Messers/

Bupa Direct - Fawateh Alkheer Consulting Engineering Office

P.O.Box 1809
Abha - 61441
king Saud St.
Nearby Riyad Bank
Abha, - Southern Region
Bupa Arabia For Cooperative Insurance
Saudi Arabia
CR No. 4030178881

Premium Invoice 01136709

Customer Name : Bupa Direct - Fawateh Alkheer Consulting Engineering Office

Customer No. : 45104700

Invoice Date : 27/11/2017
Branch/Division/Cost Centre/Contact Person : Due Date : 14/11/2017

Contract Period :14/11/2017 To 13/11/2018

Description : Amount Due (SR)

First installment:(24% of the total annual inception premium amount) against
Healthcare Contract (Non-Distributed) for the period from 14/11/2017 to 22,517.04
13/12/2017.In accordance with the Attached Initial Schedule of members.

Invoice Amount 22,517.04

Signed by Finance Credit Control Dear Customer

We would appreciate your settlement of the above amount
directly into your below Unique SABB VIBAN bank account
number either using Electronic Fund Transfer or Direct Bank
Deposit

VIBAN: SA2745000000500220165003

Yasir Sendi
Director - Finance Operations & Reporting

Corporate & Broker Clients Small and Medium Business Clients

Tel: +966 920 000 456 - Extension: 8460 Tel: +966 920 000 456 - Extension: 8446
Fax: +966 920 006 638 Fax: +966 920 006 638
Email: BA.CorporateCollectionTeam@bupa.com.sa Email: BARetailCollectionTeam@bupa.com.sa

Bupa Arabia for Cooperative Insurance – Al-Rawdah St., Al-Khalediyah Dist. - PO Box 23807, Jeddah 21436, Saudi Arabia – CR No. 4030178881 - Authorised Capital SR 800,000,000 – Paid Up Capital SR 800,000,000
ÈæÈÇ ÇáÚÑÈíå ááÊÃãíä ÇáÊÚÇæäí – Õ.È 23807 ÌÏå 21436 ÇáããáßÉ ÇáÚÑÈíÉ ÇáÓÚæÏíÉ – Ó.Ê. 4030178881 – ÑÃÓ ÇáãÇá ÇáãÏÝæÚ 800,000,000 ÑíÇá ÓÚæÏí- ÑÃÓ ÇáãÇá ÇáãÕÑÍ Èå 800,000,000

/28112017/1/1
Initial Schedule of Members

Invoice No. : 01136709

Invoice Date : 27/11/2017
Contract Period : 14/11/2017 To 13/11/2018
Customer Name : Bupa Direct - Fawateh Alkheer Consulting Engineering Office
Customer No. : 45104700
Branch/Division/Cost Centre Bupa Arabia For Cooperative Insurance
:
: CR No. 4030178881
Product : BUPA Direct - White Advanced (S)
Membership No. Membership Name Dept. Code Staff No. Contract Premium
15466723 Islam Kamal Lutfi 403.00
15466724 Hanen Kamalelden Lotfe Mohammed 303.00
15466725 Mohammed Kamal 342.00
15466726 Osama Kamaluldeen Lutfi Mohammed 342.00
15466727 Eyad Kamaluldeen Lutfi Ata 424.00
15466728 Mohaned Kamaleldin Loutfi Ata 701.00
15466729 Ahmed Kamaluldeen Lutfi Mohammed 303.00
15466732 Lama Amro Mohammed Amin 497.00
15466733 Abdalah Amro Mohammed Abdulhai 424.00
15466734 Roua Amro Mohammed Abdulhai 859.00
15466737 Amr Mohamed Fathi Attia 701.00
15466738 Moaaz Mohamed Fathi Attia 701.00
15466741 Barah Abdulrahman Abrahyamzaoy Ibrahim 497.00
15466742 Mohammed Abdelrahman Ibrahim Ibrahim 424.00
15466745 Abdulrahman Hussam Hassan 424.00
15466746 Mohammed Hussam Hassan Tayfur 424.00
15466747 Anas Hosam Hassan Hassan 701.00
15466750 Islam Ayman 342.00
15466751 Maryam Ayman Anis Albadri 472.00
15466752 Mohammed Ayman Anis Albadri 424.00
15466755 Zainab Alamin 403.00
15466756 Mohammed Abdulmonem 303.00
15466759 Mohamad Ahmad Alsaid Ahmad 342.00
15466760 Abdualmunim Ahmad Alsaid Ahmad 424.00
15466763 Ayah Abdulmoghani Atiah 403.00
15466764 Anas Abdelmoghny Abdelhay Attia 342.00
15466766 Omar Mohamed Abdelhafiz Moursy 303.00
15466767 Osama Mohamed Abdelhafiz Morsy 303.00
15466770 Abdulrahman Mohammed Iraqi 342.00
15466771 Marwan Mohammed Iraqi 424.00
15466772 Fauroz Mohamed Eraki Awad Alla 859.00
15466775 Salma Ahmed Mosad Hebish 497.00
15466776 Yousef Ahmed Mosad Hebish 701.00
15466779 Mazin Ramy Mohamed Soliman 701.00
15466782 Omar Alaa Galal Moahmed 701.00
15466783 Hamza Alaa Gala Alaa Jalal Mohamed 701.00
15466785 Asil Ismail Abdelaal Ibrahim 859.00
15466788 Aser Mahmoud Sayed Mohamed 701.00
15466791 Ziyad Abdulmaghna 701.00
15466834 Hibah Ibrahim Eisi S 477.00
15466835 Maysar Mousa Mohammed Eisi S 2,468.00

