Visitors Insurance ϥϳέ΋΍ίϟ΍ϰϠϋϥϳϣ΄Ηϟ΍

Policy Schedule ϥϳϣ΄Ηϟ΍ΔϘϳΛϭϝϭΩΟ

ᡧᣍᓆቲᎻ኏ᑰᏕቲᜓ኏ᒻፅ ᗫᖂዱᑢቨᓀᐛᡫᣃ
Name of the Company ᢝ ϥϳϣ΄Ηϟ΍Δϛέηϡγ΍
Aljazira Takaful Ta͛awuni Company
Policy No: 6174191146 ΔϘϳΛϭϟ΍ϡϗέ
Policyholder Details ΔϘϳΛϭϟ΍ϝϣΎΣΕΎϧΎϳΑ
Policyholder Name: ZULFIQAR ALI ΔϘϳΛϭϟ΍ϝϣΎΣ

Nationality: Pakistan ΔϳγϧΟϟ΍

Purpose of visit ΓέΎϳίϟ΍ϥϣνέϐϟ΍
Reference Number: ϊΟέϣϟ΍ϡϗέ
Postal Address: HOTEL DALLAH TAIBAH MADINA ϱΩϳέΑϟ΍ϥ΍ϭϧόϟ΍

Telephone No in homecountry: ΔϣΎϗϹ΍ΩϠΑϲϓϑΗΎϬϟ΍ϡϗέ

Marital Status: Married ϪϳϋΎϣΗΟϷ΍ϩΎΟΣϟ΍
Telephone No in Destination: ΩϭλϘϣϟ΍ΩϠΑϟ΍ϲϓϑΗΎϬϟ΍ϡϗέ
Fax No in Destination: ΩϭλϘϣϟ΍ΩϠΑϟ΍ϲϓαϛΎϔϟ΍ϡϗέ
Mobile Number: ϝ΍ϭΟϟ΍ϑΗΎϬϟ΍ϡϗέ
7\SHRI,QVXUDQFH ϥϳϣ΄Ηϟ΍ωϭϧ
Insurance for the visitors fo the kingdom of Saudi Arabia ᓀᘌጕᓗᎻ፭ᑢቨᓀᘭᗖᖁᎻᑢቨᓀ᜻ᑩᑿᑿᑩᑢᡧᢕᣌᑻጕቲᏽᑢቨᒢᗫᖁᓹቨፆ ᑢቨᣢᎳᡧᢕᣌᑻተኤᑢቨ
Product: Visit Visa ΞΗϧϣϟ΍
Provider's Network: C ϥϳΩϭίϣϟ΍ΔϛΑη

Policy / Insurance Period ϥϳϣ΄Ηϟ΍ΓΩϣΔϘϳΛϭϟ΍ΓΩϣ

From 22/11/2022 ϥϣ
To 22/11/2023 ϰϟ·
Both dates included ᡧᢕ ዳᗫጳ ቲኤᑢቨᕙ᛿ᑰᑿ፮ᛒ
ᣌ
ᡧ
This policy is issued once and upon expiry a new policy shall be ᒇቦ᎛ᡨᣂ፮ᛒᕕᓆᒻጤᘌጤዟᓀᏽᘭነᓆጳቨጤᎉቨᒃኤᓾቲᒳᓹቲ᎐ᏽᒐቨᑛቲዠᣚᓆᒻጤዠቨᓆᒻፅ
ᢝ ᑿᑢጳጤᎏ኏ᓀᏽᘭነᓗᑢቨᒿጥᒯ
issued and does not need to be valid for one complete year) ᓀᑩᑻቲ᛿ᓀᒙ።ቲᒳ኏ጤᑻᒇᓗᐯ኏
Premium / Contribution Amount 17.0 - USD ργϘϟ΍ϙ΍έΗηϻ΍Δϣϳϗ
Excess ϝϣΣΗϟ΍ώϠΑϣ

