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    This document is an insurance policy schedule that provides details about a third party automobile insurance policy. It lists the policy number, insured name and contact details, vehicle details including the registration number, and policy coverage periods and limits. The policy covers third party liability for death, bodily injury, and property damage up to 10 million SAR. It does not include any optional personal accident or rental car coverage. The policy also specifies that any claims resulting from an un-named driver being at fault will impact the policyholder's no claims discount eligibility.

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    This document is an insurance policy schedule that provides details about a third party automobile insurance policy. It lists the policy number, insured name and contact details, vehicle details including the registration number, and policy coverage periods and limits. The policy covers third party liability for death, bodily injury, and property damage up to 10 million SAR. It does not include any optional personal accident or rental car coverage. The policy also specifies that any claims resulting from an un-named driver being at fault will impact the policyholder's no claims discount eligibility.

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    This document is an insurance policy schedule that provides details about a third party automobile insurance policy. It lists the policy number, insured name and contact details, vehicle details including the registration number, and policy coverage periods and limits. The policy covers third party liability for death, bodily injury, and property damage up to 10 million SAR. It does not include any optional personal accident or rental car coverage. The policy also specifies that any claims resulting from an un-named driver being at fault will impact the policyholder's no claims discount eligibility.

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
    Download as pdf or txt
    140 views2 pages

    Download

    Uploaded by

    muqbil alwafi
    This document is an insurance policy schedule that provides details about a third party automobile insurance policy. It lists the policy number, insured name and contact details, vehicle details including the registration number, and policy coverage periods and limits. The policy covers third party liability for death, bodily injury, and property damage up to 10 million SAR. It does not include any optional personal accident or rental car coverage. The policy also specifies that any claims resulting from an un-named driver being at fault will impact the policyholder's no claims discount eligibility.

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    POLICY SCHEDULE ‫ﺟﺪﻭﻝ ﺍﻟﻮﺛﻴﻘﺔ‬

    TYPE OF POLICY: Third Party / A-ALAM-1-B-10-026 POLICY NUMBER:


    1/1/012/1210720298
    ‫ﺍﻟﻄﺮﻑ ﺍﻟﺜﺎﻟﺚ‬ ‫ﺭﻗﻢ ﺍﻟﻮﺛﻴﻘﺔ‬
    ‫ﻧﻮﻉ ﺍﻟﺘﻐﻄﻴﺔ‬
    CERTIFICATE:
    9732439
    ‫ﺭﻗﻢ ﺍﻟﺸﻬﺎﺩﺓ‬
    NAME OF INSURED: Muqbil Mohammed H Alwafi DATE OF ISSUE:
    03-MAR-23 01:43
    ‫ﺍﺳﻢ ﺍﻟﻤﺆﻣﻦ‬ ‫ﺗﺎﺭﻳﺦ ﺍﻹﺻﺪﺍﺭ‬
    MOBILE NO: 0505616528 INSURED CODE:
    58348964
    ‫ﺭﻗﻢ ﺍﻟﺠﻮﺍﻝ‬ ‫ﺭﻗﻢ ﺍﻟﻤﺆﻣﻦ‬
    NATIONAL ADDRESS: Building Number: 2657, BUSINESS CODE:
    DIRECT - Web/133
    ‫ﺍﻟﻌﻨﻮﺍﻥ ﺍﻟﻮﻃﻨﻲ‬ Street: Abdul Wahhab Idraq, ‫ﺭﻗﻢ ﺍﻟﻘﻄﺎﻉ‬
    District: As Sulaymaniyah Dist., PREMIUM (SAR):
    SAR 833
    Residence City: Jeddah, ‫ﺍﻟﻤﺠﻤﻮﻉ‬
    Zip Code: 22253, POLICY FEE (SAR):
    SAR 0
    Additional Number: 8708 ‫ﺭﺳﻮﻡ ﺍﻟﻮﺛﻴﻘﺔ‬

    VAT Standard 15%:


    SAR 124.95
    ‫ﻗﻴﻤﺔ ﺍﻟﻀﺮﻳﺒﺔ ﺍﻟﻤﻀﺎﻓﺔ‬
    Total Payable(SAR):
    SAR 957.95
    ‫ﺍﻟﻤﺠﻤﻮﻉ ﺍﻟﻜﻠﻲ‬

