in Section 2 below.

Original — AgriGate Uganda Copy 1 — Insurer Copy 2 — IRA Filing Contract Date: _________________ Contract Ref: _________________

1. PLATFORM OPERATOR

Legal NameAgriGate Uganda / Atine Labs Limited

Company Reg. No.UG-CO-2024-0047

Registered OfficePlot 14 Kampala Road, Kampala, Uganda

Authorized RepresentativeJohn Bosco Atine — Chief Executive Officer

2. INSURER DETAILS (Complete in BLOCK CAPITALS)

Insurance Company Legal Name *

IRA License Number *

Company Reg. No. (URSB) *

TIN (URA) *

Accounts Payable Email *

Registered Office Address *

Direct Phone *

Authorized Representative (Full Name) *

Title / Designation *

Official Email *

3. PLATFORM SERVICES SUBSCRIBED

Farmer Verification & Enrollment API Satellite NDVI & Crop Index Feed Automated Payout Trigger Engine Mobile Money Payout Rail (MTN / Airtel) USSD Farmer Self-Service Channel Admin Dashboard & Reporting Portal Annual Reconciliation PDF Reports Bulk Data Export (CSV / JSON)

Pilot District(s)

Est. Farmer-Acres (Yr 1)

Primary Crop(s)

Seasons Covered

Season A (Mar–Jun) Season B (Aug–Nov) Both Seasons Calendar Year

API Integration Method

REST API (JSON) CSV Upload Manual Entry

Contract Start Date

4. PLATFORM SERVICE FEE SCHEDULE

Fee Item	Rate	Basis	Billing Cycle	Payment Terms
Platform Access & Services Fee	USD 1.00	Per verified insured farmer-acre	Monthly (1st of month)	Net 30 days
Late Payment Interest	2% per month	On outstanding balance	Accrues daily	Due immediately
Data Export (bulk CSV/JSON)	USD 0.00	Included in base fee	On demand	—
Additional API Calls (beyond 10,000/day)	Negotiated	Per call batch	Monthly	Net 30 days

⚠ FEE ACKNOWLEDGMENT (Insurer Must Initial): The Insurer acknowledges that the Platform Service Fee of USD 1.00 per verified insured farmer-acre per calendar year is separate from and in addition to the farmer's insurance premium. This fee is invoiced monthly by AgriGate Uganda and is payable within 30 days of invoice date. Insurer Initials: ________

Preferred Payment Method

Bank Transfer (USD) Bank Transfer (UGX) MTN MoMo Airtel Money

Internal PO / Cost Centre Ref (optional)

AgriGate Uganda · Insurer Onboarding Contract · AG-IO-001 v1.0 · Atine Labs™ CONFIDENTIAL — COMMERCIAL & LEGAL DOCUMENT · Page 1 of 2

AgriGate Uganda

Platform Access & Services Agreement (continued)

AG-IO-001

Contract Ref: _____________

5. DATA SHARING & INTEGRATION OBLIGATIONS

5.1 Insurer Data to Platform: The Insurer shall provide: Farmer NIN, Policy Number, Insured Acres, Crop Type, and Season for each enrolled farmer before the start of each covered season.

5.2 Platform Data to Insurer: AgriGate Uganda shall provide: NDVI readings, satellite event triggers, payout event records, enrollment confirmations, and monthly reconciliation reports.

5.3 Data Protection: Both parties shall comply with the Uganda Data Protection & Privacy Act 2019. Farmer personal data shall be processed solely for the purposes of this agreement.