Medical emergencies ΔϳΑρϟ΍Ήέ΍ϭρϠϟ

Customer care centre 920000560 | +966 (0)1 26688877 ˯ϼϣόϟ΍ΔϣΩΧίϛέϣ
Email info@ajt.com.sa ϲϧϭέΗϛϟϻ΍ΩϳέΑϟ΍
Any claims payment made for covered losses under this policy ᒿጥᒯኸዟᓗᑿᗷᒻቲᎣᎼᑿᑢቨፅᓹቲ፭ዳᑢቲᗷᓀᏽᑩᎻኤᑿᑢቨᓀᏽዲኤ፭ᑿᑢቨቺቲᘘᑢቲᎣᑿᑢቨኹዲ኏ቲᒳᎻᏕጕᒃኤᓾᏄᑢቲᘘᑻᓭቦ
will be in Saudi Riyals (SAR). ᓭጕᓗᎻ፭ᑢቨᑛቲᗫᖁᑢቲᗷᒇᓗᐯ኏Ꮛᓗ።ᓀᏽᘭነᓗᑢቨ

Aljazira Takaful Ta¶DZXQL&R,QVXUDQFH-RLQW6WRFN&R2SHUDWLQJ6DXGL&HQWUDO%DQN ϱΩϮόδϟ΍ϱΰϛήϤϟ΍ϚϨΒϟ΍ϑ΍ήη·ϭΔΑΎϗήϟΔόοΎΧΔϤϫΎδϣϲϧϭΎόΗϦϴϣ΄ΗΔϛήηˬϲϧϭΎόΗϞϓΎϜΗΓήϳΰΠϟ΍Δϛήη

OLFHQVH1R&DSLWDO65)XOO\3DLG&51R ϱέΎΠΘϟ΍ϞΠδϟ΍ϢϗέˬϞϣΎϜϟΎΑωϮϓΪϣ୰470,664,030ϝΎϣα΃ήΑ201312/34ϥϡΕϢϗέκϴΧήΘΑ
7001791990 ±P.O.Box : 5215 Jeddah 21422, Toll Free.: 8003040400, Web Site ϊϗϮϤϟ΍ˬ8003040400ϲϧΎΠϤϟ΍ϒΗΎϬϟ΍±21422ΓΪΟ5215Ώιˬ70017919904030251980
ZZZDMWFRPVD1DWLRQDO$GGUHVV$OMD]LUD7DNDIXO7D¶awuni Co., 7512 Al-Madinah Al- ΓέϮϨϤϟ΍ΔϨϳΪϤϟ΍ϖϳήρ7512ˬϲϧϭΎόΗϞϓΎϜΗΓήϳΰΠϟ΍ΔϛήηϲϨρϮϟ΍ϥ΍ϮϨόϟ΍www.ajt.com.saϲϧϭήΘϜϟϹ΍
Munawarah Rd. ±AlHamra Dist., Unit No. 8021, Jeddah, 4516-23324, KSA. ΔϳΩϮόδϟ΍ΔϴΑήόϟ΍ΔϜϠϤϤϟ΍ˬ233244516ˬΓΪΟˬ8021ϢϗέΓΪΣϭˬ˯΍ήϤΤϟ΍±ϲϋήϔϟ΍
 Benefit Limits - ΩϭΩΣϟ΍ ᓀᎻᏟᒙᑿᑢቨ
Diagnosis and treatment of emergency cases Up to SAR 100,000 ᓀᓹጳ ቲᎣᑢቨ ቺᕕቲዲᑢቨውᕙᎳᓆᓀᒙᓾቲᎻᑻ
Hospitalization Up to SAR 100,000 ᡧᣛ፮ᙬ፭ᑿᑢቨᡧᣚᒃᗫᖔᒙኤᑢቨ
ᢝ
Emergency dental treatment (*) Up to SR 500 ;ΎͿᓀᓹጳ ቲᎣᑢቨᒇቲᒙ።ᕓቨውᕙᎳ
Treatment of emergency pregnancy and delivery cases 8SWR6$5 ᓀᓹጳ ቲᎣᑢቨᒻጕᕕᓗᑢቨᓆᑰᑿዲᑢቨ ቺ
ᕕቲዠውᕙᎳ
The treatment of premature babies (**) Up to SAR 100,000 ;ΎΎͿᒢᗫᣄ ᙬኣᑿᑢቨᑛቲᏟ᎟ᕓቨውᕙᎳ
Up to SAR 100,000 ᓀ᜻ᑩᑿᑿᑢቨውጳ ቲዡᓆᑰዡቨጕᓨጳ ቲᎣᑢቨᢔᣎ
Emergency Medical Evacuation inside and outside the Kingdom
ᢝ Ꭳᑢቨᔹᕙዡᕔቨ
(PHUJHQF\.LGQH\'LDO\VLV Up to SAR 100,000 ᓨጳ ቲᎣᑢቨᓭᓗᑩᝣᑢቨᑰᘭ፭Ꮌᑢቨ
Repatriation of mortal remains to the home country Up to SAR 10,000 ᡧ
ᣢᎉᕓቨᒿጤᑩᗷᣠቧ
ᢝ ᣚᓗኤᑿᑢቨቺቲᏕጳ
ᢝ ᒻጕቲᎳቧ
&RVWRIWUDYHODQGDFFRPSDQ\LQJRIRQHGLUHFWIDPLO\PHPEHU Up to SAR 5,000 ጤዠቨᓆᡫᣃቲᘘᑻᒻᣃ ቦᓗ᎐ᎳᓀᏽᏕቨፅ ᑻᓆፅᏟ።
Treatment to injuries resulting from road traffic accidents Up to SAR 100,000 ᓀᘭᑢᕒቨቺቲᘘᐛፅ ᑿᑢቨቻጕቨᓗዠᒢᎳᓀዱ኏ቲᒙᑢቨቺቲᗷቲ ᎉ
ᕔቨውᕙᎳ
Geographical limits ᓀᘭᏕቨፅ Ꮌዱᑢቨጕᓆጤዲᑢቨ
the insurance coverage will be effective when the insured ΔϳΩϭόγϟ΍ΔϳΑέόϟ΍ΔϛϠϣϣϟ΍ΩϭΩΣϪϟϥϣ΅ϣϟ΍ϝϭΧΩΩϧϋϲϧϳϣ΄Ηϟ΍˯Ύρϐϟ΍ϱέγϳ
enters the borders of the Kingdom of Saudi Arabia

