‫ﺟدول وﺛﯾﻘﺔ ﺗﺄﻣﯾن اﻟﻣرﻛﺑﺎت‬

‫‪Wafi Basic‬‬

‫ﺑﯾﺎﻧﺎت اﻟوﺛﯾﻘﺔ‬
‫ﺗﺟﺎه اﻟﻐﯾر‬ ‫اﻟﻣﺳؤوﻟﯾﺔ ﺗﺟﺎه اﻟﻐﯾر ‪ /‬اﻟﺷﺎﻣل‬ ‫‪533745937370189‬‬ ‫رﻗم اﻟوﺛﯾﻘﺔ‬
‫ﺿد اﻟﻐﯾر‬ ‫اﻟﻣﻧﺗﺞ‬ ‫‪2023-09-29‬‬ ‫ﺗﺎرﯾﺦ ﺑدء اﻟوﺛﯾﻘﺔ‬
‫اﻟﻣﻣﻠﻛﺔ اﻟﻌرﺑﯾﺔ اﻟﺳﻌودﯾﺔ‬ ‫اﻟﻧطﺎق اﻟﺟﻐراﻓﻲ ﻟﻠﺗﻐطﯾﺔ‪:‬‬ ‫‪2024-09-28‬‬ ‫ﺗﺎرﯾﺦ اﻧﺗﮭﺎء اﻟوﺛﯾﻘﺔ‬
‫ﺑﯾﺎﻧﺎت اﻟﻣﺷﺗرك‬
‫اﻟﻣﺎﻟك‬ ‫ﻓرد‬ ‫ﻧوع اﻟﻣﺎﻟك‬
‫ﺍﻟﺮﻳﺎﺽ‬ ‫ﻣدﯾﻧﺔ اﻹﻗﺎﻣﺔ‬ ‫ﻋﺒﺪﺍﻟﻌﺰﻳﺰ ﺗﺮﻛﻲ ﺍﻟﻌﻨﺰﻱ‬ ‫اﻻﺳم‬
‫‪28-06-1976‬‬ ‫ﺗﺎرﯾﺦ اﻟﻣﯾﻼد‬ ‫‪1129221741‬‬ ‫رﻗم اﻟﮭوﯾﺔ‪/‬اﻟﺳﺟل اﻟﺗﺟﺎري‬
‫اﻟﺑرﯾد اﻹﻟﻛﺗروﻧﻲ‬ ‫رﻗم اﻟﺟوال‬
‫اﻟﻣؤﻣن ﻋﻠﯾﮫ‬ ‫ﻓرد‬ ‫اﻟﻣﺎﻟك‬
‫ﻣﻌﻠوﻣﺎت اﻟﺳﺎﺋﻖ‬
‫ﻣدﯾﻧﺔ اﻹﻗﺎﻣﺔ‬ ‫رﻗم اﻟﮭوﯾﺔ‬ ‫ﺗﺎرﯾﺦ اﻟﻣﯾﻼد‬ ‫ﻧوع اﻟﺳﺎﺋﻖ )اﺳﺎﺳﻲ‪/‬إﺿﺎﻓﻲ(‬ ‫اﻻﺳم‬
‫ﺍﻟﺮﻳﺎﺽ‬ ‫‪1129221741‬‬ ‫‪28-06-1976‬‬ ‫اﺳﺎﺳﻲ‬ ‫ﻋﺒﺪﺍﻟﻌﺰﻳﺰ ﺗﺮﻛﻲ ﺍﻟﻌﻨﺰﻱ‬

