‫ﺷﻬﺎﺩﺓ ﺍﻟﺘﺎﻣﻴﻦ ﺍﻟﺸﺎﻣﻞ ﻭﺍﻟﻤﺴﺆﻭﻟﻴﺔ ﺗﺠﺎﻩ ﺍﻟﻄﺮﻑ ﺍﻟﺜﺎﻟﺚ‬ BA-568

Comprehensive and Third Party Liabilities Insurance Certificate

‫ﺷﺮﻛﺎﺕ‬ ‫ﻧﻮﻉ ﺍﻟﻤﺆﻣﻦ ﻟﻪ‬ 02/11/2020 ‫ﺗﺎﺭﻳﺦ ﺍﻻﺻﺪﺍﺭ‬ P/300/2902/20/001123 ‫ﺭﻗﻢ ﺍﻟﻮﺛﻴﻘﺔ‬
Corporate Insured Type 17/03/1442 Issue Date Policy No
07/11/2021 ‫ﺍﻟﻰ ﺗﺎﺭﻳﺦ‬ 08/11/2020 ‫ﻣﻦ ﺗﺎﺭﻳﺦ‬ P/300/2902/20/001123 ‫ﺭﻗﻢ ﺍﻟﻤﻠﺤﻖ‬
02/04/1443 Date To 23/03/1442 Date From Endo No

Insured Details ‫ﺑﻴﺎﻧﺎﺕ ﺍﻟﻤﺆﻣﻦ ﻟﻪ‬

‫ﺷﺮﻛﺔ ﻋﺒﺪﺍﻟﻠﻪ ﻋﺒﺪﺍﻟﻮﻫﺎﺏ ﺍﻟﺒﺮﺍﻙ ﻭﺃﻭﻻﺩﻩ‬ ‫ﺍﺳﻢ ﺍﻟﻤﺆﻣﻦ ﻟﻪ‬
ABDULLAH ABDULWAHAB AL BARRAK AND SONS CO Insured Name

‫ﺷﺮﻛﺔ ﻋﺒﺪﺍﻟﻠﻪ ﺑﻦ ﻋﺒﺪﺍﻟﻮﻫﺎﺏ ﺍﻟﺒﺮﺍﻙ ﻭﺃﻭﻻﺩﻩ‬ ‫ﺍﺳﻢ ﺍﻟﻤﺴﺘﺨﺪﻡ‬

Driver Name
3240-‫ ﺷﺎﺭﻉ‬JUBAIL-‫ﺍﻟﻤﻨﻄﻘﺔ ﺍﻟﺸﺮﻗﻴﺔ‬-120 ‫ﻭﺣﺪﻩ ﺭﻗﻢ‬-‫ ﺣﻲ ﺍﻟﻤﻨﻄﻘﺔ ﺍﻟﺼﻨﺎﻋﻴﺔ ﺍﻻﻭﻟﻲ‬35717- ‫ﻋﻨﻮﺍﻥ ﻭﺍﺻﻞ‬
Wasel Address
Vehicle Details ‫ﺑﻴﺎﻧﺎﺕ ﺍﻟﻤﺮﻛﺒﺔ‬
726578210 ‫ﺍﻟﺮﻗﻢ ﺍﻟﺘﺴﻠﺴﻠﻲ‬ MB1PBEJA6EH1E3142 ‫ﺭﻗﻢ ﺍﻟﻬﻴﻜﻞ‬ 6675 ‫ﺃ ﻫـ ﺭ‬ ‫ﺭﻗﻢ ﺍﻟﻠﻮﺣﻪ‬
Vehicle Plate No.
Sequence No. Chassis No 6675 RHA
‫ﺭﻗﻢ ﺍﻟﺒﻄﺎﻗﺔ ﺍﻟﺠﻤﺮﻛﻴﺔ‬ ‫ﺍﺑﻴﺾ‬ ‫ﻟﻮﻥ ﺍﻟﻤﺮﻛﺒﺔ‬ ‫ﺍﻟﺤﺎﻓﻠﺔ ﺍﻟﻤﺘﻮﺳﻄﺔ‬ ‫ﻧﻮﻉ ﺍﻟﻬﻴﻜﻞ‬
Custom ID Vehicle Color Body Type
White
2014 ‫ﺳﻨﺔ ﺍﻟﺼﻨﻊ‬ ‫ﻟﻴﻼﻧﺪ ﺑﺎﺹ‬ ‫ﻣﻮﺩﻳﻞ ﺍﻟﻤﺮﻛﺒﺔ‬ ‫ﺃﺷﻮﻙ‬ ‫ﻣﺎﺭﻛﺔ ﺍﻟﻤﺮﻛﺒﺔ‬
Make Year LEYLAND BUS. Vehicle Model ASHOK Vehicle Make
‫ﺭﻗﻢ ﺍﻟﺸﺮﻛﺔ‬
Company No

