Tax Invoice ‫ﺍﻟﻔﺎﺗﻮﺭﺓ ﺍﻟﻀﺮﻳﺒﻴﺔ‬

Daman TRN: 100000692200003 100000692200003 :‫ﺭﻗﻢ ﺍﻟﺘﺴﺠﻴﻞ ﺍﻟﻀﺮﻳﺒﻲ ﻟﻀﻤﺎﻥ‬

CHINA GATE GENERAL TRADING LLC

0
ABU Customer TRN: :‫ﺭﻗﻢ ﺍﻟﺘﺴﺠﻴﻞ ﺍﻟﻀﺮﻳﺒﻲ ﻟﻠﻌﻤﻴﻞ‬

:‫ﺭﻗﻢ ﺍﻟﻔﺎﺗﻮﺭﺓ‬
ABU DHABI Customer Number: 3350413 :‫ﺭﻗﻢ ﺍﻟﻌﻤﻴﻞ‬ Invoice Number: 9870528
ABU DHABI
UAE
Policy Number: 12564710 :‫ﺭﻗﻢ ﺍﻟﻮﺛﻴﻘﺔ‬ Invoice Date: 23/12/2022 :‫ﺗﺎﺭﻳﺦ ﺍﻟﻔﺎﺗﻮﺭﺓ‬

Payment
Policy Effective Date: 13/12/2022 :‫ﺗﺎﺭﻳﺦ ﺑﺪﺍﻳﺔ ﺳﺮﻳﺎﻥ ﺍﻟﻮﺛﻴﻘﺔ‬ Due Date:
23/12/2022 :‫ﺗﺎﺭﻳﺦ ﺍﺳﺘﺤﻘﺎﻕ ﺍﻟﺪﻓﻊ‬

Policy Expiry Date: 12/12/2023 :‫ﺗﺎﺭﻳﺦ ﺍﻧﺘﻬﺎﺀ ﺳﺮﻳﺎﻥ ﺍﻟﻮﺛﻴﻘﺔ‬ Issued By: 987 :‫ﺻﺎﺩﺭ ﺑﻮﺍﺳﻄﺔ‬

PRODUCT NAME POLICY TYPE CURRENCY INSURANCE SPECIALIST SALES LOCATION

‫ﺑﺮﻧﺎﻣﺞ ﺍﻟﺘﺄﻣﻴﻦ‬ ‫ﻧﻮﻉ ﺍﻟﻮﺛﻴﻘﺔ‬ ‫ﺍﻟﻌﻤﻠﺔ‬ ‫ﺇﺧﺼﺎﺋﻲ ﺍﻟﺘﺄﻣﻴﻦ‬ ‫ﻣﻮﻗﻊ ﺍﻟﻤﺒﻴﻌﺎﺕ‬
ENHANCED GROUP AED Ghenwa Ayman Central Branch