‫ﺑﯾﺎﻧﺎت اﻟﻣرﻛﺑﺔ‬
‫ﺳﻴﺎﺭﺓ ﺻﻐﻴﺮﺓ ‪ 4‬ﺑﺎﺏ‬ ‫ﻧوع ھﯾﻛل اﻟﻣرﻛﺑﺔ‬ ‫ﻧﻴﺴﺎﻥ‬ ‫طراز‪ /‬ﻣودﯾل اﻟﻣرﻛﺑﺔ‬ ‫ﺑﺎﺗﺮﻭﻝ ‪ 4‬ﺑﺎﺏ‬
‫ﻣﺎرﻛﺔ اﻟﻣرﻛﺑﺔ )اﻟﻌﻼﻣﺔ‬
‫اﻟﺗﺟﺎرﯾﺔ(‬
‫ﺍﺳﻮﺩ‬ ‫ﻟون اﻟﻣرﻛﺑﺔ‬ ‫‪9‬‬ ‫ﻋدد اﻟﻣﻘﺎﻋد‬ ‫ﺑﺎﺗﺮﻭﻝ ‪ 4‬ﺑﺎﺏ‬ ‫ﺳﻧﺔ اﻟﺻﻧﻊ‬
‫ﺷﺨﺼﻲ‬ ‫اﺳﺗﺧداﻣﺎت اﻟﻣرﻛﺑﺔ‬ ‫‪18750‬‬ ‫ﻣﺑﻠﻎ اﻟﺗﻐطﯾﺔ اﻟﺗﺄﻣﯾﻧﯾﺔ‬ ‫ﺱ ﻉ ﺩ ‪841‬‬ ‫رﻗم اﻟﻠوﺣﺔ‬
‫‪-‬‬ ‫رﻗم اﻟﺑطﺎﻗﺔ اﻟﺟﻣرﻛﯾﺔ‬ ‫‪265583010‬‬ ‫اﻟرﻗم اﻟﺗﺳﻠﺳﻠﻲ‬ ‫‪JN8AY25Y2A9004477‬‬ ‫رﻗم ھﯾﻛل اﻟﻣرﻛﺑﺔ‬
‫ﯾﺟب ﻋﻠﻰ اﻟﻣؤﻣن ﻟﮫ أن ﯾﺳﺗﺧدم اﻟﻣرﻛﺑﺔ ﻟﻠﻐرض اﻟﻣرﺧص ﻻﺟﻠﮫ‬ ‫ﻗﯾد اﻹﺳﺗﻌﻣﺎل‬ ‫ﺳﻴﺎﺭﺓ ﺧﺎﺻﺔ‬ ‫ﻧوع اﻟﻠوﺣﺔ‬
‫ﻣﻠﺧص ﻟﻠﺗﻐطﯾﺔ‬
‫ﺣدود اﻟﺗﻐطﯾﺔ‬ ‫ﯾﺷﻣل‬ ‫ﻣﻧﺎﻓﻊ اﻟﺗﻐطﯾﺔ اﻟﺗﺄﻣﯾﻧﯾﺔ‬
‫ﻐطﯾﺔ اﻟطرف اﻟﺛﺎﻟث ﺣﺗﻰ ‪ 10‬ﻣﻠﯾون ﷼‬ ‫ﻧﻌم‬ ‫ﻐطﯾﺔ اﻟطرف اﻟﺛﺎﻟث ﺣﺗﻰ ‪ 10‬ﻣﻠﯾون ﷼‬
‫رﻓﻊ اﻟﻣطﺎﻟﺑﺔ إﻟﻛﺗروﻧﯾﺎ دون اﻟﺣﺎﺟﺔ ﻟزﯾﺎرة اﻟﻔرع‬ ‫ﻧﻌم‬ ‫ﺳرﻋﺔ رﻓﻊ اﻟﻣطﺎﻟﺑﺔ‬
‫ﺗﻐطﯾﺎت ﺗﺄﻣﯾﻧﯾﺔ إﺿﺎﻓﯾﺔ )اﺧﺗﯾﺎرﯾﺔ(‬
‫ﺗﻐطﯾﺔ اﻟﺣوادث اﻟﺷﺧﺻﯾﺔ ﻟﻠﺳﺎﺋﻖ و اﻟرﻛﺎب ﺣﺗﻰ ‪ 100,000‬﷼ ﻟﻠﻔرد ﻛﺣد اﻗﺻﻰ‬ ‫ال‬ ‫ﺗﻐطﯾﺔ اﻟﺣوادث اﻟﺷﺧﺻﯾﺔ ﻟﻠﺳﺎﺋﻖ و اﻟرﻛﺎب‬
‫ﺧط اﺳﺗﻘﺑﺎل ﻣﻛﺎﻟﻣﺎت ﻣﺧﺻص ‪ 24‬ﺳﺎﻋﺔ ﻟﻣدة ‪ 7‬أﯾﺎم ﻹﺳﺗﻘﺑﺎل طﻠﺑﺎﺗﻛم داﺧل ﺣدود ﺗﻐطﯾﺗﻧﺎ‬ ‫ال‬ ‫اﻟﻣﺳﺎﻋدة ﻋﻠﻰ اﻟطرﯾﻖ‬
‫اﻟﺗﻌوﯾض ﺑﺣﺳب ﻗﯾﻣﺔ اﻟﻣرﻛﺑﺔ اﻟﺳوﻗﯾﺔ ﻋﻠﻰ أن ﻻ ﺗﺗﻌدى اﻟﻘﯾﻣﺔ اﻟﺗﺎﻣﯾﻧﺔ‬ ‫ال‬ ‫ﺗﻐطﯾﺔ ﺿد ﻛﺳر اﻟزﺟﺎج واﻟﺣراﺋﻖ واﻟﺳرﻗﺔ‬
‫اﻟﺗﻌوﯾض ﺑﺣﺳب ﻗﯾﻣﺔ اﻟﻣرﻛﺑﺔ اﻟﺳوﻗﯾﺔ ﻋﻠﻰ أن ﻻ ﺗﺗﻌدى اﻟﻘﯾﻣﺔ اﻟﺗﺎﻣﯾﻧﺔ‬ ‫ال‬ ‫ﺗﻐطﯾﺔ اﻟﻛوارث اﻟطﺑﯾﻌﯾﺔ )اﻟﻔﯾﺿﺎﻧﺎت ‪ /‬اﻟﺳﯾول ‪/‬اﻷﻣطﺎر(‬

