3710456664520

*3710456664520*
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THE VIRIYAH INSURANCE PUBLIC COMPANY LIMITED 121/28,121/65 RS Tower, Ratchadapisek Rd.,.Dindaeng Bangkok 10400 THAILAND Tel.0-2129-8888 www.viriyah.co.th
­µ µš¸ÉŘŘŘŞŝ ­µ µš¸É°°„ĝ„ε„´£µ¬¸‡º°ª·£µª—¸Ú¦ŘŚŚşŚŚŝřřŚŘ¢„ŽrŘŚŚşŚŚŝśš ª´œš¸ÉDate : 16/03/2566
Á¨ ž¦³‹Îµ˜´ªŸ¼oÁ­¸¥£µ¬¸°µ„¦Tax identification number 0107555000139 š³Á¸¥œÁ¨ š¸ÉTrade registration number 0107555000139 ĝÁ­¦È‹¦´ÁŠ·œĝ„ε„´£µ¬¸°¥nµŠ¥n° Á¨ š¸ÉNo : 5666452
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THE SCHEDULE / RECEIPT / TAX INVOICE (ABB) (Sell through electronic channel (Online))
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Co.Code VIB „¦¤›¦¦¤rž¦³„´œ£´¥Á¨ š¸É
Policy No.
VIB
08582 66001-5666452
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Item 1. The Insured Name Á¨ ž¦³‹Îµ˜´ªž¦³µœÁ¨ ž¦³‹Îµ˜´ªŸ¼oÁ­¸¥£µ¬¸°µ„¦śśŜŘşŘřřŞřřŝř Territorial Limit
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Address ™œœ˜Îµ¨‡¨°Š®œ¹ÉŠ°ÎµÁ£°‡¨°Š®¨ªŠžš»¤›µœ¸řŚřŚŘ Thailand
¦µ¥„µ¦ Ś¦³¥³Áª¨µž¦³„´œ£´¥ Á¦·É¤˜oœª´œš¸É 31/03/2566 ™¹Šª´œš¸É 31/03/2567 Áª¨µřŞśŘœ
Item 2. Period of Insurance From To at 16.30 hours
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Item 3. Particulars of Motor Vehicle
¦®´­ ºÉ°¦™ Á¨ š³Á¸¥œ Á¨ ˜´ª™´Š ˜´ª™´Š œµ—Á‡¦ºÉ°Š¥œ˜r‹Îµœªœš¸Éœ´ÉŠœÎʵ®œ´„¦ª¤
Code Motor Vehicle Model Licence No. Chassis No. Body Type No. of Seats/C.C./Weight
ISUZU
1.40A ř•¦śšŜŝ MP1TFR87JGG024379 ¦™¥œ˜r¦¦š»„ 0/0/0
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ř ŠŘŘŘ؝µš˜n°®œ¹ÉŠ‡œ­Îµ®¦´‡ªµ¤Á­¸¥®µ¥˜n°¦nµŠ„µ¥®¦º°°œµ¤´¥
¦µ¥„µ¦ Ŝ‹ÎµœªœÁŠ·œ‡»o¤‡¦°ŠŸ¼ož¦³­£´¥ 80,000 Baht per person for bodily injury or injury to health
Item 4. Limit of Coverage Ś ŝŘŘŘŘ؝µš˜n°®œ¹ÉŠ‡œ­Îµ®¦´„µ¦Á­¸¥¸ª·˜®¦º°š»¡¡¨£µ¡™µª¦­·ÊœÁ·Š
500,000 Baht per person for loss of life or total permanent disability
ś ŚŘŘŘŘ؝µš™¹ŠŝŘŘŘŘ؝µš˜n°®œ¹ÉŠ‡œ­Îµ®¦´š»¡¡¨£µ¡°¥nµŠ™µª¦®¦º°„µ¦­¼Á­¸¥°ª´¥ª³˜µ¤ÁŠºÉ°œÅ „¦¤›¦¦¤rž¦³„´œ£´¥ o°ś
200,000 Baht to 500,000 Baht per person of permanent disability or dismemberment according to Clause 3.
