Professional Documents
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ﺑﯾﺎﻧﺎت اﻟوﺛﯾﻘﺔ
ﺗﺟﺎه اﻟﻐﯾر اﻟﻣﺳؤوﻟﯾﺔ ﺗﺟﺎه اﻟﻐﯾر /اﻟﺷﺎﻣل 570412948383108 رﻗم اﻟوﺛﯾﻘﺔ
ﺿد اﻟﻐﯾر اﻟﻣﻧﺗﺞ 08/09/2022 ﺗﺎرﯾﺦ ﺑدء اﻟوﺛﯾﻘﺔ
اﻟﻣﻣﻠﻛﺔ اﻟﻌرﺑﯾﺔ اﻟﺳﻌودﯾﺔ اﻟﻧطﺎق اﻟﺟﻐراﻓﻲ ﻟﻠﺗﻐطﯾﺔ: 07/09/2023 ﺗﺎرﯾﺦ اﻧﺗﮭﺎء اﻟوﺛﯾﻘﺔ
ﺑﯾﺎﻧﺎت اﻟﻣﺷﺗرك
ﷴ ﻋﻠﻲ ﻋﻣﯾش آل ﻣﺎﻟك اﻟﺷﻣراﻧﻲ اﻟﻣﺎﻟك ﻓرد ﻧوع اﻟﻣﺎﻟك
اﻟﻧﻣﺎص ﻣدﯾﻧﺔ اﻹﻗﺎﻣﺔ ﷴ ﻋﻠﻲ ﻋﻣﯾش آل ﻣﺎﻟك اﻟﺷﻣراﻧﻲ اﻻﺳم
10-04-1393 ﺗﺎرﯾﺦ اﻟﻣﯾﻼد 1037051529 رﻗم اﻟﮭوﯾﺔ/اﻟﺳﺟل اﻟﺗﺟﺎري
oo0l0oo@hotmail.com اﻟﺑرﯾد اﻹﻟﻛﺗروﻧﻲ 0500055552 رﻗم اﻟﺟوال
ﷴ ﻋﻠﻲ ﻋﻣﯾش آل ﻣﺎﻟك اﻟﺷﻣراﻧﻲ اﻟﻣؤﻣن ﻋﻠﯾﮫ ﻓرد اﻟﻣﺎﻟك
ﻣﻌﻠوﻣﺎت اﻟﺳﺎﺋﻖ
ﻣدﯾﻧﺔ اﻹﻗﺎﻣﺔ رﻗم اﻟﮭوﯾﺔ ﺗﺎرﯾﺦ اﻟﻣﯾﻼد ﻧوع اﻟﺳﺎﺋﻖ )اﺳﺎﺳﻲ/إﺿﺎﻓﻲ( اﻻﺳم
اﻟﻧﻣﺎص 1037051529 10-04-1393 اﺳﺎﺳﻲ ﷴ ﻋﻠﻲ ﻋﻣﯾش آل ﻣﺎﻟك اﻟﺷﻣراﻧﻲ
ﺑﯾﺎﻧﺎت اﻟﻣرﻛﺑﺔ
Small Car 4 Doors ﻧوع ھﯾﻛل اﻟﻣرﻛﺑﺔ ﻓﯾوﺟن طراز /ﻣودﯾل اﻟﻣرﻛﺑﺔ ﻓورد ﻣﺎرﻛﺔ اﻟﻣرﻛﺑﺔ )اﻟﻌﻼﻣﺔ
اﻟﺗﺟﺎرﯾﺔ(
اﺑﯾض ﻟون اﻟﻣرﻛﺑﺔ 5 ﻋدد اﻟﻣﻘﺎﻋد 2009 ﺳﻧﺔ اﻟﺻﻧﻊ
Private اﺳﺗﺧداﻣﺎت اﻟﻣرﻛﺑﺔ NA ﻣﺑﻠﻎ اﻟﺗﻐطﯾﺔ اﻟﺗﺄﻣﯾﻧﯾﺔ د ص ق 7538 رﻗم اﻟﻠوﺣﺔ
رﻗم اﻟﺑطﺎﻗﺔ اﻟﺟﻣرﻛﯾﺔ 712755900 اﻟرﻗم اﻟﺗﺳﻠﺳﻠﻲ 3FAHP07Z29R114233 رﻗم ھﯾﻛل اﻟﻣرﻛﺑﺔ
ﻣﻠﺧص ﻟﻠﺗﻐطﯾﺔ
ﺣدود اﻟﺗﻐطﯾﺔ ﻣﻧﺎﻓﻊ اﻟﺗﻐطﯾﺔ اﻟﺗﺄﻣﯾﻧﯾﺔ
ﺗﻐطﯾﺔ اﻟطرف اﻟﺛﺎﻟث ﺣﺗﻰ 10ﻣﻠﯾون ﷼ ﺗﻐطﯾﺔ اﻟطرف اﻟﺛﺎﻟث ﺣﺗﻰ 10ﻣﻠﯾون ﷼
ﺗﻐطﯾﺎت ﺗﺄﻣﯾﻧﯾﺔ إﺿﺎﻓﯾﺔ )اﺧﺗﯾﺎرﯾﺔ(
ﺑﯾﺎﻧﺎت
اﻟﻣﺑﻠﻎ )ﺑﺎﻟ﷼ اﻟﺳﻌودي( اﻻﺳﺗﻘطﺎع )اﻟﺧﺻوﻣﺎت(
761.46 ﺻﺎﻓﻲ اﻻﺷﺗراك)ﺷﺎﻣل اﻟﺧﺻوﻣﺎت,ﺧﺻم ﻋدم وﺟود ﻣطﺎﻟﺑﺎت,اﻟﻌﻣوﻟﺔ(
84.00 10.00 % ﺧﺻم ﺧﺎص ﺧﺻم اﻟﻣرﻛﺑﺎت اﻟﻣﺗﻌددة ﺧﺻم اﻟوﻻء اﻟﺧﺻوﻣﺎت
13 اﻟﻣﺳﺗوى ﺧﺻم ﻋدم وﺟود ﻣطﺎﻟﺑﺎت
15.23 2% اﻟﻌﻣوﻟﺔ
114.22 15.00 % ﺿرﯾﺑﺔ اﻟﻘﯾﻣﺔ اﻟﻣﺿﺎﻓﺔ
875.68 ﻣﺟﻣوع اﻻﺷﺗراك )ﺻﺎﻓﻲ اﻻﺷﺗراك +ﺿرﯾﺑﺔ اﻟﻘﯾﻣﺔ اﻟﻣﺿﺎﻓﺔ(
ﻣﻌﻠوﻣﺎت إﺿﺎﻓﯾﺔ
.1ﺗدﻓﻊ ﻛﺎﻣل ﻗﯾﻣﺔ ﻗﺳط اﻟﺗﺄﻣﯾن ﻣﻘدﻣﺎ و ﺑﺷﻛل ﺳﻧوي
.2ﻟرﻓﻊ أي ﻣطﺎﻟﺑﺔ ﯾرﺟﻰ إرﻓﺎق ﺗﻘرﯾر ﻣن اﻟﺷرطﺔ ﺑﺎﻟﺣﺎﻟﮫ