Covid 19 Coverage COVID- ቺ

ᕕቲዲᗷᓀᏽᑩᎻኤᑿᑢቨᓀᘭ ᔏᑻተኤᑢቨᓀᘭᎣᎼኤᑢቨ
19

Emergence medical cases Up to SAR 650,000 ᓀᓹጳ ቲᎣᑢቨᓀᘭኣᎣᑢቨ ቺ

ᕕቲዲᑢቨ

Quarantine Cost SAR 450 per day (maximum of ᢔᣎ

14 days) ᢝ Ꭳᑢቨᑛፆ ᎻᑢቨᏩᘭᑢቲᜓ኏

Medical evacuation Actual costs / ᓀᘭᑩᎻᏟᑢቨᏩᘭᑢቲᜓኤᑢቨ ᣎ

ᢝᢔ Ꭳᑢቨᔹᕙዡᕔቨ
Return the remains of the deceased to his original home Actual costs / ᡧ
ᓀᘭᑩᎻᏟᑢቨᏩᘭᑢቲᜓኤᑢቨ ᣢᎉᕓቨᒷᒙ᎟ᓗᑿᑢ
ᢝ ᣚᓗኤᑿᑢቨቺቲᏕጳ ᒻጕቲᎳቧ

Aljazira Takaful Ta¶DZXQL&R,QVXUDQFH-RLQW6WRFN&R2SHUDWLQJ6DXGL&HQWUDO%DQN ϱΩϮόδϟ΍ϱΰϛήϤϟ΍ϚϨΒϟ΍ϑ΍ήη·ϭΔΑΎϗήϟΔόοΎΧΔϤϫΎδϣϲϧϭΎόΗϦϴϣ΄ΗΔϛήηˬϲϧϭΎόΗϞϓΎϜΗΓήϳΰΠϟ΍Δϛήη

