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Dubai Insurance Company Psc, Head Office, Al Rigga Road, PO Box 3027, Dubai, UAE

TRN: 100032059600003

Receipt / ‫ﺳﻨﺪ ﻗﺒﺾ‬

Receipt Number PR0008283448 ‫ﺭﻗﻢ ﺳﻨﺪ ﺍﻟﻘﺒﺾ‬


Receipt Date 09-11-2023 ‫ﺗﺎﺭﻳﺦ ﺳﻨﺪ ﺍﻟﻘﺒﺾ‬
Name of the Insured worker NAFRI ABDUL KAHAR ELIYAS ABDUL ‫ﺍﺳﻢ ﺍﻟﻌﺎﻣﻞ ﺍﻟﻤﺆﻣﻦ ﻋﻠﻴﻪ‬
KAHAR
Emirates ID No./UID number 784198791980299 ‫ ﺍﻟﺮﻗﻢ ﺍﻟﻤﻮﺣﺪ‬/ ‫ﺭﻗﻢ ﺍﻟﻬﻮﻳﺔ ﺍﻹﻣﺎﺭﺍﺗﻴﺔ‬
COI # C/01/2023/005174031 ‫ﺭﻗﻢ ﺷﻬﺎﺩﺓ ﺍﻟﺘﺄﻣﻴﻦ‬
Payment Plan (monthly/quarterly/yearly) Monthly ‫ﺩﻭﺭﻳّﺔ ﺍﻟﺴﺪﺍﺩ‬

Due Date of last installment 12-06-2024 ‫ﺗﺎﺭﻳﺦ ﺍﺳﺘﺤﻘﺎﻕ ﺍﻟﺪﻓﻌﺔ ﺍﻷﺧﻴﺮﺓ ﻣﻦ ﺍﻟﻘﺴﻂ ﺍﻟﺘﺄﻣﻴﻨﻲ‬

Instalment number 5th ‫ﺭﻗﻢ ﺍﻟﺪﻓﻌﺔ‬


Number of instalments paid (including 5 (‫ﻋﺪﺩ ﺍﻟﺪﻓﻌﺎﺕ ﺍﻟﻤﺴﺪﺩﺓ )ﻣﺘﻀﻤﻨﺔ ﻫﺬﻩ ﺍﻟﺪﻓﻌﺔ‬
this instalment)
Number of instalments outstanding 7 ‫ﻋﺪﺩ ﺍﻟﺪﻓﻌﺎﺕ ﺍﻟﻤﺘﺒﻘﻴﺔ‬
Payment against Tax Invoice 0005174031 ‫ﺍﻟﺪﻓﻌﺔ ﺿﺪّ ﺍﻟﻔﺎﺗﻮﺭﺓ ﺍﻟﻀﺮﻳﺒﻴّﺔ ﺭﻗﻢ‬
Tax Invoice date 12-07-2023 ‫ﺗﺎﺭﻳﺦ ﺍﻟﻔﺎﺗﻮﺭﺓ ﺍﻟﻀﺮﻳﺒﻴّﺔ‬
Amount received 5.00 ‫ﺍﻟﻤﺒﻠﻎ ﺍﻟﻤُﺴﺪﺩ‬
Payment Reference Number R0005170099 ‫ﺭﻗﻢ ﺍﻟﺪﻓﻌﺔ ﺍﻟﻤﺮﺟﻌﻲ‬
Payment made through Worker ‫ﺁﻟﻴﺔ ﺳﺪﺍﺩ ﺍﻟﺪﻓﻌﺔ‬

Total instalments received with VAT 28.00 ‫ﺇﺟﻤﺎﻟﻲ ﺍﻟﺪﻓﻌﺎﺕ ﺍﻟﻤُﺴﺪﺩﺓ ﺷﺎﻣﻞ ﺿﺮﻳﺒﺔ ﺍﻟﻘﻴﻤﺔ ﺍﻟﻤﻀﺎﻓﺔ‬

Balance to be received in agreed 35.00 ‫ﺇﺟﻤﺎﻟﻲ ﺍﻟﺪﻓﻌﺎﺕ ﺍﻟﻤﺘﺒﻘﻴﺔ ﺍﻟﻤﺴﺘﺤﻘﺔ ﻣﻦ ﺍﻟﻘﺴﻂ‬


instalments (AED) ‫ﺍﻟﺘﺄﻣﻴﻨﻲ‬

‫ ﻭﻗﺪ‬،‫ﻻ ﻳﺤﺘﺎﺝ ﺳﻨﺪ ﺍﻟﻘﺒﺾ ﻫﺬﺍ ﺇﻟﻰ ﺧﺘﻢ ﺃﻭ ﺗﻮﻗﻴﻊ‬


This is a system generated document
ّ‫ﺻﺪﺭ ﺑﺼﻮﺭﺓ ﺇﻟﻜﺘﺮﻭﻧﻴّﺔ ﻣﻦ ﺧﻼﻝ ﺍﻟﻨﻈﺎﻡ ﺍﻹﻟﻜﺘﺮﻭﻧﻲ‬
does not need any signature

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