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Report 13590629
Report 13590629
ﺑﯾﺎﻧﺎت اﻟوﺛﯾﻘﺔ
ﺗﺟﺎه اﻟﻐﯾر اﻟﻣﺳؤوﻟﯾﺔ ﺗﺟﺎه اﻟﻐﯾر /اﻟﺷﺎﻣل P0224-MTI-TAMB-00994423 رﻗم اﻟوﺛﯾﻘﺔ
ﺿد اﻟﻐﯾر اﻟﻣﻧﺗﺞ 07/02/2024 ﺗﺎرﯾﺦ ﺑدء اﻟوﺛﯾﻘﺔ
اﻟﻣﻣﻠﻛﺔ اﻟﻌرﺑﯾﺔ اﻟﺳﻌودﯾﺔ اﻟﻧطﺎق اﻟﺟﻐراﻓﻲ ﻟﻠﺗﻐطﯾﺔ: 06/02/2025 ﺗﺎرﯾﺦ اﻧﺗﮭﺎء اﻟوﺛﯾﻘﺔ
ﺑﯾﺎﻧﺎت اﻟﻣﺷﺗرك
ﻋرﻓﺎن اﺣﻣد ﺧﻠﯾل اﺣﻣد اﻟﻣﺎﻟك ﻓرد ﻧوع اﻟﻣﺎﻟك
ﺟدة ﻣدﯾﻧﺔ اﻹﻗﺎﻣﺔ ﻋرﻓﺎن اﺣﻣد ﺧﻠﯾل اﺣﻣد اﻻﺳم
06-06-1985 ﺗﺎرﯾﺦ اﻟﻣﯾﻼد 2260474958 رﻗم اﻟﮭوﯾﺔ/اﻟﺳﺟل اﻟﺗﺟﺎري
irfankhan786673@gmail.com اﻟﺑرﯾد اﻹﻟﻛﺗروﻧﻲ 0552127001 رﻗم اﻟﺟوال
ﻋرﻓﺎن اﺣﻣد ﺧﻠﯾل اﺣﻣد اﻟﻣؤﻣن ﻋﻠﯾﮫ ﻓرد اﻟﻣﺎﻟك
ﻣﻌﻠوﻣﺎت اﻟﺳﺎﺋﻖ
ﻣدﯾﻧﺔ اﻹﻗﺎﻣﺔ رﻗم اﻟﮭوﯾﺔ ﺗﺎرﯾﺦ اﻟﻣﯾﻼد ﻧوع اﻟﺳﺎﺋﻖ )اﺳﺎﺳﻲ/إﺿﺎﻓﻲ( اﻻﺳم
ﺟدة 2260474958 06-06-1985 اﺳﺎﺳﻲ ﻋرﻓﺎن اﺣﻣد ﺧﻠﯾل اﺣﻣد
ﺑﯾﺎﻧﺎت اﻟﻣرﻛﺑﺔ
Small Car 4 Doors ﻧوع ھﯾﻛل اﻟﻣرﻛﺑﺔ اﻟﻧﺗرا طراز /ﻣودﯾل اﻟﻣرﻛﺑﺔ ھوﻧداي ﻣﺎرﻛﺔ اﻟﻣرﻛﺑﺔ )اﻟﻌﻼﻣﺔ
اﻟﺗﺟﺎرﯾﺔ(
اﺑﯾض ﻟون اﻟﻣرﻛﺑﺔ 5 ﻋدد اﻟﻣﻘﺎﻋد 2011 ﺳﻧﺔ اﻟﺻﻧﻊ
Private اﺳﺗﺧداﻣﺎت اﻟﻣرﻛﺑﺔ NA ﻣﺑﻠﻎ اﻟﺗﻐطﯾﺔ اﻟﺗﺄﻣﯾﻧﯾﺔ ب س ط 5168 رﻗم اﻟﻠوﺣﺔ
رﻗم اﻟﺑطﺎﻗﺔ اﻟﺟﻣرﻛﯾﺔ 943652010 اﻟرﻗم اﻟﺗﺳﻠﺳﻠﻲ KMHDT41B8BU173238 رﻗم ھﯾﻛل اﻟﻣرﻛﺑﺔ
ﯾﺟب ﻋﻠﻰ اﻟﻣؤﻣن ﻟﮫ أن ﯾﺳﺗﺧدم اﻟﻣرﻛﺑﺔ ﻗﯾد اﻻﺳﺗﻌﻣﺎل Private Car ﻧوع اﻟﻠوﺣﺔ
ﻟﻠﻐرض اﻟﻣرﺧﺻﺔ ﻷﺟﻠﮫ
ﻣﻠﺧص ﻟﻠﺗﻐطﯾﺔ
ﺣدود اﻟﺗﻐطﯾﺔ ﻣﻧﺎﻓﻊ اﻟﺗﻐطﯾﺔ اﻟﺗﺄﻣﯾﻧﯾﺔ
ﺗﻐطﯾﺔ اﻟطرف اﻟﺛﺎﻟث ﺣﺗﻰ 10ﻣﻠﯾون ﷼ ﺗﻐطﯾﺔ اﻟطرف اﻟﺛﺎﻟث ﺣﺗﻰ 10ﻣﻠﯾون ﷼
ﺗﻐطﯾﺎت ﺗﺄﻣﯾﻧﯾﺔ إﺿﺎﻓﯾﺔ )اﺧﺗﯾﺎرﯾﺔ(
ﺑﯾﺎﻧﺎت
اﻟﻣﺑﻠﻎ )ﺑﺎﻟ﷼ اﻟﺳﻌودي( اﻻﺳﺗﻘطﺎع )اﻟﺧﺻوﻣﺎت(
896.80 ﺻﺎﻓﻲ اﻻﺷﺗراك)ﺷﺎﻣل اﻟﺧﺻوﻣﺎت,ﺧﺻم ﻋدم وﺟود ﻣطﺎﻟﺑﺎت,اﻟﻌﻣوﻟﺔ(