Number of Members for Product : 41 22,663.00

/28112017/2/1
Initial Schedule of Members

Invoice No. : 01136709

Invoice Date : 27/11/2017
Contract Period : 14/11/2017 To 13/11/2018
Customer Name : Bupa Direct - Fawateh Alkheer Consulting Engineering Office
Customer No. : 45104700
Branch/Division/Cost Centre Bupa Arabia For Cooperative Insurance
:
: CR No. 4030178881
Product : BUPA Direct - White Advanced
Membership No. Membership Name Dept. Code Staff No. Contract Premium
15466720 Kamaluldeen Lutfi Mohammed 1,766.00
15466721 Amal Mahmoud Abdelalem Alsnose 2,027.00
15466722 Nafin Mustafa Nayil Mohammed 1,448.00
15466730 Amro Mohammed Amin Abdulhai 590.00
15466731 Shaimaa Abdalla Mohamed Abdelnabbi 1,521.00
15466735 Mohamed Fathi Elsayed Attia 590.00
15466736 Smah Ibrhyam Moahmed Ibrhyam 1,359.00
15466739 Abdelrahman Ibrahim Dawi Ibrahim 1,249.00
15466740 Magda Sied Ahmed Yosaf Saied Ahmed 2,468.00
15466743 Hosam Hassan Daifour Hassan 955.00
15466744 Samiha Khalaf Ismail Attia 1,430.00
15466748 Ayman Anis Albadri 724.00
15466749 Nadiyah Fathi Abdulfattah Alhabibi 1,430.00
15466753 Abdulmonem A Mohammed A 1,766.00
15466754 Fawziah Othman Alawadh Ali 2,468.00
15466757 Ahmd Mohamad Alsaid Ahmad 955.00
15466758 Obaida Ahmad Shrideh 1,521.00
15466761 Abdelmoghny Abdelhay Ibrahim Attia 2,390.00
15466762 Fawzya Ahmed Rashed Shoulah 2,027.00
15466765 Mohammed Abdulhafith Mursi Mansour 955.00
15466768 Mohamed Eraki Mohamed Awad Alla 590.00
15466769 Fatmah Ali Mohammed Elsangri 1,521.00
15466773 Ahmed Mosaad Ibrahim Hebish 477.00
15466774 Shimaa Mosad Mosad Hamouda 1,359.00
15466777 Ramy Mohamed Abdelazim Soliman 477.00
15466778 Nora Abduallah 1,430.00
15466780 Alaa Galal Haridy Mohamed 590.00
15466781 Elsayed Ahmed Hamza Marwa 1,359.00
15466784 Ismail Abdelaal Mohamed Ibrahim 403.00
15466786 Mahmoud Sayed Aly Mohamed 403.00
15466787 Hader Mohamed Abdelsadek Mohamed 1,259.00
15466789 Ahmed Abdalmoghny Abdalhay Ibrahim 403.00
15466790 Manal Abdu 1,359.00
15466792 Mohammed Abdulfattah Abdulhamid Alikal 1,249.00
15466793 Mohammed Ahmed Abdullatif Ahmed Othman 1,249.00
15466794 Mohammed Robiul Harunar Rashid 590.00
15466795 Ahmed Salah Attia Elhoussiny 477.00
15466796 Mohammed Ali Mohammed Amin 477.00
15466797 Mohamed Gafar Ali Mohamed 590.00
15466798 Hamada Refaat Abdelhafiz Moursy 403.00
15466799 Atta Abdelrahman Mohamed Elgamal 955.00
15466800 Mohamed Alweali 1,249.00
15466801 Mohammed Kutty Akkara Parambil 955.00
15466802 Mohamed Samir Mohamed Moustafa 403.00
15466803 Ahmad Ali 403.00
15466804 Midhat Abdulaziz Atiah Humrah 1,249.00
15466805 Ahmed Mohamed Hassan Abdellah 477.00
15466806 Osama Mohamed Mohamed Aly 477.00

