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ﺑﻴﺎﻧﺎﺕ ﺍﻟﺤﺎﺩﺙ
3 ﻋﺪﺩ ﺍﻟﻤﺮﻛﺒﺎﺕ ﺍﻟﻤﺸﺘﺮﻛﺔ ﺑﺎﻟﺤﺎﺩﺙ ﻋﺪﻡ ﺗﺮﻙ ﻣﺴﺎﻓﺔ ﻛﺎﻓﻴﺔ ﺳﺒﺐ ﺍﻟﺤﺎﺩﺙ ﺍﻟﺮﺋﻴﺴﻰ 04/04/2018 ﺗﺎﺭﻳﺦ ﺍﻟﺤﺎﺩﺙ
No. of Vehicles Involved Primary Cause Accident Date
ﻣﻌﺒﺪ -ﺟﺎﻑ ﺣﺎﻟﺔ ﺳﻄﺢ ﺍﻟﻄﺮﻳﻖ ﻻ ﻳﻮﺟﺪ ﺳﺒﺐ ﺍﻟﺤﺎﺩﺙ ﺍﻟﺜﺎﻧﻮﻱ 21:08 ﻭﻗﺖ ﺍﻟﺤﺎﺩﺙ
Road Condition Secondary Cause Accident Time
The Affected Party ﺍﻟﻄﺮﻑ ﺍﻟﻤﺘﻀﺮﺭ )( / The Liable Party ﺍﻟﻄﺮﻑ ﺍﻟﻤﺘﺴﺒﺐ ﺑﺎﻟﺤﺎﺩﺙ /
ﺍﻭﺩﺍﻱ ﺭﺍﺝ ﺳﻴﻨﻎ ﻳﺎﺩﺍﻑ ﺭﺍﺷﺪ ﺣﺴﻴﻦ Driver Name ﺍﺳﻢ ﺍﻟﺴﺎﺋﻖ
971509221117 Mobile Number ﺭﻗﻢ ﺍﻟﻬﺎﺗﻒ
02/02/1971 20/03/1992 Age ﺍﻟﻌﻤﺮ
ﺫﻛﺮ ﺫﻛﺮ Gender ﺍﻟﺠﻨﺲ
ﺍﻟﻬﻨﺪ ﺍﻟﻬﻨﺪ Nationality ﺍﻟﺠﻨﺴﻴﺔ
647177 3718110 License No ﺭﻗﻢ ﺍﻟﺮﺧﺼﺔ
ﺩﺑﻲ ﺩﺑﻲ License Issue Place ﻣﺼﺪﺭ ﺍﻟﺮﺧﺼﺔ
25/10/2022 07/05/2027 License Expiry Date ﺗﺎﺭﻳﺦ ﺍﻧﺘﻬﺎﺀ ﺍﻟﺮﺧﺼﺔ
ـــ 9000808486 Liable Party Fine No ﺭﻗﻢ ﻣﺨﺎﻟﻔﺔ ﺍﻟﻤﺘﺴﺒﺐ
ﺷﺮﻛﺔ ﺍﻭﺭﻳﻨﺖ ﻟﻠﺘﺄﻣﻴﻦ ﻣﺴﺎﻫﻤﺔ ﻋﺎﻣﺔ ﺷﺮﻛﻪ ﺍﻟﻌﻴﻦ ﺍﻻﻫﻠﻴﻪ ﻟﻠﺘﺎﻣﻴﻦ Insurance Company ﺷﺮﻛﺔ ﺍﻟﺘﺄﻣﻴﻦ
01/1033228 T1/12101009 Policy No ﺭﻗﻢ ﺍﻟﺒﻮﻟﻴﺼﺔ
30/11/2018 12/05/2018 Ins. Expiry Date ﺗﺎﺭﻳﺦ ﺍﻧﺘﻬﺎﺀ ﺍﻟﺒﻮﺑﻴﺼﺔ
43326ﺩﺑﻲ ﺧﺼﻮﺻﻲ B 84135ﺍﺑﻮ ﻇﺒﻲ ﺧﺼﻮﺻﻲ 9 Plate Details ﺑﻴﺎﻧﺎﺕ ﺍﻟﻠﻮﺣﺔ
