11/4/2019 ::P c Sc ed e ::

Schedule No. (5) ‫ﺟﺪ ر‬

Schedule of Details of the Insured Motor Vehicle in the Insurance Policy against
Third Party Liability
‫ا ﺴﺆ ﺔ ا ﺪ ﺔ‬ ‫ﺎ ﺛ ﺔ ﺗﺄ‬ ‫ﺟﺪ ﺑ ﺎ ﺎت ا ﺮ ﺒﺔ ا ﺆ‬
Ref Number: DP/10/1010/19/18095 DP/10/1010/19/18095 ‫رﻗﻢ اﻟ ﺮﺟﻊ‬

Polic Number: 1021824220 1021824220 ‫رﻗﻢ اﻟ ﺛ ﻘﺔ‬

The term of insurance begins at 16:17 on :‫م‬ ‫ظ ﺮا ﻣ‬ 16:17 ‫ ﺗﺒﺪأ ﻓ ﺗ ﺎم اﻟﺴﺎﻋﺔ‬:(‫ﻣﺪة اﻟﺘﺄﻣ )ﻓﺘﺮة اﻟﺘﻐﻄ ﺔ‬
04/11/2019, and e pires at 23:59 on 03/12/2020 03/12/2020: ‫م‬ ‫ﻣﺴﺎء ﻣ‬23:59‫ ﺗ ﺘ ﻓ اﻟﺴﺎﻋﺔ‬04/11/2019

Agreed upon premium: AED. 992.25 Including VAT ‫ در ﻢ‬992.25 ‫ﺮﺒ‬ ‫ا‬ ‫ ﺸ‬: ‫ا ﺟ ﺎﻟ‬ ‫ﻗﺴﻂ اﻟﺘﺄﻣ‬
AED NINE HUNDRED NINETY-TWO AND FILS TWENTY-FIVE ONLY
‫ﻓﻘﻂ ﻏ ﺮ‬ ‫ﺧ ﺴﺔ ﻋﺸﺮ‬ ‫ﺗﺴﻌ‬ ‫در ﻢ ﺗﺴﻌ ﺎﺋﺔ إﺛ ﺎ‬

INSURANCE HOUSE Compan declares that the Motor Vehicle detailed ‫ﺬا اﻟﺠﺪ ل ﻣﺆﻣ ﺔ ﻟﺪ ﺎ‬ ‫ﺑﺄ اﻟ ﺮﻛﺒﺔ اﻟ اردة ﺑ ﺎ ﺎﺗ ﺎ ﻓ‬ ‫ﺗ ﺮ ﺷﺮ ﺔ دار ا ﺘﺄ‬
below in this Schedule is insured with it according to the provision of this ‫ﻓﻘﺎ ً ﺣﻜﺎم ﺬ اﻟ ﺛ ﻘﺔ‬
Polic .
VEHICLE DETAILS ‫ﺑ ﺎ ــــــــﺎت ا ﺮ ﺒﺔ‬
‫ﺌﺔ ا ﺮ ﺒﺔ‬ ‫ـــ ا ﺮ ﺒﺔ‬ ‫ا ﺮ ﺒﺔ‬ ‫ر ا ﺣﺔ‬ ‫ﺑ ﺪ ﺻ ا ﺮ ﺒﺔ‬
Motor Vehicle Classification Color Make & Model Plate Number Country of Manufacture

4WD GREY NISSAN MURANO 1 Japan

‫ا ﺴﺎﺋ‬ ‫ﺪد ا ﺮ ﺎب‬ ‫ﺪد ا ﺳ ا ﺎت‬ ‫ ا ز‬/ ‫اﺤ ﺔ‬ ‫ﺳﺔ اﺼ‬ ‫ﺻ ﺔ ا ﺳﺘ ﺎ‬ ‫ﺻ ﺔ ا ﺘﺴﺠ‬
Seating Capacity No. of Cylinders Tonnage/ Weight Manufacturing Year Purpose of use Registration on Type

5 6 N/A 2017 Private Individual

‫ر ا ﺤﺮ‬ ‫)ا ﺸﺎﺻ‬ ‫)ر ا‬
NIL 5N1AZ2MH8HN143438
Engine Number Chassis Number

Geographical Area: Within United Arab Emirates ‫د ﻟﺔ ا ﻣﺎرات اﻟﻌﺮﺑ ﺔ اﻟ ﺘﺤﺪة‬: ‫ا ﺤﺪ د ا ﺠ ﺮا ﺔ‬

