‫ﺟدول اﻟوﺛﯾﻘﺔ اﻟﻣوﺣدة ﻟﻠﺗﺄﻣﯾن اﻹﻟزاﻣﻲ ﻋﻠﻰ اﻟﻣرﻛﺑﺎت‬

‫‪Schedule of the Unified Compulsory Motor Insurance Policy‬‬

‫‪P/175/2913/23/609985‬‬ ‫رﻗم اﻟوﺛﯾﻘﺔ‬ ‫‪ - Individual‬ﻓرد‬ ‫ﻧوع اﻟﻣؤﻣن ﻟﮫ‬
‫‪Policy No‬‬ ‫‪Type of Insured‬‬
‫ﺑﯾﺎﻧﺎت اﻟﻣؤﻣن ﻟﮫ ‪Insured information‬‬
‫‪2443408501‬‬ ‫رﻗم ھوﯾﺔ اﻟﻣؤﻣن ﻟﮫ‬
‫‪Insured's ID No.‬‬
‫ﻋﺑده ﻋﺑدﷲ ﷴ ﻧﺎﺻر‬ ‫اﺳم اﻟﻣؤﻣن ﻟﮫ‬
‫‪Name of Insured‬‬
‫‪0504773934‬‬ ‫رﻗم اﻟﮭﺎﺗف‬
‫‪Phone No.‬‬
‫‪ ,4847‬ﺷﺎرع اﻟﻣﺳﻠﻣﺔ‪ ,‬ﺣﻲ اﻟﻣﻘﺎم‪ ,‬ﻣﻛﺔ اﻟﻣﻛرﻣﺔ‪7475 ,24431 ,‬‬ ‫اﻟﻌﻧوان‬
‫‪Address‬‬
‫ﺑﯾﺎﻧﺎت اﻟﻣرﻛﺑﺔ‬
‫‪Vehicle Details‬‬
‫ﻋﺑده ﻋﺑدﷲ ﷴ ﻧﺎﺻر‬ ‫اﺳم ﻣﺎﻟك اﻟﻣرﻛﺑﺔ‬ ‫‪2443408501‬‬ ‫رﻗم ھوﯾﺔ ﻣﺎﻟك اﻟﻣرﻛﺑﺔ‬
‫‪Owner's Name‬‬ ‫‪Owner's ID No.‬‬
‫‪6T1BE42K69X547066‬‬ ‫رﻗم اﻟﮭﯾﻛل‬ ‫ا ق ر ‪8982‬‬ ‫رﻗم ﻟوﺣﺔ اﻟﻣرﻛﺑﺔ‬
‫‪Chassis No.‬‬ ‫‪Registration Plate No.‬‬
‫‪28/02/1445‬‬ ‫ﺗﺎرﯾﺦ اﻧﺗﮭﺎء رﺧﺻﺔ اﻟﺳﯾر‬ ‫اﺧﺿر ﻓﺎﺗﺢ‬ ‫ﻟون اﻟﻣرﻛﺑﺔ‬
‫‪Vehicle Registration Expiry‬‬ ‫‪Vehicle Color‬‬
‫‪Date‬‬
‫‪13641900‬‬ ‫اﻟرﻗم اﻟﺗﺳﻠﺳﻠﻲ‬ ‫ﺳﯾﺎرة ﺻﻐﯾرة ‪ 4‬ﺑﺎب‬ ‫ﻧوع ھﯾﻛل اﻟﻣرﻛﺑﺔ‬
‫‪Sequence Number‬‬ ‫‪Type of Chassis‬‬