ﺍﻟﻔﻄﻴﻢ ﺍﻟﻬﻨﺪﺳﻴﺔ )ﺵ ﺫ ﻡ ﻡ( ﻧﺠﻢ ﺍﻟﻤﺮﺳﺎﻝ ﻟﻠﻤﻘﺎﻭﻻﺕ ﺍﻟﻌﺎﻣﻪ ﻭﻗﻴﺎﺱ ﺍﻟﻤﺴﺎﺣﻪ Owner Name ﺍﺳﻢ ﺍﻟﻤﺎﻟﻚ
ﺗﻮﻳﻮﺗﺎ - - YARISﺍﺑﻴﺾ 2009 - ﺟﻴﺐ -ﺷﻴﺮﻭﻛﻲ -ﺑﻨﻲ 2002 - ﺍﻟﻨﻮﻉ-ﺍﻟﻄﺮﺍﺯ-ﺍﻟﻠﻮﻥ-ﺍﻟﺴﻨﺔ Make-Model-Color-Year
ﻣﻼﺣﻈﺎﺕ ﻫﺎﻣﺔ:
ﺗﻘﺪﻡ ﺗﻘﺎﺭﻳﺮ ﺗﻜﺎﻟﻴﻒ ﺗﺼﻠﻴﺢ ﻣﺮﻛﺒﺎﺕ ﺍﻷﻃﺮﺍﻑ ﺍﻟﻤﺘﻀﺮﺭﺓ ﺇﻟﻰ ﺷﺮﻛﺔ ﺍﻟﺘﺄﻣﻴﻦ .ﻭ ﻓﻴﻲ ﺣﺎﻟﺔ ﻋﺪﻡ ﻗﺒﻮﻟﻬﺎ ﻣﻦ ﻗﺒﻞ ﺍﻟﺸﺮﻛﺔ ﺍﻟﻤﺨﺘﺼﺔ ﺗﺤﺎﻝ ﺇﻟﻰ ﺍﻟﺸﺮﻃﺔ ﻻﻋﺘﻤﺎﺩﻫﺎ. .1
ﻻ ﻣﺎﻧﻊ ﻣﻦ ﺗﺼﻠﻴﺢ ﺍﻷﺿﺮﺍﺭ ﺍﻟﺘﻲ ﺣﺼﻠﺖ ﻓﻲ ﺍﻟﻤﺮﻛﺒﺎﺕ ﺍﻟﻤﺸﺘﺮﻛﺔ ﻓﻲ ﺍﻟﺤﺎﺩﺙ ﺍﻟﻤﺪﻭﻧﺔ ﺗﻔﺎﺻﻴﻠﻪ ﺃﻋﻼﻩ. .2
ﻟﻐﺎﻳﺔ ﺍﻹﻋﺘﺮﺍﺽ ﻋﻠﻰ ﺍﻟﺘﻘﺮﻳﺮﻳﺮﺟﻰ ﺯﻳﺎﺭﺓﺍﻟﻤﺮﻛﺰ ﺍﻟﻤﻌﻨﻲ ﺧﻼﻝ 24ﺳﺎﻋﺔ. .3
ﻧﺴﺨﺔ ﺍﻟﻤﺘﺴﺒﺐ ﺑﺎﻟﺤﺎﺩﺙ ﺍﻟﺮﻗﻢ ﺍﻟﺴﺮﻱ Security Code / ﺭﻗﻢ ﺍﻟﺘﻘﺮﻳﺮ Report Number /
Liable Party Copy 4401 202609700407
ﺍﻟﻤﺮﻛﺰ 04/04/2018 ﺗﺎﺭﻳﺦ ﺍﻟﺘﻘﺮﻳﺮ Report Date /
ﺑﻴﺎﻧﺎﺕ ﺍﻟﺤﺎﺩﺙ
3 ﻋﺪﺩ ﺍﻟﻤﺮﻛﺒﺎﺕ ﺍﻟﻤﺸﺘﺮﻛﺔ ﺑﺎﻟﺤﺎﺩﺙ ﻋﺪﻡ ﺗﺮﻙ ﻣﺴﺎﻓﺔ ﻛﺎﻓﻴﺔ ﺳﺒﺐ ﺍﻟﺤﺎﺩﺙ ﺍﻟﺮﺋﻴﺴﻰ 04/04/2018 ﺗﺎﺭﻳﺦ ﺍﻟﺤﺎﺩﺙ
No. of Vehicles Involved Primary Cause Accident Date
ﻣﻌﺒﺪ -ﺟﺎﻑ ﺣﺎﻟﺔ ﺳﻄﺢ ﺍﻟﻄﺮﻳﻖ ﻻ ﻳﻮﺟﺪ ﺳﺒﺐ ﺍﻟﺤﺎﺩﺙ ﺍﻟﺜﺎﻧﻮﻱ 21:08 ﻭﻗﺖ ﺍﻟﺤﺎﺩﺙ
Road Condition Secondary Cause Accident Time
The Affected Party ﺍﻟﻄﺮﻑ ﺍﻟﻤﺘﻀﺮﺭ )( / The Liable Party ﺍﻟﻄﺮﻑ ﺍﻟﻤﺘﺴﺒﺐ ﺑﺎﻟﺤﺎﺩﺙ /
ﺷﺎﻧﺪ ﺷﻴﺮﻭﻓﺎﻳﺎﻟﻴﻞ ﻛﺎﺭﻭﻓﺎﻧﺖ ﻓﺎﻻﺑﻴﻞ ﺭﺍﺷﺪ ﺣﺴﻴﻦ Driver Name ﺍﺳﻢ ﺍﻟﺴﺎﺋﻖ