OLFHQVH1R&DSLWDO65)XOO\3DLG&51R ϱέΎΠΘϟ΍ϞΠδϟ΍ϢϗέˬϞϣΎϜϟΎΑωϮϓΪϣ୰470,664,030ϝΎϣα΃ήΑ201312/34ϥϡΕϢϗέκϴΧήΘΑ
7001791990 ±P.O.Box : 5215 Jeddah 21422, Toll Free.: 8003040400, Web Site ϊϗϮϤϟ΍ˬ8003040400ϲϧΎΠϤϟ΍ϒΗΎϬϟ΍±21422ΓΪΟ5215Ώιˬ70017919904030251980
ZZZDMWFRPVD1DWLRQDO$GGUHVV$OMD]LUD7DNDIXO7D¶awuni Co., 7512 Al-Madinah Al- ΓέϮϨϤϟ΍ΔϨϳΪϤϟ΍ϖϳήρ7512ˬϲϧϭΎόΗϞϓΎϜΗΓήϳΰΠϟ΍ΔϛήηϲϨρϮϟ΍ϥ΍ϮϨόϟ΍www.ajt.com.saϲϧϭήΘϜϟϹ΍
Munawarah Rd. ±AlHamra Dist., Unit No. 8021, Jeddah, 4516-23324, KSA. ΔϳΩϮόδϟ΍ΔϴΑήόϟ΍ΔϜϠϤϤϟ΍ˬ233244516ˬΓΪΟˬ8021ϢϗέΓΪΣϭˬ˯΍ήϤΤϟ΍±ϲϋήϔϟ΍
 Insurance eligibility criteria ϥϳϣ΄ΗϠϟϥϭϠϫ΅ϣϟ΍
Includes all individuals arriving in the Kingdom of Saudi Γέϳη΄ΗΏΟϭϣΑˬϡϫέγ΃Ω΍έϓ΃ϭΔϳΩϭόγϟ΍ΔϳΑέόϟ΍ΔϛϠϣϣϠϟϥϳϣΩΎϘϟ΍ϊϳϣΟϝϣηϳ
Arabia and their family members, under a legitimate visit
visa (except for pilgrims - Hajj and Umrah)
Special Conditions:
The company¶s prior approval is required for medical expense
to be covered under the policy at the selected provider
network
Compensation will be paid after the company approval of those
expenses that are covered after completing the insurance
application form and submitting it to the company along with the
original detailed bills in additional to any other related documents
such as medical information documents, flight tickets and travelling
documents
Treatment in day care and outpatient clinics shall not be covered
unless it is for emergency
7KHUHZLOOEHQRFRYHUIRUDQ\LOOQHVVRULQMXU\RUSK\VLFDO
weakness or physical disabilities, and the consequences and
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This product does not cover pregnancy and delivery cases unless
declared on the porposal from and cover will be limited to
emergency only.
The policyholder and any other person that is listed on the policy