    INSURED AND AUTHORIZED DRIVERS ‫ﺍﻟﻤﺆﻣﻦ ﻟﻪ ﻭﺍﻟﺴﺎﺋﻘﻴﻦ ﺍﻟﻤﺴﻤﻴﻴﻦ‬


    Marital Status / ‫ﺍﻟﺤﺎﻟﺔ‬ Driver License Type / ‫ﻧﻮﻉ‬
    Name/‫ﺍﺳﻢ‬ ID No./‫ﺭﻗﻢ ﻫﻮﻳﺔ‬ Age/ ‫ﺍﻟﻌﻤﺮ‬ Gender / ‫ﺍﻟﺠﻨﺲ‬ Occupation / ‫ﺍﻟﻤﻬﻨﺔ‬
    ‫ﺍﻹﺟﺘﻤﺎﻋﻴﺔ‬ ‫ﺭﺧﺼﺔ ﺍﻟﻘﻴﺎﺩﺓ‬
    MUQBIL 1002751723 74 Male Widowed Others Heavy Vehicle

    VEHICLE DETAILS ‫ﺗﻔﺎﺻﻴﻞ ﺍﻟﻤﺮﻛﺒﺔ‬


    REG NO CHASSIS NUMBER CUSTOM/SEQUENCE No. COLOUR REG EXPIRY DATE /
    ‫ﺭﻗﻢ ﺍﻟﻠﻮﺣﺔ‬ ‫ﺭﻗﻢ ﺍﻟﻬﻴﻜﻞ‬ ‫ ﺗﺴﻠﺴﻠﻲ‬/‫ﺭﻗﻢ ﺟﻤﺮﻛﻲ‬ ‫ﺍﻟﻠﻮﻥ‬ ‫ﺗﺎﺭﻳﺦ ﺍﻧﺘﻬﺎء ﺭﺧﺼﺔ ﺍﻟﺴﻴﺮ‬

    1652 JM7BK326981379274 390353800 Grey

    TYPE OF BODY / ‫ﻧﻮﻉ ﺍﻟﻬﻴﻜﻞ‬ USE / ‫ﺍﻻﺳﺘﺨﺪﺍﻡ‬ MAKE AND MODEL / ‫ﻃﺮﺍﺯ ﻭﻣﻮﺩﻳﻞ‬ YEAR / ‫ﺳﻨﺔ ﺍﻟﺼﻨﻊ‬ SEATING CAPACITY / ‫ﻋﺪﺩ ﺍﻟﺮﻛﺎﺏ‬

    Sedan Domestic Driver Mazda 3 2008 4+1

    TRANSMISSION / ‫ﻧﺎﻗﻞ ﺍﻟﺤﺮﻛﺔ‬ PARKING LOCATION AT NIGHT / ‫ﻣﻜﺎﻥ ﺍﻻﻳﻘﺎﻑ ﻟﻴﻼﹸ‬ VEHICLE MODIFICATIONS / ‫ﻟﺘﻌﺪﻳﻼﺕ ﻋﻠﻰ ﺍﻟﻤﺮﻛﺒﺔ‬

    AUTOMATIC Road-side No

    PERIOD OF INSURANCE \ ‫ ﻓﺘﺮﺓ ﺍﻟﺘﻐﻄﻴﺔ ﺍﻟﺘﺄﻣﻴﻨﻴﺔ‬: FROM \ ‫ﻣﻦ‬04-MAR-23 00:00 To \ ‫ﺍﻟﻰ‬03-MAR-24 00:00

    LIMIT OF LIABILITY ‫ﺣﺪﻭﺩ ﺍﻟﻤﺴﺆﻭﻟﻴﺔ‬


    Third Party Liability for Death, Bodily Injury and SR. 10,000,000 .‫ﺭﻳﺎﻝ‬10,000,000 ‫ﺣﺪﻭﺩ ﺍﻟﻤﺴﺆﻭﻟﻴﺔ ﺗﺠﺎﻩ ﺍﻟﻄﺮﻑ ﺍﻟﺜﺎﻟﺚ ﻓﻴﻤﺎ ﻳﺘﻌﻠﻖ ﺑﺎﻟﻮﻓﺎﺓ ﻭ ﺍﻹﺻﺎﺑﺎﺕ‬
    Property Damage is ‫ﺍﻟﺠﺴﻤﺎﻧﻴﺔ ﻭﺃﺿﺮﺍﺭ ﺍﻟﻤﻤﺘﻠﻜﺎﺕ‬

