Motor Vehicle Fleet Certificate ‫ﺷﻬﺎﺩﺓ ﺗﺄﻣﻳﻥ ﺃﺳﻁﻭﻝ ﺍﻟﻣﺭﻛﺑﺎﺕ‬

Policy Number: SMM/6013551-9 :‫ﺭﻗﻡ ﺍﻟﻭﺛﻳﻘﺔ‬

Insured name: ‫ﻣﺅﺳﺳﺔ ﺷﺎﻳﻊ ﻣﺣﻣﺩ ﺑﻥ ﺷﺎﻳﻊ ﻟﻠﻣﻘﺎﻭﻻﺕ ﻭﺗﺄﺟﻳﺭ ﺍﻟﻣﻌﺩﺍﺕ‬ :‫ﺃﺳﻡ ﺍﻟﻣﺅﻣﻥ ﻟﻪ‬
Owner ID: 7012918566 :‫ﻫﻭﻳﺔ ﺍﻟﻣﺎﻟﻙ‬
Driver Name: ‫ﻣﺅﺳﺳﺔ ﺷﺎﻳﻊ ﻣﺣﻣﺩ ﺑﻥ ﺷﺎﻳﻊ ﻟﻠﻣﻘﺎﻭﻻﺕ ﻭﺗﺄﺟﻳﺭ‬ :‫ﺍﺳﻡ ﺍﻟﺳﺎﺋﻖ‬
Insured Type: Corporate :‫ﻧﻭﻉ ﺍﻟﻣﺅﻣﻥ ﻟﻪ‬
Insurance Type: Third Party Liability :‫ﻧﻭﻉ ﺍﻟﺗﺄﻣﻳﻥ‬
Coverage Inception Date: 20/03/2023 :‫ﺗﺎﺭﻳﺦ ﺑﺩﺍﻳﺔ ﺍﻟﺗﻐﻁﻳﺔ‬
Coverage Expiry Date: 16/11/2023 :‫ﺗﺎﺭﻳﺦ ﻧﻬﺎﻳﺔ ﺍﻟﺗﻐﻁﻳﺔ‬
(Both dates are covered - ‫)ﻛﻼ ﺍﻟﺗﺎﺭﻳﺧﻳﻥ ﻣﺷﻣﻭﻟﻳﻥ‬

The Vehicle Information ‫ﺑﻳﺎﻧﺎﺕ ﺍﻟﻣﺭﻛﺑﺔ‬

Brand/Model: TADANO CRANE :‫ ﺍﻟﻁﺭﺍﺯ‬/‫ﺍﻟﻣﺎﺭﻛﺔ‬
Year of Manufacture: 2004 :‫ﺳﻧﺔ ﺍﻟﺻﻧﻊ‬
Plate Number: 7501 ‫ﺍ ﺍ ﺹ‬ :‫ﺭﻗﻡ ﺍﻟﻠﻭﺣﺔ‬
Vehicle Color: White :‫ﻟﻭﻥ ﺍﻟﻣﺭﻛﺑﺔ‬
Serial Number: 21153600 :‫ﺍﻟﺭﻗﻡ ﺍﻟﺗﺳﻠﺳﻠﻲ‬
Customs Card Number: :‫ﺭﻗﻡ ﺍﻟﺑﻁﺎﻗﺔ ﺍﻟﺟﻣﺭﻛﻳﺔ‬
Chassis Number: KG56T00163 :‫ﺭﻗﻡ ﺍﻟﻬﻳﻛﻝ‬
Body Type: Equipment : ‫ﻣﻌﺩﺍﺕ‬ :‫ﻧﻭﻉ ﺍﻟﻬﻳﻛﻝ‬
Repair Type: Not applicable – ‫ﻏﻳﺭ ﻣﻁﺑﻖ‬ :‫ﻧﻭﻉ ﺍﻹﺻﻼﺡ‬
TADANO CRANE|2896716||T|Corporate|Equipment : ãÚÏÇÊ
|Heavy Trucks|Not applicable – ÛíÑ ãØÈÞ |7012918566|White