/28112017/3/1
Initial Schedule of Members

Invoice No. : 01136709

Invoice Date : 27/11/2017
Contract Period : 14/11/2017 To 13/11/2018
Customer Name : Bupa Direct - Fawateh Alkheer Consulting Engineering Office
Customer No. : 45104700
Branch/Division/Cost Centre Bupa Arabia For Cooperative Insurance
:
: CR No. 4030178881
Product : BUPA Direct - White Advanced
Membership No. Membership Name Dept. Code Staff No. Contract Premium
15466807 Abdulkader Kouilakam 955.00
15466808 Tamimi Farouk Mohammed Osman 590.00
15466809 Yaser Abdullah Mohammed Alsalahi 477.00
15466810 Mohammad Shahid Ayub Khan 955.00
15466811 Ahmed Gamal Ibrahim Mohamed 403.00
15466812 Ahmed Abdelaziz Assem Abdelsalam 477.00
15466813 Mohamed Ibrahim Hassan Ibrahim 590.00
15466814 Abdeltawwab Ahmed Gomaa Mohamed 590.00
15466815 Ahmed Belal Ahmed Mostafa 403.00
15466816 Ahmed Abdulaziz Abdulmawjud Abdulaal 590.00
15466817 Kinattin Mohammed 955.00
15466818 Firoz Hossain 590.00
15466819 Mukhtar Mahfouz Marsa Mansour 590.00
15466820 Ahmed Mohamed Ahmed Mohamed 403.00
15466821 Mahmoud Abdulrahman Mohammed Aljamal 1,249.00
15466822 Ahmed Samir Fawzi Elgouhari 477.00
15466823 Saithalavi Akkaraparambil Muhammed 403.00
15466824 Md Nasir Fakir Dalil 590.00
15466825 Salim Molui Abdulsalam 955.00
15466826 Abdulla Abdlhmed Abwod 955.00
15466827 Hussein Ahmed Mahdi Algaishi 1,766.00
15466828 Haitham Abdullah 359.00
15466829 Omar Alshehri 359.00
15466830 Faisal Alshehri 403.00
15466831 Abdulsalam Husain 1,766.00
15466832 Essa Ibrahim Essa S 477.00
15466833 Mousa Ibrahim Issa Shaltaf 359.00

Number of Members for Product : 75 71,158.00

Total Number of Initial Members : 116 93,821.00

/28112017/4/1
Agreed Invoicing and Payment Schedule:

Contract Period : 14/11/2017 To 13/11/2018

Invoicing : Non-Distributed
Customer Name : Bupa Direct - Fawateh Alkheer Consulting Engineering Office
Customer No. : 45104700
Branch/Division/Cost Centre :

Installment % Invoice date Payment date Amount (SR)

First Payment 24.00% 27/11/2017 14/11/2017 22,517.04

Second Payment 26.00% 11/12/2017 14/12/2017 24,393.46
Third Payment 25.00% 14/12/2017 14/01/2018 23,455.25
Fourth Payment 25.00% 14/01/2018 14/02/2018 23,455.25