    POLICY DEDUCTIBLE: SAR 0 :‫ﻗﻴﻤﺔ ﺍﻟﺘﺤﻤﻞ‬

    OPTIONAL COVERS ‫ﺍﻟﺘﻐﻄﻴﺎﺕ ﺍﻻﺧﺘﻴﺎﺭﻳﺔ‬


    Benefits Covered Benefits Covered

    Personal accident benefit for the driver NO Un-Named Driver > 21 year NO
    ‫ﺗﻐﻄﻴﺔ ﺍﻟﺤﻮﺍﺩﺙ ﺍﻟﺸﺨﺼﻴﺔ ﻟﻠﺴﺎﺋﻖ‬ ‫ﻋﺎﻣﺎ‬ 21 ‫ﺳﺎﺋﻖ ﻏﻴﺮ ﻣﺴﻤﻰ ﻓﻮﻕ‬
    Personal accident benefit for passengers NO Un-Named Driver related to the Insured NO
    ‫ﺗﻐﻄﻴﺔ ﺍﻟﺤﻮﺍﺩﺙ ﺍﻟﺸﺨﺼﻴﺔ ﻟﻠﺮﻛﺎﺏ‬ ‫ﺗﻐﻄﻴﺔ ﺍﻟﺴﺎﺋﻖ ﺫﻭ ﺻﻠﺔ ﻗﺮﺍﺑﺔ ﺑﺎﻟﻤﺆﻣﻦ ﻟﻪ‬
    Roadside Assistance NO Geographical Extensions NO
    ‫ﺧﺪﻣﺔ ﺍﻟﻤﺴﺎﻋﺪﺓ ﻋﻠﻰ ﺍﻟﻄﺮﻳﻖ‬ ‫ﺗﻤﺪﻳﺪ ﺍﻟﺘﻐﻄﻴﺔ ﺍﻟﺠﻐﺮﺍﻓﻴﺔ‬
    Temporary Rent a Car NO
    ‫ﺗﻮﻓﻴﺮ ﺳﻴﺎﺭﺓ ﺑﺪﻳﻠﺔ‬

    Policy No / ‫ﺭﻗﻢ ﺍﻟﻮﺛﻴﻘﺔ‬ 1/1/012/1210720298 Insured / ‫ﺍﻟﻤﺆﻣﻦ‬ Muqbil Mohammed H Alwafi

    Page 1 of 2
    No Claims Discout(NCD) Eligibility

    In case of an 'UnNamed Driver' being held responsible for an accident, the insurance ‫ﺍﻟﺴﺎﺋﻖ ﺍﻟﻤﺠﺎﺯ ﻓﻲ ﺣﺎﻝ " ﻛﺎﻥ ﺍﻟﺴﺎﺋﻖ ﻏﻴﺮ ﻣﺠﺎﺯ " ﻭﻛﺎﻥ ﺍﻟﻤﺴﺆﻭﻝ ﻋﻦ ﺍﻟﺤﺎﺩﺙ ﺳﻮﻕ ﺗﻜﻮﻥ ﺍﻟﻤﻄﺎﻟﺒﺔ‬
    claim shall be counted towards the record of the Policyholder (and not the 'UnNamed ‫ﻋﻠﻰ ﻫﺬﺍ ﺍﻟﻨﺤﻮ ﺗﺤﺘﺴﺐ ﻋﻠﻰ ﺳﺠﻞ ﺣﺎﻣﻞ ﺍﻟﻮﺛﻴﻘﺔ ) ﻭﻟﻴﺲ ﺍﺫﺍ ﻛﺎﻥ ﺍﻟﺴﺎﺋﻖ ﺍﻟﻐﻴﺮ ﻣﺠﺎﺯ ( ﺳﻮﻑ ﻳﺆﺛﺮ ﺫﻟﻚ‬
    Driver') affecting the NCD eligibility of the Policyholder. .‫ﻋﻠﻰ ﺧﺼﻢ ﻋﺪﻡ ﻭﺟﻮﺩ ﻣﻄﺎﻟﺒﺔ ﻋﻠﻰ ﺣﺎﻣﻞ ﺍﻟﻮﺛﻴﻘﺔ‬

    ‫ﺍﻟﺸﺮﻛﺔ ﺍﻟﻌﺎﻟﻤﻴﺔ ﻟﻠﺘﺄﻣﻴﻦ ﺍﻟﺘﻌﺎﻭﻧﻲ‬


    Al Alamiya for Cooperative Insurance Company

    ‫ﺍﻟﻤﺨﻮﻝ ﺑﺎﻟﺘﻮﻗﻴﻊ‬
    Authorised Signatory
    Issued by ONLINEUSER - KSA/500

    Page 2 of 2

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