‫ﺑﯾﺎﻧﺎت‬
‫اﻟﻣﺑﻠﻎ )ﺑﺎﻟ﷼ اﻟﺳﻌودي(‬ ‫اﻻﺳﺗﻘطﺎع )اﻟﺧﺻوﻣﺎت(‬
‫‪693‬‬ ‫ﺻﺎﻓﻲ اﻻﺷﺗراك‬
‫‪0‬‬ ‫‪0‬‬ ‫ﺧﺻم ﺧﺎص‬ ‫‪0.00‬‬ ‫ﺧﺻم اﻟﻣرﻛﺑﺎت اﻟﻣﺗﻌددة‬ ‫‪0.00‬‬ ‫ﺧﺻم اﻟوﻻء‬ ‫اﻟﺧﺻوﻣﺎت‬
‫‪0.00‬‬ ‫‪3‬‬ ‫اﻟﻣﺳﺗوى‬ ‫‪0‬‬ ‫‪%‬‬ ‫ﺧﺻم ﻋدم وﺟود ﻣطﺎﻟﺑﺎت‬
‫‪13.86‬‬ ‫‪2%‬‬ ‫اﻟﻌﻣوﻟﺔ‬
‫‪103.95‬‬ ‫‪15.00 %‬‬ ‫ﺿرﯾﺑﺔ اﻟﻘﯾﻣﺔ اﻟﻣﺿﺎﻓﺔ‬
‫‪796.95‬‬ ‫ﻣﺟﻣوع اﻻﺷﺗراك )ﺻﺎﻓﻲ اﻻﺷﺗراك ‪ +‬اﻟﺧﺻوﻣﺎت ‪ +‬ﺧﺻم ﻋدم اﻟﻣطﺎﻟﺑﺔ ‪ +‬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
‫‪ .8‬ﻓﻘًﺎ ﻟﻘواﻋد اﻟﺑﻧك اﻟﻣرﻛزي اﻟﺳﻌودي )‪ ، (SAMA‬ﺳﯾﺗم ﻓرض رﺳوم إدارﯾﺔ ﻗدرھﺎ ‪ 30‬﷼ ﺳﻌودي ﻋﻧد إﻟﻐﺎء اﻟوﺛﯾﻘﺔ‪.‬‬