0.00 0.00 % ﺧﺻم ﺧﺎص ﺧﺻم اﻟﻣرﻛﺑﺎت اﻟﻣﺗﻌددة ﺧﺻم اﻟوﻻء اﻟﺧﺻوﻣﺎت
224.00 12 اﻟﻣﺳﺗوى 20.00 % ﺧﺻم ﻋدم وﺟود ﻣطﺎﻟﺑﺎت
17.94 2% اﻟﻌﻣوﻟﺔ
134.52 15.00 % ﺿرﯾﺑﺔ اﻟﻘﯾﻣﺔ اﻟﻣﺿﺎﻓﺔ
1031.32 ﻣﺟﻣوع اﻻﺷﺗراك )ﺻﺎﻓﻲ اﻻﺷﺗراك +ﺿرﯾﺑﺔ اﻟﻘﯾﻣﺔ اﻟﻣﺿﺎﻓﺔ(
ﻣﻌﻠوﻣﺎت إﺿﺎﻓﯾﺔ
.1ﺗدﻓﻊ ﻛﺎﻣل ﻗﯾﻣﺔ ﻗﺳط اﻟﺗﺄﻣﯾن ﻣﻘدﻣﺎ و ﺑﺷﻛل ﺳﻧوي
.2ﻟرﻓﻊ أي ﻣطﺎﻟﺑﺔ ﯾرﺟﻰ إرﻓﺎق ﺗﻘرﯾر ﻣن اﻟﺟﮭﺎت اﻟﻣﻌﻧﯾﺔ ﺑﺎﻟﺣﺎﻟﮫ
.3ﻓﻲ ﺣﺎل ﺗﻌوﯾض اﻟطرف اﻟﺛﺎﻟث ﻋن ﻣرﻛﺑﺔ ﺗم ﻗﯾﺎدﺗﮭﺎ ﻣن ﺷﺧص ﻋﻣره أﻗل ﻣن 18ﺳﻧﺔ ﻓﺈن ﺗﻛﺎﻓل اﻟراﺟﺣﻲ ﺗﺣﺗﻔظ ﺑﺣﻖ اﻟرﺟوع وﺗﺣﺻﯾل اﻟﺗﻌوﯾض ﻣن اﻟﻣؤﻣن ﻟﮫ ﻋدا إذا ﻣﺎﻛﺎن اﻟﻣؤﻣن ﻟﮫ ﻣدرج ﻓﻲ ﺟدول اﻟوﺛﯾﻘﺔ .ﻛﻣﺎ ﯾﺣﻖ أﯾﺿﺎ ً ﻟﺗﻛﺎﻓل
اﻟراﺟﺣﻲ رﻓض ﻣطﺎﻟﺑﺔ اﺻﻼح ﻣرﻛﺑﺔ اﻟﻣؤﻣن ﻟﮫ ﻓﻲ ﺣﺎل ﻗﯾﺎدة ﺷﺧص ﻋﻣره أﻗل ﻣن 18ﺳﻧﺔ ﻟم ﯾدرج ﻓﻲ ﺟدول اﻟوﺛﯾﻘﺔ
.4ﺟدول اﻟوﺛﯾﻘﺔ ﯾﺣﺗوي ﻋﻠﻰ ﻣﻠﺧص اﻟﺗﻐطﯾﺔ ﻓﻘط وﻟﻼطﻼع ﻋﻠﻰ اﻟﺷروط واﻷﺣﻛﺎم ﯾرﺟﻰ اﻻطﻼع ﻋﻠﻰ ﻣﺳﺗﻧدات اﻟوﺛﯾﻘﺔ وﻗراءﺗﮭﺎ ﺑﺗﻣﻌن ﻟﻠﺗﺄﻛد ﻣن ﻓﮭﻣك اﻟﺗﻐطﯾﺎت اﻟﻣﺗﺎﺣﺔ ﻟك واﻻﺳﺗﺛﻧﺎءات ﻣن اﻟﺗﻐطﯾﺔ واﻟﺗﻌرف ﻋﻠﻰ آﻟﯾﺔ رﻓﻊ ﻣطﺎﻟﺑﺔ
.5ﺗم اﻋﺗﻣﺎد اﻟﺗﻐطﯾﺔ ﺑﻧﺎءاً ﻋﻠﻰ ﻣﻌﻠوﻣﺎت اﻟﺳﺎﺋﻖ واﻟﻣرﻛﺑﺔ وﻧوع اﺳﺗﺧدام اﻟﻣرﻛﺑﺔ اﻟﻣﻘدﻣﺔ ﻣن اﻟﻌﻣﯾل وﻓﻲ ﺣﺎل أن ﻣﻌﻠوﻣﺎت اﻟﻣرﻛﺑﺔ واﻟﺳﺎﺋﻖ ﻣﺧﺗﻠﻔﺔ ﻋن ﻣﺎذﻛر اﻟﻌﻣﯾل أو اﺳﺗﺧدام اﻟﻣرﻛﺑﺔ ﻋﻛس ﻣﺎ ذﻛره اﻟﻌﻣﯾل ﯾﻔﻘد اﻟﻌﻣﯾل اﻟﺗﻐطﯾﺔ
.6ﺗﺎﻣﯾن اﻟﻣرﻛﺑﺔ ﺗم اﻛﺗﺗﺎﺑﮫ ﺑواﺳطﺔ ﺷرﻛﺔ ﺗﻛﺎﻓل اﻟراﺟﺣﻲ ﻟﻠﺗﺄﻣﯾن
.7ﻗﯾﻣﺔ اﻟﺿرﯾﺑﺔ اﻟﻣﺿﺎﻓﺔ ﻋﻠﻰ اﻟوﺛﯾﻘﺔ ﺗم ﺗﺣﺻﯾﻠﮭﺎ ﺑﺎﻟﻧﯾﺎﺑﺔ ﻋن ﺣﻛوﻣﺔ اﻟﻣﻣﻠﻛﺔ اﻟﻌرﺑﯾﺔ اﻟﺳﻌودﯾﺔ ﺑﻧﺎءا ﻋﻠﻰ ﻗﺎﻧون اﻟﺿراﺋب اﻟﺻﺎدر ﻣن اﻟﮭﯾﺋﺔ اﻟﻌﺎﻣﺔ ﻟﻠزﻛﺎة واﻟدﺧل ﻓﻲ ﻋﺎم 1438ھـ
.8وﻓﻘﺎ ﻟﻘواﻋد اﻟﺑﻧك اﻟﻣرﻛزي اﻟﺳﻌودي ,ﺳﯾﺗم ﻓرض رﺳوم ادارﯾﺔ ﻗدرھﺎ 30﷼ ﺳﻌودي ﻋﻧد إﻟﻐﺎء اﻟوﺛﯾﻘﺔ
Policy Details