‫ﺍﻟﻤﻤﻠﻜﺔ ﺍﻟﻌﺮﺑﻴﺔ ﺍﻟﺴﻌﻮﺩﻳﺔ‬ ‫ﺍﻟﺤﺪﻭﺩ ﺍﻟﺠﻐﺮﺍﻓﻴﺔ‬

Kingdom of Saudi Arabia Geographical Area

‫ﻳﺠﺐ ﻋﻠﻰ ﺍﻟﻤﺆﻣﻦ ﻟﻪ ﺃﻥ ﻻ ﻳﺴﺘﻌﻤﻞ ﺍﻟﻤﺮﻛﺒﺔ ﺇﻻ ﻟﻠﻐﺮﺽ ﺍﻟﻤﺮﺧﺺ ﻣﻦ ﺃﺟﻠﻪ‬ ‫ﻗﻴﻮﺩ ﺍﻹﺳﺘﻌﻤﺎﻝ‬
The insured must use the vehicle only for the purpose declared and licensed Limitations as to Use

‫ ﺭﻳﺎﻝ ﻟﻼﺿﺮﺍﺭ ﺍﻟﺠﺴﺪﻳﺔ ﻭﺍﻟﻤﺎﺩﻳﺔ ﻻﻳﺔ ﻭﺍﻗﻌﺔ ﻭﺍﺣﺪﺓ ﻭﻓﻲ ﺍﻻﺟﻤﺎﻟﻲ ﺧﻼﻝ ﻓﺘﺮﻩ ﺍﻟﺘﺎﻣﻴﻦ‬10000000 ‫ﺣﺪﻭﺩ ﻣﺴﺆﻭﻟﻴﺔ ﺍﻟﻄﺮﻑ ﺍﻟﺜﺎﻟﺚ‬
SAR 10,000,000 for physical and material damage to any one incident and in the aggregate Third Party Lability
during the insurance period Limits

Important Notes ‫ﻣﻼﺣﻈﺎﺕ ﻫﺎﻣﺔ‬

Please make sure that the personal data contained in the policy is
correct and notify the company by calling the unified number
920029926 should you need any corrections
This certificate is subject to the terms and conditions and the general
exceptions and limitations set forth as printed on the back of SAMA
(The Unified Compulsory Motor Insurance Policy) and policy
schedule.
In case of accident call 920000560 and provide all data and
information to the investigation officer
‫ﻧﻈﺮﺍ ﻷﻫﻤﻴﺔ ﺍﻟﺒﻴﺎﻧﺎﺕ ﺍﻟﻮﺍﺭﺩﺓ ﻓﻲ ﻫﺬﻩ ﺍﻟﺸﻬﺎﺩﺓ ﺍﻟﺮﺟﺎﺀ ﺍﻟﺘﺄﻛﺪ ﻣﻨﻬﺎ ﻭﺍﻟﺘﻮﺍﺻﻞ ﻣﻊ ﺍﻟﺸﺮﻛﺔ ﻋﻠﻰ ﺍﻟﺮﻗﻢ ﺍﻟﻤﻮﺣﺪ‬
‫ ﻓﻲ ﺣﺎﻝ ﻭﺟﻮﺩ ﺃﻱ ﺇﺧﺘﻼﻑ‬920029926
‫ ﺗﺨﻀﻊ ﻫﺬﻩ ﺍﻟﺸﻬﺎﺩﺓ ﻟﻠﺸﺮﻭﻁ ﻭﺍﻷﺣﻜﺎﻡ ﻭﺍﻹﺳﺘﺜﻨﺎﺀﺍﺕ ﺍﻟﻌﺎﻣﺔ ﻭﺍﻟﺤﺪﻭﺩ ﺍﻟﻤﻨﺼﻮﺹ‬.
‫ﻋﻠﻴﻬﺎ ﺑﺎﻟﻮﺛﻴﻘﺔ ﺍﻟﻤﻮﺣﺪﺓ ﻟﻤﺆﺳﺴﺔ ﺍﻟﻨﻘﺪ ﺍﻟﻌﺮﺑﻲ ﺍﻟﺴﻌﻮﺩﻱ ﻭﺍﻟﻤﺮﻓﻘﺔ ﻣﻊ ﺍﻟﺸﻬﺎﺩﺓ‬
‫ﻭﺟﺪﻭﻝ ﺍﻟﻮﺛﻴﻘﺔ‬
‫ ﻣﻊ ﺍﻹﻟﺘﺰﺍﻡ ﺑﺘﻘﺪﻳﻢ‬920000560 ‫ ﻓﻲ ﺣﺎﻝ ﻭﻗﻮﻉ ﺣﺎﺩﺙ ﻣﺮﻭﺭﻱ ﻳﺮﺟﻰ ﺍﻹﺗﺼﺎﻝ ﻋﻠﻰ ﺍﻟﺮﻗﻢ‬.
‫ﺟﻤﻴﻊ ﺍﻟﺒﻴﺎﻧﺎﺕ ﻭﺍﻟﻤﻌﻠﻮﻣﺎﺕ ﻋﻨﺪ ﺗﻘﺪﻳﻢ ﺍﻟﺒﻼﻍ ﻫﺎﺗﻔﻴﺎ ﻟﻤﺤﻘﻖ ﺍﻟﺤﻮﺍﺩﺙ‬

‫ﺷﺮﻛﺔ ﺍﺗﺤﺎﺩ ﺍﻟﺨﻠﻴﺞ ﻟﻠﺘﺎﻣﻴﻦ ﺍﻟﺘﻌﺎﻭﻧﻲ‬