Ŝ ŚŘ؝µš˜n°ª´œ¦ª¤„´œÅ¤nÁ„·œŚŘª´œ­Îµ®¦´„µ¦—Á¥¦µ¥ª´œ„¦–¸Á oµ¦´„¬µÄœ­™µœ¡¥µµ¨Äœ“µœ³‡œÅ oĜ
200 Baht per day, not more than 20 days for daily compensation in case of hospitalization as an inpatient.
ŝ „¦–¸Ÿ¼ož¦³­£´¥š¸ÉÁžÈœŸ¼o ´ ¸É¦™‡´œš¸ÉÁ°µž¦³„´œ£´¥‹³Å—o¦´‡ªµ¤‡»o¤‡¦°ŠÅ¤nÁ„·œ‹Îµœªœ‡nµÁ­¸¥®µ¥ÁºÊ°Š˜oœ˜µ¤š¸É¦³»Äœ¦µ¥„µ¦š¸Éŝ
In the event that the victim is a driver this vehicle will cover only Preliminary Compensation according to Item 5.
š´ÊŠœ¸Ê‹ÎµœªœÁŠ·œ‡»o¤‡¦°Š­¼Š­»—­Îµ®¦´ ř  Ś  ś ¨³ Ŝ ¦ª¤„´œÅ¤nÁ„·œŝŘŜŘŘ؝µš˜n°®œ¹ÉŠ‡œ
¨³¦ª¤„´œÅ¤nÁ„·œ®oµ¨oµœµš­Îµ®¦´¦™š¸É¤¸š¸Éœ´ÉŠÅ¤nÁ„·œÁ‹È—‡œ®¦º°¦™¦¦š»„Ÿ¼o×¥­µ¦¦ª¤š´ÊŠŸ¼o ´ ¸ÉŤnÁ„·œÁ‹È—‡œ
¨³Å¤nÁ„·œ­·¨oµœµš­Îµ®¦´¦™š¸É¤¸š¸Éœ´ÉŠÁ„·œÁ‹È—‡œ®¦º°¦™¦¦š»„Ÿ¼o×¥­µ¦¦ª¤š´ÊŠŸ¼o ´ ¸ÉÁ„·œÁ‹È—‡œ˜n°°»´˜·Á®˜»Â˜n¨³‡¦´ÊŠ
Maximum coverage for item (1), (2), (3) and (4) combined shall not exceed 504,000 Baht per person and total coverage per accident shall not exceed
5 million Baht for vehicle not more than 7 seats or vehicle carrying not more than 7persons including driver and not exceed 10 million Baht per
accident for vehicle more than 7 seats or vehicle carrying more than 7 persons including driver.
š´ÊŠœ¸Ê¦µ¥¨³Á°¸¥—‡ªµ¤‡»o¤‡¦°ŠÁžÈœÅž˜µ¤ÁŠºÉ°œÅ „¦¤›¦¦¤rž¦³„´œ£´¥œ¸Ê
¦µ¥„µ¦ ŝ‹ÎµœªœÁŠ·œ‡nµÁ­¸¥®µ¥ÁºÊ°Š˜oœ ‡ªµ¤Á­¸¥®µ¥˜n°¦nµŠ„µ¥ŤnÁ„·œśŘŘŘ؝µš˜n°®œ¹ÉŠ‡œ®¦º°˜µ¤š¸É„‘®¤µ¥„ε®œ—
Bodily injury not exceeding 30,000 Baht per person or according to the law.
Item 5. Limit of Preliminary Compensation ‡ªµ¤Á­¸¥®µ¥˜n°¦nµŠ„µ¥­Îµ®¦´„µ¦­¼Á­¸¥°ª´¥ª³®¦º°š»¡¡¨£µ¡°¥nµŠ™µª¦śŝŘŘ؝µš®¦º°˜µ¤š¸É„‘®¤µ¥„ε®œ—
Bodily injury for dismemberment of permanent disability 35,000 Baht or according to law.