.3ﻓﻲ ﺣﺎل ﺗﻌوﯾض اﻟطرف اﻟﺛﺎﻟث ﻋن ﻣرﻛﺑﺔ ﺗم ﻗﯾﺎدﺗﮭﺎ ﻣن ﺷﺧص ﻋﻣره أﻗل ﻣن 18ﺳﻧﺔ ﻓﺈن ﺗﻛﺎﻓل اﻟراﺟﺣﻲ ﺗﺣﺗﻔظ ﺑﺣﻖ اﻟرﺟوع وﺗﺣﺻﯾل اﻟﺗﻌوﯾض ﻣن اﻟﻣؤﻣن ﻟﮫ ﻋدا إذا ﻣﺎﻛﺎن اﻟﻣؤﻣن ﻟﮫ ﻣدرج ﻓﻲ ﺟدول اﻟوﺛﯾﻘﺔ .ﻛﻣﺎ ﯾﺣﻖ أﯾﺿﺎ ً ﻟﺗﻛﺎﻓل
اﻟراﺟﺣﻲ رﻓض ﻣطﺎﻟﺑﺔ اﺻﻼح ﻣرﻛﺑﺔ اﻟﻣؤﻣن ﻟﮫ ﻓﻲ ﺣﺎل ﻗﯾﺎدة ﺷﺧص ﻋﻣره أﻗل ﻣن 18ﺳﻧﺔ ﻟم ﯾدرج ﻓﻲ ﺟدول اﻟوﺛﯾﻘﺔ
.4ﺟدول اﻟوﺛﯾﻘﺔ ﯾﺣﺗوي ﻋﻠﻰ ﻣﻠﺧص اﻟﺗﻐطﯾﺔ ﻓﻘط وﻟﻼطﻼع ﻋﻠﻰ اﻟﺷروط واﻷﺣﻛﺎم ﯾرﺟﻰ اﻻطﻼع ﻋﻠﻰ ﻣﺳﺗﻧدات اﻟوﺛﯾﻘﺔ وﻗراءﺗﮭﺎ ﺑﺗﻣﻌن ﻟﻠﺗﺄﻛد ﻣن ﻓﮭﻣك اﻟﺗﻐطﯾﺎت اﻟﻣﺗﺎﺣﺔ ﻟك واﻻﺳﺗﺛﻧﺎءات ﻣن اﻟﺗﻐطﯾﺔ واﻟﺗﻌرف ﻋﻠﻰ آﻟﯾﺔ رﻓﻊ ﻣطﺎﻟﺑﺔ
.5ﺗم اﻋﺗﻣﺎد اﻟﺗﻐطﯾﺔ ﺑﻧﺎءاً ﻋﻠﻰ ﻣﻌﻠوﻣﺎت اﻟﺳﺎﺋﻖ واﻟﻣرﻛﺑﺔ وﻧوع اﺳﺗﺧدام اﻟﻣرﻛﺑﺔ اﻟﻣﻘدﻣﺔ ﻣن اﻟﻌﻣﯾل وﻓﻲ ﺣﺎل أن ﻣﻌﻠوﻣﺎت اﻟﻣرﻛﺑﺔ واﻟﺳﺎﺋﻖ ﻣﺧﺗﻠﻔﺔ ﻋن ﻣﺎذﻛر اﻟﻌﻣﯾل أو اﺳﺗﺧدام اﻟﻣرﻛﺑﺔ ﻋﻛس ﻣﺎ ذﻛره اﻟﻌﻣﯾل ﯾﻔﻘد اﻟﻌﻣﯾل اﻟﺗﻐطﯾﺔ
.6ﺗﺎﻣﯾن اﻟﻣرﻛﺑﺔ ﺗم اﻛﺗﺗﺎﺑﮫ ﺑواﺳطﺔ ﺷرﻛﺔ ﺗﻛﺎﻓل اﻟراﺟﺣﻲ ﻟﻠﺗﺄﻣﯾن
.7ﻗﯾﻣﺔ اﻟﺿرﯾﺑﺔ اﻟﻣﺿﺎﻓﺔ ﻋﻠﻰ اﻟوﺛﯾﻘﺔ ﺗم ﺗﺣﺻﯾﻠﮭﺎ ﺑﺎﻟﻧﯾﺎﺑﺔ ﻋن ﺣﻛوﻣﺔ اﻟﻣﻣﻠﻛﺔ اﻟﻌرﺑﯾﺔ اﻟﺳﻌودﯾﺔ ﺑﻧﺎءا ﻋﻠﻰ ﻗﺎﻧون اﻟﺿراﺋب اﻟﺻﺎدر ﻣن اﻟﮭﯾﺋﺔ اﻟﻌﺎﻣﺔ ﻟﻠزﻛﺎة واﻟدﺧل ﻓﻲ ﻋﺎم 1438ھـ
Policy Details
Policy # 570412948383108 Plan Type Third Party Liability
Start Date 08/09/2022 Product TPL
End Date 07/09/2023 Geographical Scope Kingdom of Saudi Arabia
Participant Details
Type Individual Owner ﷴ ﻋﻠﻲ ﻋﻣﯾش آل ﻣﺎﻟك اﻟﺷﻣراﻧﻲ
Name ﷴ ﻋﻠﻲ ﻋﻣﯾش آل ﻣﺎﻟك اﻟﺷﻣراﻧﻲ City of Residence اﻟﻧﻣﺎص
ID / CR # 1037051529 DOB 10-04-1393
Mobile # 0500055552 Email oo0l0oo@hotmail.com
Owner Individual Insured ﷴ ﻋﻠﻲ ﻋﻣﯾش آل ﻣﺎﻟك اﻟﺷﻣراﻧﻲ
Driver Information
Name(s) Main/Additional DOB ID # City of Residence
ﷴ ﻋﻠﻲ ﻋﻣﯾش آل ﻣﺎﻟك اﻟﺷﻣراﻧﻲ Main 10-04-1393 1037051529 اﻟﻧﻣﺎص
Vehicle Details
Make ﻓورد Model ﻓﯾوﺟن Body Type Small Car 4 Doors
Model Year 2009 No. of Seats 5 Color اﺑﯾض
Plate # 7538 د ص ق Sum Insured NA Vehicle Use Private
Chassis # 3FAHP07Z29R114233 Sequence # 712755900 Custom ID
Summary of Cover
Benefit Limit
Third Party Liability up to 10 Million riyals Third Party Liability up to 10 Million riyals