SUMMARY OF TAX INVOICE ‫ﻣﻠﺨﺺ ﺍﻟﻔﺎﺗﻮﺭﺓ ﺍﻟﻀﺮﻳﺒﻴﺔ‬

NON-TAXABLE SUPPLY VAT RATE
TAXABLE SUPPLY (AED) ‫ﻧﺴﺒﻪ ﺿﺮﻳﺒﺔ‬ VAT AMOUNT TOTAL AMOUNT
DESCRIPTION
(AED) ‫ﺍﻟﻘﻴﻤﺔ ﺍﻟﻤﻀﺎﻓﺔ‬ (AED) (AED)
‫ﺍﻟﻮﺻﻒ‬ ‫ﺍﻟﺘﻮﺭﻳﺪﺍﺕ ﻏﻴﺮ ﺍﻟﺨﺎﺿﻌﺔ ﻟﻠﻀﺮﻳﺒﺔ‬
(‫ﺇ‬.‫ﺍﻟﺘﻮﺭﻳﺪﺍﺕ ﺍﻟﺨﺎﺿﻌﺔ ﻟﻠﻀﺮﻳﺒﺔ )ﺩ‬ (‫ﺇ‬.‫ﻣﺒﻠﻎ ﺿﺮﻳﺒﺔ ﺍﻟﻘﻴﻤﺔ ﺍﻟﻤﻀﺎﻓﺔ )ﺩ‬ (‫ﺇ‬.‫ﺇﺟﻤﺎﻟﻲ ﺍﻟﻤﺒﻠﻎ )ﺩ‬
(‫ﺇ‬.‫)ﺩ‬
Health Insurance Premium - Enhanced Product Standard Premium
2,875.13 0.00 5.00% 143.76 3,018.89
{‫ ﻗﺴﻂ ﺍﻟﺘﺄﻣﻴﻦ ﺍﻟﺼﺤﻲ }ﻭﺻﻒ ﺍﻟﺒﺮﻧﺎﻣﺞ‬- Enhanced Product Standard Premium
Dubai Health Authority - Patient Support Program Enrolment Fee: Basmah
0.00 0.00 5.00% 0.00 0.00
BASMAH :‫ ﺭﺳﻮﻡ ﺍﻹﺩﺭﺍﺝ ﻓﻲ ﺑﺮﻧﺎﻣﺞ ﺑﺴﻤﺔ ﻟﺪﻋﻢ ﺍﻟﻤﺮﺿﻰ‬- ‫ﻫﻴﺌﺔ ﺍﻟﺼﺤﺔ ﺩﺑﻲ‬
Dubai Health Authority - Patient Support Program Enrolment Fee: HCV
0.00 0.00 5.00% 0.00 0.00
HCV :‫ ﺭﺳﻮﻡ ﺍﻹﺩﺭﺍﺝ ﻓﻲ ﺑﺮﻧﺎﻣﺞ ﺇﺗﺶ ﺳﻲ ﻓﻲ ﻟﺪﻋﻢ ﺍﻟﻤﺮﺿﻰ‬- ‫ﻫﻴﺌﺔ ﺍﻟﺼﺤﺔ ﺩﺑﻲ‬
Total (AED)
2,875.13 0.00 143.76 3,018.89
(‫ﺇ‬.‫ﺍﻹﺟﻤﺎﻟﻲ )ﺩ‬

AMOUNT IN WORDS (AED): Three Thousand Eighteen Dirham And Eighty-Nine Fils :(‫ﺇ‬.‫ﺍﻟﻤﺒﻠﻎ ﺑﺎﻟﺤﺮﻭﻑ )ﺩ‬

National Health Insurance Company - Daman (PJSC) POB. 128888,AUH, UAE │ 07221R10 │ DAMAN CONFIDENTIAL │ 1 of 4
Payment Instructions ‫ﺗﻌﻠﻴﻤﺎﺕ ﺍﻟﺪﻓﻊ‬
Bank transfer: Please remit in full and net of bank charges, reference invoice number 9870528. We ‫ ﻳﺮﺟﻰ ﺇﺭﺳﺎﻝ ﺻﻮﺭﺓ ﻣﻦ ﺇﻳﺼﺎﻝ ﺗﺄﻛﻴﺪ ﺍﻟﺪﻓﻊ‬9870528 . ‫ ﺍﻟﻔﺎﺗﻮﺭﺓ ﺭﻗﻢ ﻣﺮﺟﻊ‬،‫ ﻳﺮﺟﻰ ﺗﺤﻮﻳﻞ ﺍﻟﻤﺒﻠﻎ ﺑﺎﻟﻜﺎﻣﻞ ﻭﺻﺎﻓﻲ ﺍﻟﺮﺳﻮﻡ ﺍﻟﺒﻨﻜﻴﺔ‬:‫ﺍﻟﺘﺤﻮﻳﻞ ﺍﻟﺒﻨﻜﻲ‬
would appreciate if you could send a copy of the payment confirmation & details of payment allocation to
‫ ﻭﺇﻻ ﺳﻴﺘﻢ ﺍﺣﺘﺴﺎﺏ ﺍﻟﻤﺒﻠﻎ ﺍﻟﻤﺪﻓﻮﻉ ﻟﺴﺪﺍﺩ‬Distribution.Support@damanhealth.ae ‫ﻭﺗﻔﺎﺻﻴﻞ ﺍﻟﻔﻮﺍﺗﻴﺮ ﺍﻟﻤﺪﻓﻮﻋﺔ ﻟﻌﻨﻮﺍﻥ ﺍﻟﺒﺮﻳﺪ ﺍﻹﻟﻜﺘﺮﻭﻧﻲ‬
invoices details to Distribution.Support@damanhealth.ae
.‫ﺍﻟﻔﻮﺍﺗﻴﺮ ﺍﻟﻤﺘﺄﺧﺮﺓ ﻟﻸﻗﺴﺎﻁ ﺍﻷﻗﺪﻡ‬
failing which, your payment will be applied to oldest outstanding premium invoices