Fields Insurer Will Provide (tick all that apply)

Farmer NIN Policy Number Insured Acres Crop Type Premium Amount Payout Cap/Acre

Upload Frequency

Real-time Daily Weekly Monthly

6. SERVICE LEVEL AGREEMENT (AgriGate Uganda Commitments)

Service	SLA Commitment	Credit if Breached
Platform Uptime	≥ 99.5% per calendar month	5% fee credit per 0.5% below threshold
Satellite Trigger Processing	Within 24 hours of event detection	5% fee credit per incident
Payout Notification to Farmer	Within 48 hours of confirmed trigger	5% fee credit per incident
API Response Time (p95)	< 2,000 ms	Measured monthly; credits on request
Support Response (critical)	Within 4 business hours	Escalation to CEO level

7. TERM, RENEWAL & TERMINATION

7.1 Initial Term: This agreement is effective from the Contract Start Date and continues for twelve (12) months.
7.2 Auto-Renewal: This agreement automatically renews for successive 12-month terms unless either party gives 30 days' written notice of non-renewal before the term end date.
7.3 Termination for Cause: Either party may terminate immediately on written notice if the other party commits a material breach that remains unremedied for 14 days after notice.
7.4 Data Return: Within 30 days of termination, AgriGate Uganda shall return or destroy all Insurer-provided farmer data, and provide a final reconciliation report.
7.5 Outstanding Fees: All outstanding platform service fees remain due and payable regardless of termination.

8. DECLARATIONS & AUTHORIZED SIGNATURES

Both parties confirm that: (a) they have read and understood this agreement in full; (b) the information provided is accurate and complete; (c) the signatories below are duly authorized to bind their respective organizations; (d) this agreement supersedes all prior oral or written communications regarding platform access.

SIGNATURE — INSURER AUTHORIZED REPRESENTATIVE

Full Name (Print)

Title

Date

Place

SIGNATURE — AGRIGATE UGANDA (ATINE LABS LIMITED)

Full Name (Print)John Bosco Atine

TitleChief Executive Officer

Date

PlaceKampala, Uganda

WITNESS (one witness required)

WITNESS SIGNATURE

Witness Full Name

Witness Address / Organization

Date

INSURER COMPANY STAMP / SEAL

AGRIGATE UGANDA — OFFICIAL SEAL

AGRIGATE UGANDA — OFFICE USE ONLY

Contract ID Assigned

Insurer Account ID

API Key Issued

Yes No

MOU Also Signed

Yes Pending

Received By (AgriGate Staff)

Date Received

IRA Copy Filed

Yes No

AgriGate Uganda · Insurer Onboarding Contract · AG-IO-001 v1.0 · Atine Labs™ CONFIDENTIAL — COMMERCIAL & LEGAL DOCUMENT · Page 2 of 2

type	name	label::English	label::Runyankole	label::Luganda	required	constraint	hint
text	full_name	Full Name	Amazina Mamare	Erinnya Lyoona	yes		As on National ID
text	nin	National ID (NIN)	Akaunti ya Gavumenti	Ekaadi ey'Gavumenti	yes	regex(.,'^[A-Z]{2}[0-9]{9}[A-Z]{3}[0-9]$')	14-char NIN
date	date_of_birth	Date of Birth	Akasiku k'Okuzaalibwa	Olunaku lw'Okuzaalibwa	yes		Must be 18+
select_one gender	gender	Gender	Ekicweka	Obuwere	yes
tel	phone	Phone Number	Nimba y'Esimu	Namba y'Essimu	yes	regex(.,'^07[0-9]{8}$')	MTN or Airtel
select_one mmo	mobile_money_provider	Mobile Money Provider	Banki y'Esimu	Banki y'Essimu	yes		For payout delivery
select_one lang	language_pref	Language Preference	Orulimi Oreeba	Olulimi Olwegombwa	no
select_one district	district	District	Akarere	Distirikiti	yes
… + 17 more fields (sub-county, village, GPS, farm size, land ownership, primary/secondary crop, season, coverage, payment method, agent ID, consent, enrollment date …)

form_title	form_id	version	default_language
AgriGuard — Farmer Onboarding	AG-FO-001	2026090601	Runyankole
AgriGuard — Crop Assessment	AG-CA-001	2026090601	Runyankole
AgriGuard — Payout Verification	AG-PV-001	2026090601	Runyankole
AgriGuard — Agent Registration	AG-AR-001	2026090601	English
AgriGuard — Insurer Registration	AG-IR-001	2026090601	English
AgriGuard — Insurer Onboarding Contract	AG-IO-001	2026090601	English

Field Agent Onboarding Forms