Policy # P0224-MTI-TAMB-00994423 Plan Type Third Party Liability
Start Date 07/02/2024 Product TPL
End Date 06/02/2025 Geographical Scope Kingdom of Saudi Arabia
Participant Details
Type Individual Owner ﻋرﻓﺎن اﺣﻣد ﺧﻠﯾل اﺣﻣد
Name ﻋرﻓﺎن اﺣﻣد ﺧﻠﯾل اﺣﻣد City of Residence ﺟدة
ID / CR # 2260474958 DOB 06-06-1985
Mobile # 0552127001 Email irfankhan786673@gmail.com
Owner Individual Insured ﻋرﻓﺎن اﺣﻣد ﺧﻠﯾل اﺣﻣد
Driver Information
Name(s) Main/Additional DOB ID # City of Residence
ﻋرﻓﺎن اﺣﻣد ﺧﻠﯾل اﺣﻣد Main 06-06-1985 2260474958 ﺟدة
Vehicle Details
Make ھوﻧداي Model اﻟﻧﺗرا Body Type Small Car 4 Doors
Model Year 2011 No. of Seats 5 Color اﺑﯾض
Plate # 5168 ب س ط Sum Insured NA Vehicle Use Private
Chassis # KMHDT41B8BU173238 Sequence # 943652010 Custom ID
The Insured should not
Plate Type Private Car Use Restrains use the vehicle for other
than the authorized
purpose
Summary of Cover
Benefit Limit
Third Party Liability up to 10 Million riyals Third Party Liability up to 10 Million riyals
Optional Cover(s)
Contribution Information
Description Amount (in SAR)
Net Contribution(Inclusive of Discount, NCD, Commissions) 896.80
Discount - Loyalty Multi Vehicle Special 0.00 % 0.00
No Claims Discount (NCD) 20.00 % Level 12 224.00
Commission 2% 17.94
Value Added Tax (VAT) 15.00 % 134.52
Total Contribution (Net Contribution + VAT) 1031.32
Additional Information
1. Annual contribution must be fully paid in advance.
2. Every claim must be accompanied by a Concerned Parties report.
3. In case of third party liability claim whilst the insured vehicle is being driven by a person below 18 years of age, Al Rajhi Takaful reserves the right of recourse
upon indemnifying the third party, unless anyone below 18 years of age is stated in the policy schedule. Al Rajhi Takaful reserves the right to decline own
damage claims if any, whilst the insured vehicle is being driven by anyone whose age is below the age of the Main Driver or Additional Driver mentioned in the
policy schedule.
4. This Policy Schedule contains a Summary of Cover only. For full Terms & Conditions, please read the policy wording carefully, to ensure your understanding of
what is covered, what is not covered and what to do if you need to apply for a claim.
5. This policy is based on driver's & vehicle's information and Vehicle's use as provided. Excludes cover if Vehicle Use is different from what is mentioned in
Vehicle Details section.
6. This motor insurance is underwritten by Al Rajhi Company for Co-operative Insurance (ARCCI).
7. Value Added Tax (VAT) has been charged on behalf of the Government of the Kingdom of Saudi Arabia in accordance with the VAT Act announced by General
Authority of Zakat and Tax (GAZT) in H1438.
8. As per SAMA rules, an administrative fee of SAR 30 will be charged on policy cancelation.