9/29/2020 Schedule

Phone: 00971 4 3502777

Fax: 00917 4 3502888
Quotation Number Q/100/2020-2117/45583

Date Of Issue 29/09/2020

Client No. 0090082
Assured No.
Please notify Tokio Marine Nichido immediately for any change of details mentioned below

Insured
Name Of Insured AL SAFA
Address DUBAI Mobile 0558513827
DUBAI Phone
Fax

Period of Insurance Type of Policy

From: 29/09/2020 10:40 To: 28/10/2021 23:59 TOKIO Third Party

Insured vehicle Limit of Liability/Memoranda/Conditions/Endorsements
Endorsements no. 1, 2& 3 in the clause attached shall apply only if stated herein
Vehicle Make TOYOTA the schedule.
Vehicle Model HIACE
Model Year 2018 1.The Company's maximum liability in respect of paragraph (a) of Clause 1 of Section
two in respect of any one claim or series of claims resulting from one accident is the
Date of First Registration 29/09/2020 sum awarded by the UAE Court.
Registration Number RAK-A-90861 2. The Company's maximum liability respect of paragraph (b) of Clause 1 of Section
two in respect of any one claim or series of claims resulting from one accident is AED
Chassis Number JTFHX02P5J0120278 2,000,000.00
Engine Number 2TR9184392
Engine Output(BHP) Personal Accident Benefit to the Driver: Applicable (As per Endorsement No. 1)
Seating Capacity 2+1 Limit: AED 200,000 any one occurrence

Color WHITE Personal Accident Benefit to the Passengers: Applicable(As per Endorsement No.1)
Limit: AED 200,000 per passenger any one occurrence
Use Of Vehicle PRIVATE PURPOSE ONLY Number of passengers covered: As per seating capacity of the vehicle
Sum Insured 3. This policy does not cover """ Tool of Trade/Operational risk """ extension

The Insured must not use the vehicle except for the purpose for it is mentioned
Vehicle Segment E034
Geographical Area Ambulance Service Cover
U.A.E Only
Excess for Section One

TPL Premium AED 1,000.00

Additional Covers Premium AED -200.00
Total Premium (Including VAT ) AED 840.00

Date: 29/09/2020

Notice:1.Premium is subject to change due to the implementation of Value Added

Tax (VAT).
2.Quotations are Valid for 30 days from the Date of Issue
This is a computer-generated document.Any hand written correction to this
policy schedule shall void policy.
0090082 - / SHUBAM

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9/29/2020 Schedule

MOTOR PROPOSAL FORM

1. The Insured and main driver

Insured Name First AL SAFA Middle Last Title TOKIO Third Party

Address DUBAI P.O.Box Emirate/City DUBAI Country 072

Landline Fax Mobile 0558513827 Email MOTORINS@SAVINGTON-IIB.COM

Personal Details Marital Status Employeer & Occupation

Date Of Full UAE driving license Other licenses held for years from Will this vehicle be used
Nationality
Birth 12/05/1980 held for years for business or commercial use?

If the vehicle will be driven by persons other than the proposer above, please provide details on a separate sheet.

2. Claims History of Main Driver

Have you or any person who will drive this vehicle had any claims in the past years?*
Yes No

No.Of.Claims Amount NCD Years : 3 Insurance Company

*Excluding claims which were fully recovered from a Third Party.

3. Vehicle Details

Make & Model Type Of Body Year of Manufacture Color Seats Engine Power Parallel Import

TOYOTA & HIACE PANEL VAN 2018 WHITE 2 +1 Yes / No

Engine No. Chassis No. Date First Registered as New Plate No. Financed By

2TR9184392 JTFHX02P5J0120278 29/09/2020 90861

Original Purchase Price Year of Purchase Purchased as New / Used Current Vehicle Value Additional Accessories (Please specify) Value, if any Total Vehicle Value

AED AED AED AED

Has the engine or body modified from the manufacturer’s standard specification?
Yes No

4. Important Queries

Will any person under the age of 25 drive this vehicle?

Yes No

Will any person with less than 12 months of driving experience drive this vehicle?
Yes No

Will this vehicle be used for business or commercial use?

Yes No

Have you been convicted during the last 3 years for any offence involving a motor accident
Yes No

5. Documents Required (Attach copies of)

Driving license Passport copy with valid UAE residence visa/ National ID card

Registration card copy/ Vehicle customs certificate (VCC) No claim letter

DISCLAIMER(PLEASE READ CAREFULLY)

It is hereby declared and agreed that with the acceptance of premium payment, the Policy Holder / Insured named in this Quotation unconditionally confirms that he/she has
read the Motor Proposal Form, understood & accepted the Terms & Conditions of this quote, which are in accordance with the Unified Motor Vehicle Insurance policy in UAE
without the need of physical signature. In the event that any untrue or mismatching or incomplete or un-updated information has formed the basis of underwriting and
issuance of this Quotation and subsequently the policy issuance, then Tokio Marine & Nichido Fire Insurance Co., LTD at its sole discretion shall retain the full right to reject
Quote/any claim(s) submitted under such issued Quote/Policy and/or treat the Quote/Policy or any section of it as voidable. Should there be any issue arise out of the above,
please refer to the Terms and Conditions that form part of this insurance policy and shall prevail in case of dispute. Terms and Conditions should be thoroughly reviewed to
understand the full scope of the available covers. This quotation becomes invalid (unless accepted by Tokio Marine & Nichido Fire Insurance Co., LTD) if you have an existing
motor policy with Tokio Marine & Nichido Fire Insurance Co., LTD for this vehicle and with claim(s)

I Agree Terms And Conditions

29-SEP-20

Please note that Tokio Marine reserve the right to ask for any additional information, impose special terms or decline. The liability of the Company does not commence until
the acceptance of the Proposal has been intimated by the Company or official cover note issued.

Premium as agreed (For official use only)

Base Premium: 1000.00 Additional Premium:

Total Premium: (13 months) AED 840.00 Excess: 0

Policy start date: 29/09/2020 12months 13Months

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9/29/2020 Schedule
Type of Policy: Corporate Scheme Non Scheme

(Incorporated in Japan, registered in the Insurance Companies register under Regn. No.45 dated 29th December 1984) AGENTS FOR UNITED ARAB
EMIRATES: AL FUTTAIM DEVELOPMENT SERVICES CO. LLC.

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