971504351226 Mobile Number ﺭﻗﻢ ﺍﻟﻬﺎﺗﻒ
10/04/1982 20/03/1992 Age ﺍﻟﻌﻤﺮ
ﺫﻛﺮ ﺫﻛﺮ Gender ﺍﻟﺠﻨﺲ
ﺍﻟﻬﻨﺪ ﺍﻟﻬﻨﺪ Nationality ﺍﻟﺠﻨﺴﻴﺔ
1694054 3718110 License No ﺭﻗﻢ ﺍﻟﺮﺧﺼﺔ
ﺩﺑﻲ ﺩﺑﻲ License Issue Place ﻣﺼﺪﺭ ﺍﻟﺮﺧﺼﺔ
06/06/2021 07/05/2027 License Expiry Date ﺗﺎﺭﻳﺦ ﺍﻧﺘﻬﺎﺀ ﺍﻟﺮﺧﺼﺔ
ـــ 9000808486 Liable Party Fine No ﺭﻗﻢ ﻣﺨﺎﻟﻔﺔ ﺍﻟﻤﺘﺴﺒﺐ
ﺷﺮﻛﺔ ﺍﻭﺭﻳﻨﺖ ﻟﻠﺘﺄﻣﻴﻦ ﻣﺴﺎﻫﻤﺔ ﻋﺎﻣﺔ ﺷﺮﻛﻪ ﺍﻟﻌﻴﻦ ﺍﻻﻫﻠﻴﻪ ﻟﻠﺘﺎﻣﻴﻦ Insurance Company ﺷﺮﻛﺔ ﺍﻟﺘﺄﻣﻴﻦ
04/1023169 T1/12101009 Policy No ﺭﻗﻢ ﺍﻟﺒﻮﻟﻴﺼﺔ
18/11/2018 12/05/2018 Ins. Expiry Date ﺗﺎﺭﻳﺦ ﺍﻧﺘﻬﺎﺀ ﺍﻟﺒﻮﺑﻴﺼﺔ
84365ﺩﺑﻲ ﺧﺼﻮﺻﻲ P 84135ﺍﺑﻮ ﻇﺒﻲ ﺧﺼﻮﺻﻲ 9 Plate Details ﺑﻴﺎﻧﺎﺕ ﺍﻟﻠﻮﺣﺔ
ﺷﺎﻧﺪ ﺷﻴﺮﻭﻓﺎﻳﺎﻟﻴﻞ ﻛﺎﺭﻭﻓﺎﻧﺖ ﻓﺎﻻﺑﻴﻞ ﻧﺠﻢ ﺍﻟﻤﺮﺳﺎﻝ ﻟﻠﻤﻘﺎﻭﻻﺕ ﺍﻟﻌﺎﻣﻪ ﻭﻗﻴﺎﺱ ﺍﻟﻤﺴﺎﺣﻪ Owner Name ﺍﺳﻢ ﺍﻟﻤﺎﻟﻚ
- - TOYOTA YARISﺍﺑﻴﺾ 2015 - ﺟﻴﺐ -ﺷﻴﺮﻭﻛﻲ -ﺑﻨﻲ 2002 - ﺍﻟﻨﻮﻉ-ﺍﻟﻄﺮﺍﺯ-ﺍﻟﻠﻮﻥ-ﺍﻟﺴﻨﺔ Make-Model-Color-Year
ﻣﻼﺣﻈﺎﺕ ﻫﺎﻣﺔ:
ﺗﻘﺪﻡ ﺗﻘﺎﺭﻳﺮ ﺗﻜﺎﻟﻴﻒ ﺗﺼﻠﻴﺢ ﻣﺮﻛﺒﺎﺕ ﺍﻷﻃﺮﺍﻑ ﺍﻟﻤﺘﻀﺮﺭﺓ ﺇﻟﻰ ﺷﺮﻛﺔ ﺍﻟﺘﺄﻣﻴﻦ .ﻭ ﻓﻴﻲ ﺣﺎﻟﺔ ﻋﺪﻡ ﻗﺒﻮﻟﻬﺎ ﻣﻦ ﻗﺒﻞ ﺍﻟﺸﺮﻛﺔ ﺍﻟﻤﺨﺘﺼﺔ ﺗﺤﺎﻝ ﺇﻟﻰ ﺍﻟﺸﺮﻃﺔ ﻻﻋﺘﻤﺎﺩﻫﺎ. .1
ﻻ ﻣﺎﻧﻊ ﻣﻦ ﺗﺼﻠﻴﺢ ﺍﻷﺿﺮﺍﺭ ﺍﻟﺘﻲ ﺣﺼﻠﺖ ﻓﻲ ﺍﻟﻤﺮﻛﺒﺎﺕ ﺍﻟﻤﺸﺘﺮﻛﺔ ﻓﻲ ﺍﻟﺤﺎﺩﺙ ﺍﻟﻤﺪﻭﻧﺔ ﺗﻔﺎﺻﻴﻠﻪ ﺃﻋﻼﻩ. .2
ﻟﻐﺎﻳﺔ ﺍﻹﻋﺘﺮﺍﺽ ﻋﻠﻰ ﺍﻟﺘﻘﺮﻳﺮﻳﺮﺟﻰ ﺯﻳﺎﺭﺓﺍﻟﻤﺮﻛﺰ ﺍﻟﻤﻌﻨﻲ ﺧﻼﻝ 24ﺳﺎﻋﺔ. .3