100.00% Total Contract Value of Inception members: 93,821.00

/28112017/5/1
Initial Schedule of Members

Invoice No. : 01136709

Invoice Date : 27/11/2017
Contract Period : 14/11/2017 To 13/11/2018
Customer Name : Bupa Direct - Fawateh Alkheer Consulting Engineering Office
Customer No. : 45104700
Branch/Division/Cost Centre Bupa Arabia For Cooperative Insurance
:
: CR No. 4030178881
Policy No. : 451047001
Membership No. Membership Name Dept. Code Staff No. Contract Premium
15466723 Islam Kamal Lutfi 403.00
15466724 Hanen Kamalelden Lotfe Mohammed 303.00
15466725 Mohammed Kamal 342.00
15466726 Osama Kamaluldeen Lutfi Mohammed 342.00
15466727 Eyad Kamaluldeen Lutfi Ata 424.00
15466728 Mohaned Kamaleldin Loutfi Ata 701.00
15466729 Ahmed Kamaluldeen Lutfi Mohammed 303.00
15466732 Lama Amro Mohammed Amin 497.00
15466733 Abdalah Amro Mohammed Abdulhai 424.00
15466734 Roua Amro Mohammed Abdulhai 859.00
15466737 Amr Mohamed Fathi Attia 701.00
15466738 Moaaz Mohamed Fathi Attia 701.00
15466741 Barah Abdulrahman Abrahyamzaoy Ibrahim 497.00
15466742 Mohammed Abdelrahman Ibrahim Ibrahim 424.00
15466745 Abdulrahman Hussam Hassan 424.00
15466746 Mohammed Hussam Hassan Tayfur 424.00
15466747 Anas Hosam Hassan Hassan 701.00
15466750 Islam Ayman 342.00
15466751 Maryam Ayman Anis Albadri 472.00
15466752 Mohammed Ayman Anis Albadri 424.00
15466755 Zainab Alamin 403.00
15466756 Mohammed Abdulmonem 303.00
15466759 Mohamad Ahmad Alsaid Ahmad 342.00
15466760 Abdualmunim Ahmad Alsaid Ahmad 424.00
15466763 Ayah Abdulmoghani Atiah 403.00
15466764 Anas Abdelmoghny Abdelhay Attia 342.00
15466766 Omar Mohamed Abdelhafiz Moursy 303.00
15466767 Osama Mohamed Abdelhafiz Morsy 303.00
15466770 Abdulrahman Mohammed Iraqi 342.00
15466771 Marwan Mohammed Iraqi 424.00
15466772 Fauroz Mohamed Eraki Awad Alla 859.00
15466775 Salma Ahmed Mosad Hebish 497.00
15466776 Yousef Ahmed Mosad Hebish 701.00
15466779 Mazin Ramy Mohamed Soliman 701.00
15466782 Omar Alaa Galal Moahmed 701.00
15466783 Hamza Alaa Gala Alaa Jalal Mohamed 701.00
15466785 Asil Ismail Abdelaal Ibrahim 859.00
15466788 Aser Mahmoud Sayed Mohamed 701.00
15466791 Ziyad Abdulmaghna 701.00
15466834 Hibah Ibrahim Eisi S 477.00
15466835 Maysar Mousa Mohammed Eisi S 2,468.00