Bank account details: :‫ﺗﻔﺎﺻﻴﻞ ﺍﻟﺤﺴﺎﺏ ﺍﻟﺒﻨﻜﻲ‬

Beneficiary Name: National Health Insurance Company – Daman - PJSC (‫ﻉ‬.‫ﻡ‬.‫ ﺿﻤﺎﻥ )ﺵ‬-‫ﺍﻟﺸﺮﻛﺔ ﺍﻟﻮﻃﻨﻴﺔ ﻟﻠﻀﻤﺎﻥ ﺍﻟﺼﺤﻲ‬ :‫ﺍﺳﻢ ﺍﻟﻤﺴﺘﻔﻴﺪ‬
Bank Details: First Abu Dhabi Bank ‫ﺑﻨﻚ ﺃﺑﻮﻇﺒﻲ ﺍﻷﻭﻝ‬ :‫ﺍﺳﻢ ﺍﻟﺒﻨﻚ‬

Account Number: ‫ﺭﻗﻢ ﺍﻟﺤﺴﺎﺏ ﺍﻟﻤﺼﺮﻓﻲ‬

4021203195760047
IBAN Number: :(IBAN) ‫ﺭﻗﻢ ﺍﻟﺤﺴﺎﺏ ﺍﻟﻤﺼﺮﻓﻲ ﺍﻟﺪﻭﻟﻲ‬
AE090354021203195760047
Branch Details: Bateen Branch - Abu Dhabi, UAE ‫ ﺍﻹﻣﺎﺭﺍﺕ ﺍﻟﻌﺮﺑﻴﺔ ﺍﻟﻤﺘﺤﺪﺓ‬،‫ ﺃﺑﻮﻇﺒﻲ‬-‫ﻓﺮﻉ ﺍﻟﺒﻄﻴﻦ‬ :‫ﺍﻟﻔﺮﻉ‬
Swift Code: NBADAEAABAT :SWIFT CODE

Cheque payment: National Health Insurance Company – Daman – PJSC (‫ﻉ‬.‫ﻡ‬.‫ ﺿﻤﺎﻥ )ﺵ‬-‫ ﺍﻟﺸﺮﻛﺔ ﺍﻟﻮﻃﻨﻴﺔ ﻟﻠﻀﻤﺎﻥ ﺍﻟﺼﺤﻲ‬:‫ﺍﻟﺪﻓﻊ ﻋﻦ ﻃﺮﻳﻖ ﺷﻴﻚ‬

For direct cheque deposit in ATM, please use the Daman account number, send a copy of the payment ‫ ﻣﻊ ﺍﺭﺳﺎﻝ ﻧﺴﺨﺔ ﻣﻦ ﺇﻳﺼﺎﻝ ﺗﺄﻛﻴﺪ ﺍﻟﺪﻓﻊ ﻭﺗﻔﺎﺻﻴﻞ ﺍﻟﻔﻮﺍﺗﻴﺮ‬،‫ ﻳﺮﺟﻰ ﺍﺳﺘﺨﺪﻡ ﺭﻗﻢ ﺍﻟﺤﺴﺎﺏ ﺍﻟﻤﺼﺮﻓﻲ ﻟﻀﻤﺎﻥ‬،(ATM) ‫ﻟﻺﻳﺪﺍﻉ ﺍﻟﻤﺒﺎﺷﺮ ﻟﻠﺸﻴﻚ ﻓﻲ ﺃﺣﺪ ﺃﺟﻬﺰﺓ‬
confirmation & payment allocation details to Distribution.Support@damanhealth.ae Distribution.Support@damanhealth.ae ‫ﺍﻟﻤﺪﻓﻮﻋﺔ ﺍﻟﻰ‬

Online Payment: https://www.damanhealth.ae/eDamanApp/loadMyPortalPage.action :‫ﺍﻟﺪﻓﻊ ﺍﻹﻟﻜﺘﺮﻭﻧﻲ‬

