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

TRN: 100032059600003

Receipt / ‫ﺳﻨﺪ ﻗﺒﺾ‬

Receipt Number PR0010870654 ‫ﺭﻗﻢ ﺳﻨﺪ ﺍﻟﻘﺒﺾ‬

Receipt Date 02-04-2024 ‫ﺗﺎﺭﻳﺦ ﺳﻨﺪ ﺍﻟﻘﺒﺾ‬
Name of the Insured worker WASEEM AKRAM ‫ﺍﺳﻢ ﺍﻟﻌﺎﻣﻞ ﺍﻟﻤﺆﻣﻦ ﻋﻠﻴﻪ‬
Emirates ID No./UID number 784199829568502 ‫ ﺍﻟﺮﻗﻢ ﺍﻟﻤﻮﺣﺪ‬/ ‫ﺭﻗﻢ ﺍﻟﻬﻮﻳﺔ ﺍﻹﻣﺎﺭﺍﺗﻴﺔ‬
COI # C/01/2023/006564068 ‫ﺭﻗﻢ ﺷﻬﺎﺩﺓ ﺍﻟﺘﺄﻣﻴﻦ‬
Payment Plan (monthly/quarterly/yearly) Semi Annual ‫ﺩﻭﺭﻳّﺔ ﺍﻟﺴﺪﺍﺩ‬

Due Date of last installment 04-04-2024 ‫ﺗﺎﺭﻳﺦ ﺍﺳﺘﺤﻘﺎﻕ ﺍﻟﺪﻓﻌﺔ ﺍﻷﺧﻴﺮﺓ ﻣﻦ ﺍﻟﻘﺴﻂ ﺍﻟﺘﺄﻣﻴﻨﻲ‬

Instalment number 2nd ‫ﺭﻗﻢ ﺍﻟﺪﻓﻌﺔ‬

Number of instalments paid (including 2 (‫ﻋﺪﺩ ﺍﻟﺪﻓﻌﺎﺕ ﺍﻟﻤﺴﺪﺩﺓ )ﻣﺘﻀﻤﻨﺔ ﻫﺬﻩ ﺍﻟﺪﻓﻌﺔ‬
this instalment)
Number of instalments outstanding Nil ‫ﻋﺪﺩ ﺍﻟﺪﻓﻌﺎﺕ ﺍﻟﻤﺘﺒﻘﻴﺔ‬
Payment against Tax Invoice 0006564151 ‫ﺍﻟﺪﻓﻌﺔ ﺿﺪّ ﺍﻟﻔﺎﺗﻮﺭﺓ ﺍﻟﻀﺮﻳﺒﻴّﺔ ﺭﻗﻢ‬
Tax Invoice date 04-10-2023 ‫ﺗﺎﺭﻳﺦ ﺍﻟﻔﺎﺗﻮﺭﺓ ﺍﻟﻀﺮﻳﺒﻴّﺔ‬
Amount received 30.00 ‫ﺍﻟﻤﺒﻠﻎ ﺍﻟﻤُﺴﺪﺩ‬
Payment Reference Number R0006560159 ‫ﺭﻗﻢ ﺍﻟﺪﻓﻌﺔ ﺍﻟﻤﺮﺟﻌﻲ‬
Payment made through Worker ‫ﺁﻟﻴﺔ ﺳﺪﺍﺩ ﺍﻟﺪﻓﻌﺔ‬

Total instalments received with VAT 63.00 ‫ﺇﺟﻤﺎﻟﻲ ﺍﻟﺪﻓﻌﺎﺕ ﺍﻟﻤُﺴﺪﺩﺓ ﺷﺎﻣﻞ ﺿﺮﻳﺒﺔ ﺍﻟﻘﻴﻤﺔ ﺍﻟﻤﻀﺎﻓﺔ‬

Balance to be received in agreed 0.00 ‫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