‫‪2009‬‬ ‫ﺳﻧﺔ اﻟﺻﻧﻊ‬ ‫ﺗوﯾوﺗﺎ‬ ‫ﻣﺎرﻛﺔ اﻟﻣرﻛﺑﺔ‬

‫‪Year of Manufacture‬‬ ‫‪Vehicle Make‬‬
‫ﺷﺧﺻﻲ‬ ‫ﻏرض اﻻﺳﺗﻌﻣﺎل‬ ‫ﻛﺎﻣري‬ ‫ﻣودﯾل اﻟﻣرﻛﺑﺔ‬
‫ﺷﺧﺻﻲ‬ ‫‪Purpose of Use‬‬ ‫‪Vehicle Model‬‬
‫‪ - Private Car‬ﺳﯾﺎرة ﺧﺎﺻﺔ‬ ‫ﻧوع ﺗﺳﺟﯾل اﻟﻣرﻛﺑﺔ‬
‫‪Type of Registration Plate‬‬
‫ﺗﺄﻣﯾن اﻟﻣﺳؤوﻟﯾﺔ اﻟﻣدﻧﯾﺔ ﺿد اﻟﻐﯾر‬ ‫ﻧوع اﻟﺗﻐطﯾﺔ‬
‫‪Third Party Liability Insurance‬‬ ‫‪Coverage Type‬‬
‫‪License Number‬‬ ‫‪ Driver Name‬رﻗم رﺧﺻﺔ اﻟﻘﯾﺎدة‬ ‫اﺳم اﻟﺳﺎﺋﻖ‬ ‫أﺳﻣﺎء اﻟﺳﺎﺋﻘﯾن اﻟُﻣﺳﻣﯾن )ﻣﻊ رﻗم رﺧص اﻟﻘﯾﺎدة اﻟﺧﺎﺻﺔ‬
‫‪2443408501‬‬ ‫ﻋﺑده ﻋﺑدﷲ ﷴ ﻧﺎﺻر‬ ‫ﺑﮭم(‬
‫‪Names of authorized drivers (with‬‬
‫)‪their driving licenses numbers‬‬
‫داﺧل أراﺿﻲ اﻟﻣﻣﻠﻛﺔ اﻟﻌرﺑﯾﺔ اﻟﺳﻌودﯾﺔ‬ ‫اﻟﺣدود اﻟﺟﻐراﻓﯾﺔ‬
‫‪On Saudi Arabian territories‬‬ ‫‪Geographic borders‬‬
‫ﯾﺟب ﻋﻠﻰ اﻟﻣؤ َ ّﻣن ﻟﮫ أﻻ ﯾﺳﺗﻌﻣل اﻟﻣرﻛﺑﺔ إﻻ ﻟﻠﻐرض اﻟﻣرﺧص ﻣن أﺟﻠﮫ‬ ‫ﻗﯾد اﻻﺳﺗﻌﻣﺎل‬
‫‪The insured should not use the vehicle for other than its authorized purpose‬‬ ‫‪Use Restraints‬‬
‫‪0.00‬‬ ‫اﻟﻘﺳط اﻹﺿﺎﻓﻲ‬ ‫‪0.00‬‬ ‫‪ 1377.00‬ﺗﺣﻣل اﻟﺣوادث‬ ‫ﻣﺑﻠﻎ ﻗﺳط اﻟﺗﺄﻣﯾن‬
‫‪Additional Premium‬‬ ‫‪Claim Loading‬‬ ‫‪Premium‬‬
‫ﺧﺻم ﻋدم وﺟود ﻣطﺎﻟﺑﺎت‬ ‫رﺳوم اﻹﺻدار‬ ‫ﺧﺻم اﻟوﻻء‬
‫‪NCD‬‬ ‫‪Issue Fee‬‬ ‫‪Loyalty Discount‬‬
‫‪1583.55‬‬ ‫‪ 206.55‬إﺟﻣﺎﻟﻲ اﻟﻣﺑﻠﻎ اﻟﻣدﻓوع‬ ‫‪ 1377.00‬ﺿرﯾﺑﺔ اﻟﻘﯾﻣﺔ اﻟﻣﺿﺎﻓﺔ‬ ‫إﺟﻣﺎﻟﻲ ﻣﺑﻠﻎ اﻟﺗﺄﻣﯾن‬
‫‪Total Paid Amount‬‬ ‫‪VAT % 15‬‬ ‫‪Total Premium‬‬
‫‪ From : day‬اﻷﺣد ‪dated 24/09/2023 Time 12:00 AM‬‬ ‫ﻣن‪ :‬ﯾوم اﻷﺣد اﻟﻣواﻓﻖ ‪ 1445-3-10‬اﻟﺳﺎﻋﺔ ‪AM 12:00‬‬ ‫ﻓﺗرة اﻟﺗﻐطﯾﺔ‬
‫‪Coverage Period‬‬
‫‪ To : day‬اﻹﺛﻧﯾن ‪dated 23/09/2024 Time 11:59 PM‬‬ ‫إﻟﻰ‪ :‬ﯾوم اﻹﺛﻧﯾن اﻟﻣواﻓﻖ ‪ 1446-3-20‬اﻟﺳﺎﻋﺔ ‪PM 11:59‬‬ ‫ﻓﺗرة اﻟﺗﻐطﯾﺔ‬
‫‪Coverage Period‬‬