List of Vehicles

Insured Name :
Policy Number : ……………………………………………..
Vehicle Owner's ID Number as appearing in the Istamarah :

Vehicle Type (S - Sedans) :

(A - All wheel drive
Jeeps) : (C - Pickups, PLATE NO.
Sl. #. Make Model
Busses, Trucks & (ARABIC)
Trailers) : (O - All other
Vehicle types)
hicles

…………..

Rent a car
SEQUENCE SUM
CHASSIS NO. Year ( yes/No) - if
NO. INSURED
applicable
 Personal
Personal
Accident Benefit Agency
Accident Benefit Effective Transaction type
Cover (PAB Repair
Cover (PAB date (A- Addition / D-
cover) - if indicater
cover) - if (dd/mm/yyy) Deletion)
applicable (Yes/No)
applicable Driver
Passengers
 Vehicle Owner's ID
Number as
Insured Name (if
Insured Name (if different from the appearing in the
different from the
above) - English Istamarah (if
above) - Arabic
different from the
above)
 Owner Date of
Istamarah
Owner Birth (Non-
Expiry date
Nationality Mobile corporate)
(Hijri)
Number dd/mm/yyyy
dd/mm/yyyy
(G)