‡ªµ¤Á­¸¥®µ¥˜n°¸ª·˜śŝŘŘ؝µš˜n°®œ¹ÉŠ‡œ®¦º°˜µ¤š¸É„‘®¤µ¥„ε®œ—
Loss of life 35,000 Baht per person or according to law.
‹ÎµœªœÁŠ·œ‡nµÁ­¸¥®µ¥ÁºÊ°Š˜oœœ¸ÊÁžÈœ­nªœ®œ¹ÉŠ °Š‹ÎµœªœÁŠ·œ‡»o¤‡¦°ŠŸ¼ož¦³­£´¥˜µ¤¦µ¥„µ¦Ŝ
Preliminary Compensation is part of compensation according to item 4.
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Item 6. Premium : (Baht)
Á¸Ê¥ž¦³„´œ£´¥ ­nªœ¨—‹µ„„µ¦ž¦³„´œ£´¥Ã—¥˜¦Š Á¸Ê¥ž¦³„´œ£´¥­»š›· °µ„¦Â­˜¤žr £µ¬¸¤¼¨‡nµÁ¡·É¤ ¦ª¤ÁŠ·œ
Premium Direct Insurance Discounts Net Premium Revenue Stamps VAT Total
900.00 27.00 873.00 4.00 61.39 938.39
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Item 7. Use of Motor Vehicle
„µ¦ž¦³„´œ£´¥Ã—¥˜¦ŠDirect Insurance......................... ˜´ªÂšœž¦³„´œ£´¥¦µ¥œ¸ÊAgent.......................... œµ¥®œoµž¦³„´œ£´¥¦µ¥œ¸ÊBroker.......................... ĝ°œ»µ˜Á¨ š¸ÉLicense No. ................
16/03/2566
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Agreement made on Policy issued on
Á¡ºÉ°ÁžÈœ®¨´„“µœ¦·¬´šÃ—¥»‡‡¨Ÿ¼o¤¸°Îµœµ‹Å—o¨Š¨µ¥¤º°ºÉ°Â¨³ž¦³š´˜¦µ °Š¦·¬´šÅªoÁžÈœ­Îµ‡´–­Îµœ´„Šµœ °Š¦·¬´š
To be evidence the Company by an authorized persons signed and affixed the Company seal at its Office

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3710456664520
Evidence of Insurance under the Protection for Motor Vehicle Victims Act.
to apply for a new vehicle registration or annual tax with the Land Transport registrar 3 7 1 0 4 5 6 6 6 4 5 2 0
*3710456664520*
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Á°„­µ¦œ¸ÊÄ®oŪoÁ¡ºÉ°Â­—Šªnµ¦™®¤µ¥Á¨ š³Á¸¥œš¸ÉThis document is intended to indicate motor vehicle registration No. ......................................................................................................................................
MP1TFR87JGG024379
˜´ª™´Š¦™Á¨ š¸ÉChassis No. ..................................................................................................................................................................................................................................................................................................
ŗošÎµž¦³„´œ£´¥˜µ¤¡¦³¦µ´´˜·‡»o¤‡¦°ŠŸ¼ož¦³­£´¥‹µ„¦™¡«Śŝśŝ¨oª×¥¤¸¦³¥³Áª¨µž¦³„´œ£´¥Is insured under the Protection for Motor Vehicle Victims Act B.E. 2535
31/03/2566
Á¦·É¤˜oœª´œš¸ÉPeriod Insured from................................................... 31/03/2567
™¹Šª´œš¸Éto........................................... 66001-5666452
˜µ¤„¦¤›¦¦¤rž¦³„´œ£´¥Á¨ š¸ÉInsurance Policy No.......................................................................................
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