‫ﻟﻠﻣﺳﺎﻋدة واﻟﻣطﺎﻟﺑﺎت ﯾرﺟﻰ اﻟﺗواﺻل ﻋﺑر ﻗﻧوات اﻟﺗواﺻل اﻵﺗﯾﺔ‪:‬‬

‫اﺗﺻل ﻋﻠﻰ ‪ 920004414‬أو ‪8001184444‬‬ ‫ﻟﺗﻘدﯾم ﻣطﺎﻟﺑﺔ ﺧﻼل ﺳﺎﻋﺎت اﻟﻌﻣل )ﻣﺎ ﻋدا أﯾﺎم اﻟﻌطل اﻟرﺳﻣﯾﺔ( ﻣن اﻟﺳﺎﻋﺔ اﻟﺛﺎﻣﻧﺔ ﺻﺑﺎﺣﺎ ﺣﺗﻰ اﻟﺛﺎﻟﺛﺔ ﻣﺳﺎء ‪ ،‬ﻣن‬
‫اﻷﺣد إﻟﻰ اﻟﺧﻣﯾس ﯾرﺟﻰ اﻻﺗﺻﺎل ﻋﻠﻰ‬
‫‪Damen broker‬‬ ‫اﻟﻔرع‬ ‫‪websales 032‬‬ ‫اﻟﻘﻧﺎة‬
‫ﻣﻛﺎن اﻹﺻدار‬ ‫‪9/28/2023‬‬ ‫ﺗﺎرﯾﺦ اﻹﺻدار‬
‫رﻗم اﻟرﺧﺻﺔ‬ ‫ﺿﺎﻣﻦ ﻟﻮﺳﺎﻃﺔ ﺍﻟﺘﺄﻣﻴﻦ‬ ‫أﺻدرت ﻣن ﻗﺑل‬
 Policy Schedule – Motor Insurance
Wafi Basic

Policy Details
Policy # 533745937370189 Plan Type Third Party Liability
Start Date 2023-09-29 Product Wafi Basic
End Date 2024-09-28 Geographical Scope Kingdom of Saudi Arabia
Participant Details
Type Individual Owner
Name ABDULAZIZ TURKI ALANAZI City of Residence ‫ﺍﻟﺮﻳﺎﺽ‬
ID / CR # 1129221741 DOB 28-06-1976
Mobile # Email
Owner Individual Insured
Driver Information
Name(s) Main/Additional DOB ID # City of Residence
ABDULAZIZ TURKI ALANAZI Main 28-06-1976 1129221741 ‫ﺍﻟﺮﻳﺎﺽ‬

Vehicle Details
Make ‫ ﺑﺎﺏ‬4 ‫ﺑﺎﺗﺮﻭﻝ‬ Model ‫ﻧﻴﺴﺎﻥ‬ Body Type Small Car 4 Doors
Model Year ‫ ﺑﺎﺏ‬4 ‫ﺑﺎﺗﺮﻭﻝ‬ No. of Seats 9 Color ‫ﺍﺳﻮﺩ‬
Plate # 841 ‫ﺱ ﻉ ﺩ‬ Sum Insured 18750 Vehicle Use Private
Chassis # JN8AY25Y2A9004477 Sequence # 265583010 Custom ID -
Plate Type Private Car Use Restrains The Insured should not use the vehicle for other than the authorized purpose

Summary of Cover
Benefit Include Limit
Third Party Liability up to 10 Million riyals Yes Third Party Liability up to 10 Million riyals
Claim in a Click Yes Report a claim digitally without need to visit any Claims Branch.
Optional Cover(s)
Personal Accident (Driver and Passengers) No Personal Accident For Driver and Passengers Up to SAR 100,000 Per Individual
Road Side Assistance No Road Side Assistance
Windscreen, Fire and Theft No Market value not exceeding declared Sum Insured
Natural Hazards (rain, hail & flood) No Market value not exceeding declared Sum Insured
Contribution Information
Description Amount (in SAR)
Net Contribution 693
Discount - Loyalty 0.00 Multi Vehicle 0.00 Special 0 0
No Claims Discount (NCD) 0 % Level 3 0.00
Commission 2% 13.86
Value Added Tax (VAT) 15.00 %
Total Contribution (Net Contribution + Discount + NCD + VAT)
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
For any assistance and/or claims,
To report a Claim Working hours: (except public holidays) 8AM to 5PM, Sunday Call 920004414 or 8001184444
to Thursday
Channel websales 032 Branch Damen broker
Date of Issue 9/28/2023 Place of Issue
Issued by Damen broker License #