The certificate is proof that the vehicle is insured under ‫ﺱ( ﺑﺄﻥ‬.‫ﻡ‬.‫ﺗﺷﻬﺩ ﺷﺭﻛﺔ ﺍﻟﻣﺗﻭﺳﻁ ﻟﻠﺗﺄﻣﻳﻥ ﻭ ﺇﻋﺎﺩﺓ ﺍﻟﺗﺄﻣﻳﻥ ﺍﻟﺗﻌﺎﻭﻧﻲ )ﺵ‬
Medgulf Insurance & Reinsurance company by the Policy .‫ﺍﻟﻣﺭﻛﺑﺔ ﺍﻟﻣﺫﻛﻭﺭﺓ ﺃﻭﺻﺎﻓﻬﺎ ﻣﺅﻣﻧﺔ ﺗﺣﺕ ﻭﺛﻳﻘﺔ ﺍﻟﺗﺄﻣﻳﻥ ﺍﻟﻣﺫﻛﻭﺭﺓ ﺃﻋﻼﻩ‬
No. above.
This Certificate is considered for third party liability of physical‫ﺑﻘﻳﺎﺩﺓ ﺍﻟﻣﻔﻭﺽ ﻣﻥ ﻗﺑﻝ ﻣﺎﻟﻙ ﺍﻟﺳﻳﺎﺭﺓ ﺍﻟﻣﺫﻛﻭﺭﺓ ﺃﻋﻼﻩ ; ﻫﺫﻩ ﺍﻟﺷﻬﺎﺩﺓ ﺗﻌﺗﺑﺭ‬
& bodily damage resulting from the liability of the insured or ‫ﺷﻬﺎﺩﺓ ﻏﺭﻡ ﻭ ﺃﺩﺍء ﻟﻠﺣﻖ ﺍﻟﺧﺎﺹ ﺑﺎﻟﻁﺭﻑ ﺍﻟﺛﺎﻟﺙ ﻋﻥ ﺍﻷﺿﺭﺍﺭ ﺍﻟﻣﺎﺩﻳﺔ‬
authorized driver for the accident and according to his ‫ﻭ ﺍﻟﺟﺳﺩﻳﺔ ﺍﻟﻧﺎﺗﺟﺔ ﻋﻥ ﻣﺳﺅﻭﻟﻳﺔ ﺍﻟﻣﺅﻣﻥ ﻟﻪ ﻋﻥ ﺍﻟﺣﺎﺩﺙ ﻭ ﺣﺳﺏ ﺍﺩﺍﻧﺗﻪ‬
conviction and is obliged to pay compensation according to the . ‫ﻭ ﻛﺎﻥ ﻣﻠﺯﻣﺎ ﺑﺄﺩﺍء ﺍﻟﺗﻌﻭﻳﺽ ﻁﺑﻘﺎ ﻟﻠﻘﺎﻧﻭﻥ ﻭ ﺿﻣﻥ ﺣﺩﻭﺩ ﺍﻟﻣﺳﺅﻭﻟﻳﺔ‬
law and within the limits of ability.

‫ﺍﻟﺗﻭﻗﻳﻊ ﺍﻟﻣﻔﻭﺽ‬

Shari’a certificate ref#: (MDF-1463-38-38-02-20-01)

Identification Number: A-MEDG-1-B-15-046

Riyadh HO: P.O Box: 2302 – Riyadh 11451 – Tel: 011 405 5550 – Fax 011 405 5588 email: riyadh@medgulf.com.sa 011 405 5588 :‫ ﻓﺎﻛﺱ‬- 011 405 5550 :‫ ﻫﺎﺗﻑ‬- 11451 ‫ ﺍﻟﺭﻳﺎﺽ‬- 2302 :‫ﺏ‬.‫ ﺹ‬:‫ﺍﻟﺭﻳﺎﺽ ﺍﻟﻣﺭﻛﺯ ﺍﻟﺭﺋﻳﺳﻲ‬
Jeddah Br.: P.O Box: 51830 – Jeddah 21553 – Tel: 012 660 6366 – Fax: 012 668 0098 email: jeddah@medgulf.com.sa 012 668 0098 :‫ – ﻓﺎﻛﺱ‬012 660 6366 :‫ – ﻫﺎﺗﻑ‬21553 ‫ – ﺟﺩﺓ‬51830 :‫ﺏ‬.‫ ﺹ‬:‫ﻓﺭﻉ ﺟﺩﺓ‬
Khobar Br.: P.O Box: 8836 – Dammam 31492 – Tel: 013 814 7667 – Fax: 013 814 7665 email: khobar@medgulf.com.sa 013 814 7665 :‫ – ﻓﺎﻛﺱ‬7667 814 013 :‫ – ﻫﺎﺗﻑ‬31492 ‫ – ﺍﻟﺩﻣﺎﻡ‬8836 :‫ﺏ‬.‫ ﺹ‬:‫ﻓﺭﻉ ﺍﻟﺧﺑﺭ‬