Number of Members for Product : 41 22,663.00

/28112017/6/1
Initial Schedule of Members

Invoice No. : 01136709

Invoice Date : 27/11/2017
Contract Period : 14/11/2017 To 13/11/2018
Customer Name : Bupa Direct - Fawateh Alkheer Consulting Engineering Office
Customer No. : 45104700
Branch/Division/Cost Centre Bupa Arabia For Cooperative Insurance
:
: CR No. 4030178881
Policy No. : 451047001
Membership No. Membership Name Dept. Code Staff No. Contract Premium
15466720 Kamaluldeen Lutfi Mohammed 1,766.00
15466721 Amal Mahmoud Abdelalem Alsnose 2,027.00
15466722 Nafin Mustafa Nayil Mohammed 1,448.00
15466730 Amro Mohammed Amin Abdulhai 590.00
15466731 Shaimaa Abdalla Mohamed Abdelnabbi 1,521.00
15466735 Mohamed Fathi Elsayed Attia 590.00
15466736 Smah Ibrhyam Moahmed Ibrhyam 1,359.00
15466739 Abdelrahman Ibrahim Dawi Ibrahim 1,249.00
15466740 Magda Sied Ahmed Yosaf Saied Ahmed 2,468.00
15466743 Hosam Hassan Daifour Hassan 955.00
15466744 Samiha Khalaf Ismail Attia 1,430.00
15466748 Ayman Anis Albadri 724.00
15466749 Nadiyah Fathi Abdulfattah Alhabibi 1,430.00
15466753 Abdulmonem A Mohammed A 1,766.00
15466754 Fawziah Othman Alawadh Ali 2,468.00
15466757 Ahmd Mohamad Alsaid Ahmad 955.00
15466758 Obaida Ahmad Shrideh 1,521.00
15466761 Abdelmoghny Abdelhay Ibrahim Attia 2,390.00
15466762 Fawzya Ahmed Rashed Shoulah 2,027.00
15466765 Mohammed Abdulhafith Mursi Mansour 955.00
15466768 Mohamed Eraki Mohamed Awad Alla 590.00
15466769 Fatmah Ali Mohammed Elsangri 1,521.00
15466773 Ahmed Mosaad Ibrahim Hebish 477.00
15466774 Shimaa Mosad Mosad Hamouda 1,359.00
15466777 Ramy Mohamed Abdelazim Soliman 477.00
15466778 Nora Abduallah 1,430.00
15466780 Alaa Galal Haridy Mohamed 590.00
15466781 Elsayed Ahmed Hamza Marwa 1,359.00
15466784 Ismail Abdelaal Mohamed Ibrahim 403.00
15466786 Mahmoud Sayed Aly Mohamed 403.00
15466787 Hader Mohamed Abdelsadek Mohamed 1,259.00
15466789 Ahmed Abdalmoghny Abdalhay Ibrahim 403.00
15466790 Manal Abdu 1,359.00
15466792 Mohammed Abdulfattah Abdulhamid Alikal 1,249.00
15466793 Mohammed Ahmed Abdullatif Ahmed Othman 1,249.00
15466794 Mohammed Robiul Harunar Rashid 590.00
15466795 Ahmed Salah Attia Elhoussiny 477.00
15466796 Mohammed Ali Mohammed Amin 477.00
15466797 Mohamed Gafar Ali Mohamed 590.00
15466798 Hamada Refaat Abdelhafiz Moursy 403.00
15466799 Atta Abdelrahman Mohamed Elgamal 955.00
15466800 Mohamed Alweali 1,249.00
15466801 Mohammed Kutty Akkara Parambil 955.00
15466802 Mohamed Samir Mohamed Moustafa 403.00
15466803 Ahmad Ali 403.00
15466804 Midhat Abdulaziz Atiah Humrah 1,249.00
15466805 Ahmed Mohamed Hassan Abdellah 477.00
15466806 Osama Mohamed Mohamed Aly 477.00
15466807 Abdulkader Kouilakam 955.00
15466808 Tamimi Farouk Mohammed Osman 590.00

/28112017/7/1
Initial Schedule of Members

Invoice No. : 01136709

Invoice Date : 27/11/2017
Contract Period : 14/11/2017 To 13/11/2018
Customer Name : Bupa Direct - Fawateh Alkheer Consulting Engineering Office
Customer No. : 45104700
Branch/Division/Cost Centre Bupa Arabia For Cooperative Insurance
:
: CR No. 4030178881
Policy No. : 451047001
Membership No. Membership Name Dept. Code Staff No. Contract Premium
15466809 Yaser Abdullah Mohammed Alsalahi 477.00
15466810 Mohammad Shahid Ayub Khan 955.00
15466811 Ahmed Gamal Ibrahim Mohamed 403.00
15466812 Ahmed Abdelaziz Assem Abdelsalam 477.00
15466813 Mohamed Ibrahim Hassan Ibrahim 590.00
15466814 Abdeltawwab Ahmed Gomaa Mohamed 590.00
15466815 Ahmed Belal Ahmed Mostafa 403.00
15466816 Ahmed Abdulaziz Abdulmawjud Abdulaal 590.00
15466817 Kinattin Mohammed 955.00
15466818 Firoz Hossain 590.00
15466819 Mukhtar Mahfouz Marsa Mansour 590.00
15466820 Ahmed Mohamed Ahmed Mohamed 403.00
15466821 Mahmoud Abdulrahman Mohammed Aljamal 1,249.00
15466822 Ahmed Samir Fawzi Elgouhari 477.00
15466823 Saithalavi Akkaraparambil Muhammed 403.00
15466824 Md Nasir Fakir Dalil 590.00
15466825 Salim Molui Abdulsalam 955.00
15466826 Abdulla Abdlhmed Abwod 955.00
15466827 Hussein Ahmed Mahdi Algaishi 1,766.00
15466828 Haitham Abdullah 359.00
15466829 Omar Alshehri 359.00
15466830 Faisal Alshehri 403.00
15466831 Abdulsalam Husain 1,766.00
15466832 Essa Ibrahim Essa S 477.00
15466833 Mousa Ibrahim Issa Shaltaf 359.00

Number of Members for Product : 75 71,158.00

/28112017/8/1