LIMIT OF LIABILITY :‫ﺗﺤﺪ ﺪ ا ﺴﺆ ﺔ‬

The Compan 's ma imum liabilit in respect of Paragragh ‫ﻋ‬ ‫( ﻣ اﻟﻔﺼﻞ اﻟﺜﺎ‬1) ‫اﻟﺤﺪ ا ﻗﺼ ﻟ ﺴﺆ ﻟ ﺔ اﻟﺸﺮﻛﺔ ﺑﺎﻟ ﺴﺒﺔ ﻟﻠﻔﻘﺮة )ج( ﻣ اﻟﺒ ﺪ‬
(c) of Clause 1 of chapter II in respect of an claim or total ‫ در ﻢ‬2,000,000 ‫ﻣﺒﻠﻎ‬ ‫ﻣﻄﺎﻟﺒﺔ أ ﺟ ﻠﺔ ﻣﻄﺎﻟﺒﺎت ﺸﺄت ﻋ ﺣﺎدث اﺣﺪ‬
claims arising from one accident is AED 2,000,000.

CONDITIONS, CLAUSES AND ANY EXTENSION OF

COVERS AS PER ATTACHED DOCUMENTS ‫ا ﺤ‬ ‫اردة‬ ‫ﺎ‬ ‫ﺎت ا ﺎ ﺔ‬ ‫أ ﺗ‬ ‫اﺒ د‬ ‫ا ﺸﺮ‬

Insured's Details ‫ﺑ ﺎ ﺎت ا ﺆ‬

ALI MURTAZA MUHAMMAD

Insured's Name: ‫ﻋﻠ ﻣﺮﺗﻀ ﻣﺤ ﺪ ﻣ ﺘﺎز‬ : ‫اﺳ ا ﺆ‬
MUMTAZ
Address: 0 0 : ‫ا‬ ‫ا‬
Email: INFO@AIBDUBAI.COM INFO@AIBDUBAI.COM : ‫ﺘﺮ‬ ‫ا ﺒﺮ ﺪ ا‬
PO Box No: 0 0 : ‫ا ا ﺒﺮ ﺪ‬ ‫ا‬
Mobile No: 0501111111 0501111111 : ‫ا ﺎﺗ‬ ‫ر‬
Identification No: - - : ‫ﺔا ﺆ‬ ‫ر‬

Issued B : Motor Underwriting Department ‫اﻟ ﺮﻛﺒﺎت‬ ‫ ﻗﺴﻢ ﺗﺎﻣ‬:‫ﻣﺮﻛﺰ ا ﺻﺪار‬

Issuance Date: 04/11/2019 04/11/2019: ‫ﺗﺎر ﺦ ا ﺻﺪار‬

Name and signature of the Insured or their representative: Signature and stamp of the Compan :

VALUE ADDED TAX “VAT CLAUSE ‫ﺎﺔ‬ ‫ﺔا‬ ‫ﺮ ﺒﺔ ا‬ ‫ﺷﺮ‬

This polic is subject to Federal Law No. 8/2017 on Value Added ‫أ ﺿﺮاﺋﺐ ﻗﺪ‬ ‫اﻟ ﻀﺎﻓ‬ ‫ ﺑﺸﺄ اﻟﻘ‬2017 ‫ ﻟﺴ ﺔ‬8 ‫ا ﺗﺤﺎد رﻗﻢ‬ ‫ﺬ اﻟ ﺛ ﻘ ﺗﺨﻀﻊ ﺣﻜﺎم اﻟﻘﺎ‬
Ta (VAT) and an other ta es could be applied b the Government. ‫ﺗﻔﺮض ﻣ ﻗﺒﻞ أﻟﺴﻠﻄﺎت اﻟ ﺨﺘﺼ‬

:// . e.ae/TPSc ed e.a ? a a RefId=233702&F eNa e=TEMPLATE_MOTOR_TPL 1/2

11/4/2019 ::P c Sc ed e ::

Signa re and s amp of he compan ‫ﻊ ا ﺨﺘ ﻋ ا ﺸﺮ ﺔ‬ ‫اﺘ‬

:// . e.ae/TPSc ed e.a ? a a RefId=233702&F eNa e=TEMPLATE_MOTOR_TPL 2/2