schedule and included in the insurance undertake not to use this
policy to cover any previously known treatment or diagnostic nor
visit the kingdom in order to obtain this treatment within this
coverage.
Signed on behalf of the company
Attorney:
Company Seal
Aljazira Takaful Ta¶DZXQL&R,QVXUDQFH-RLQW6WRFN&R2SHUDWLQJ6DXGL&HQWUDO%DQN
OLFHQVH1R&DSLWDO65)XOO\3DLG&51R
7001791990 ±P.O.Box : 5215 Jeddah 21422, Toll Free.: 8003040400, Web Site
ZZZDMWFRPVD1DWLRQDO$GGUHVV$OMD]LUD7DNDIXO7D¶awuni Co., 7512 Al-Madinah Al-
Munawarah Rd. ±AlHamra Dist., Unit No. 8021, Jeddah, 4516-23324, KSA.
ϥϳέϣΗόϣϟ΍ϭΝΎΟΣϟ΍˯ΎϧΛΗγΎΑΔϳϣΎυϧΓέΎϳί
ΔλΎΧρϭέη
ϥϣοΔϘϳΛϭϟ΍ϕΎυϧϲϓΔϳΑρϑϳέΎλϣϱ΃ΔϳρϐΗϟΔϛέηϟ΍ϥϣΔϘΑγϣϟ΍ΔϘϓ΍ϭϣϟ΍ϰϠϋϝϭλΣϟ΍ΏΟϳ
ΓΩΩΣϣϟ΍ϥϳΩϭίϣϟ΍ΔϛΑη
ΝΫϭϣϧϝΎϣϛΗγ΍ΩόΑ˱Ύϳϧϳϣ΄ΗΓΎρϐϣΕΎϘϔϧϟ΍ϥϭϛϰϠϋΔϛέηϟ΍ΔϘϓ΍ϭϣΩόΑνϳϭόΗϟ΍ΩϳΩγΗϡΗϳϑϭγ
Ε΍ΩϧΗγϣϱ΃ϰϟ·ΔϓΎοϹΎΑΔϠλϔϣϟ΍ΔϳϠλϷ΍έϳΗ΍ϭϔϟ΍ϪόϣϖϓέϣϭΔϛέηϠϟϪϣϳϠγΗϭϥϳϣ΄Ηϟ΍ΏϠρ
έϔγϟ΍Ε΍ΩϧΗγϣϭϥ΍έϳρϟ΍έϛ΍ΫΗϭΔϳΑρϟ΍ΕΎϣϭϠόϣϟ΍Ε΍ΩϧΗγϣϝΛϣΔϠλΕ΍ΫϯέΧ΃
Δ΋έΎρΔϟΎΣϟϥϛϳϡϟΎϣϰρϐϣέϳϏΔϳΟέΎΧϟ΍Ε΍ΩΎϳόϟ΍ϭΩΣ΍ϭϟ΍ϡϭϳϟ΍ίϛ΍έϣϲϓΝϼόϟ΍
ϲΗϟ΍ϭϪϳϠϋΔΑΗέΗϣϟ΍Ξ΋ΎΗϧϟ΍ϭϲϧΩΑίΟϋϭ΃ϱΩγΟϑόοϭ΃ΔΑΎλ·ϭ΃νέϣϱ΃ϲρϐϳϻϥϳϣ΄Ηϟ΍
ˬΝέΎΧϠϟΔϠΣέϝϛϝΑϗΎϬο΍έϋ΃έϬυΗϭ΃ΙΩΣΗ
ϭΏϠρϟ΍ΓέΎϣΗγ·ϲϓϙϟΫϥϋ΢ϳέλΗϟ΍ϡΗ΍Ϋ·ϻ·ΓΩϻϭϟ΍ϭϝϣΣϟ΍ΕϻΎΣϲρϐϳϻΞΗϧϣϟ΍΍Ϋϫ
ρϘϓΉέ΍ϭρϟ΍ΕϻΎΣϰϠϋΔϳρϐΗϟ΍έλΗϘΗγ
ϲϓΝέΩϣϥϳϣ΄ΗϟΎΑϝϭϣηϣιΧηϱ΃ϭΔϘϳΛϭϟ΍ϝϣΎΣΩϬόΗϳΝϼόϟ΍νέϐϟΓέΎϳίϟ΍ϡΩόΑΩϬόΗϟ΍
ϭ΃ϪϳΩϟϡϭϠόϣΝϼϋϱ΃ΔϳρϐΗϟΔϘϳΛϭϟ΍ϩΫϫϡ΍ΩΧΗγ΍ϡΩόΑΔϘϳΛϭϟ΍ϩΫϬΑϪϟϥϣ΅ϣϟ΍ιΎΧηϷ΍ϝϭΩΟ
ΔϳρϐΗϟ΍ΞϣΎϧέΑϥϣοϥϣΝϼόϟ΍΍ΫϫϰϠϋϝϭλΣϟ΍ϑΩϬΑΔϛϠϣϣϟ΍ΓέΎϳίϭΎϘΑγϣιΧηϣ
Δϛέηϟ΍ϥϋΔΑΎϳϧΎϬόϗϭ
ϊϳϗϭΗϟΎΑϝϭΧϣϟ΍
Δϛέηϟ΍ϡΗΧ
ϱΩϮόδϟ΍ϱΰϛήϤϟ΍ϚϨΒϟ΍ϑ΍ήη·ϭΔΑΎϗήϟΔόοΎΧΔϤϫΎδϣϲϧϭΎόΗϦϴϣ΄ΗΔϛήηˬϲϧϭΎόΗϞϓΎϜΗΓήϳΰΠϟ΍Δϛήη
ϱέΎΠΘϟ΍ϞΠδϟ΍ϢϗέˬϞϣΎϜϟΎΑωϮϓΪϣ୰470,664,030ϝΎϣα΃ήΑ201312/34ϥϡΕϢϗέκϴΧήΘΑ
ϊϗϮϤϟ΍ˬ8003040400ϲϧΎΠϤϟ΍ϒΗΎϬϟ΍±21422ΓΪΟ5215Ώιˬ70017919904030251980
ΓέϮϨϤϟ΍ΔϨϳΪϤϟ΍ϖϳήρ7512ˬϲϧϭΎόΗϞϓΎϜΗΓήϳΰΠϟ΍ΔϛήηϲϨρϮϟ΍ϥ΍ϮϨόϟ΍www.ajt.com.saϲϧϭήΘϜϟϹ΍
ΔϳΩϮόδϟ΍ΔϴΑήόϟ΍ΔϜϠϤϤϟ΍ˬ233244516ˬΓΪΟˬ8021ϢϗέΓΪΣϭˬ˯΍ήϤΤϟ΍±ϲϋήϔϟ΍