Optional Cover(s)
Contribution Information
Description Amount (in SAR)
Net Contribution(Inclusive of Discount, NCD, Commissions) 761.46
Discount - Loyalty Multi Vehicle Special 10.00 % 84.00
No Claims Discount (NCD) Level 13
Commission 2% 15.23
Value Added Tax (VAT) 15.00 % 114.22
Total Contribution (Net Contribution + VAT) 875.68
Additional Information
1. Annual contribution must be fully paid in advance.
2. Every claim must be accompanied by a police report.
3. In case of third party liability claim whilst the insured vehicle is being driven by a person below 18 years of age, Al Rajhi Takaful reserves the right of recourse
upon indemnifying the third party, unless anyone below 18 years of age is stated in the policy schedule. Al Rajhi Takaful reserves the right to decline own
damage claims if any, whilst the insured vehicle is being driven by anyone whose age is below the age of the Main Driver or Additional Driver mentioned in the
policy schedule.
4. This Policy Schedule contains a Summary of Cover only. For full Terms & Conditions, please read the policy wording carefully, to ensure your understanding of
what is covered, what is not covered and what to do if you need to apply for a claim.
5. This policy is based on driver's & vehicle's information and Vehicle's use as provided. Excludes cover if Vehicle Use is different from what is mentioned in
Vehicle Details section.
6. This motor insurance is underwritten by Al Rajhi Company for Co-operative Insurance (ARCCI).
7. Value Added Tax (VAT) has been charged on behalf of the Government of the Kingdom of Saudi Arabia in accordance with the VAT Act announced by General
Authority of Zakat and Tax (GAZT) in H1438.