This invoice is certified and does not require any official stamp from Daman. .‫ﺗﻌﺪ ﺍﻟﻔﺎﺗﻮﺭﺓ ﻫﺬﻩ ﻭﺛﻴﻘﺔ ﻣﻌﺘﻤﺪﺓ ﻭﻻ ﺗﺤﺘﺎﺝ ﻷﻱ ﺧﺘﻢ ﺭﺳﻤﻲ ﻣﻦ ﺿﻤﺎﻥ‬
Please inform Daman for any discrepancy in the cards or certificates within 2 working days of receiving ‫ ﻳﺠﺐ‬.‫( ﻣﻦ ﺍﺳﺘﻼﻣﻬﻢ ﻭﺇﻻ ﺗﻌﺘﺒﺮ ﺿﻤﺎﻥ ﻏﻴﺮ ﻣﺴﺆﻭﻟﺔ ﻋﻦ ﺃﻱ ﺗﺼﺤﻴﺤﺎﺕ‬2) ‫ﻳﺮﺟﻰ ﺇﺑﻼﻍ ﺿﻤﺎﻥ ﺑﺄﻱ ﺗﻨﺎﻗﺾ ﻓﻲ ﺍﻟﺒﻄﺎﻗﺎﺕ ﺃﻭ ﺍﻟﺸﻬﺎﺩﺍﺕ ﺧﻼﻝ ﻳﻮﻣﻲ ﻋﻤﻞ‬
them, failing of which Daman will not be held responsible for any corrections. All cards/packages must be c .‫ ﻳﻮﻡ ﻣﻦ ﺗﺎﺭﻳﺦ ﺍﻟﻔﺎﺗﻮﺭﺓ ﺃﻭ ﺗﺎﺭﻳﺦ ﺍﻟﻘﺒﻮﻝ‬30 ‫ﺗﺤﺼﻴﻞ ﻭﺗﻔﻌﻴﻞ ﺟﻤﻴﻊ ﺍﻟﺒﻄﺎﻗﺎﺕ ﺧﻼﻝ‬
collected or activated within 30 days from the invoice date or the letter of acceptance date.

According to Dubai Health Authority related circular, all premiums related to insured members holding ‫ ﻓﺈﻥ ﺟﻤﻴﻊ ﺍﻷﻗﺴﺎﻁ ﺍﻟﺘﺄﻣﻴﻨﻴﺔ ﺍﻟﺨﺎﺻﺔ ﺑﺎﻷﺷﺨﺎﺹ ﺍﻟﻤﺆﻣﻦ ﻋﻠﻴﻬﻢ ﻣﻦ ﺣﻤﻠﺔ ﺗﺄﺷﻴﺮﺓ ﺇﻗﺎﻣﺔ ﻓﻲ ﺩﺑﻲ‬،‫ ﻫﻴﺌﺔ ﺍﻟﺼﺤﺔ ﺩﺑﻲ‬/‫ﻭﻭﻓﻖ ﺍﻟﺘﻌﻤﻴﻢ ﺍﻟﺼﺎﺩﺭ ﻋﻦ ﺍﻟﺴﺎﺩﺓ‬
Dubai residency visa are subject to a non-refundable AED 19.00 (subject to VAT) and AED 18.00 (subject ‫ ﺩﺭﻫﻢ )ﺧﺎﺿﻊ ﻟﻀﺮﻳﺒﺔ ﺍﻟﻘﻴﻤﺔ ﺍﻟﻤﻀﺎﻓﺔ( ﻛﺮﺳﻮﻡ ﺍﺷﺘﺮﺍﻙ ﺇﺟﺒﺎﺭﻳﺔ ﻓﻲ ﺑﺮﺍﻣﺞ‬18 ‫ ﺩﺭﻫﻢ ﻏﻴﺮ ﻣﺴﺘﺮﺩ )ﺧﺎﺿﻊ ﻟﻀﺮﻳﺒﺔ ﺍﻟﻘﻴﻤﺔ ﺍﻟﻤﻀﺎﻓﺔ( ﻭ ﻣﺒﻠﻎ‬19 ‫ﺧﺎﺿﻌﺔ ﻟﻤﺒﻠﻎ‬
to VAT) mandatory enrolment fees in BASMAH and HCV programs, respectively. .‫( ﻋﻠﻰ ﺍﻟﺘﻮﺍﻟﻲ‬HCV ‫ ﻭ‬BASMAH) ‫ﺑﺴﻤﺔ ﻭ ﺃﺗﺶ ﺳﻲ ﻓﻲ‬

National Health Insurance Company - Daman (PJSC) POB. 128888,AUH, UAE │ 07221R10 │ DAMAN CONFIDENTIAL │ 2 of 4
‫‪BILL DETAIL‬‬ ‫ﺗﻔﺎﺻﻴﻞ ﺍﻟﻔﺎﺗﻮﺭﺓ‬

‫‪Event Number:‬‬ ‫‪1‬‬ ‫‪ Endorsement Type:‬ﺭﻗﻢ ﺍﻟﺤﺮﻛﺔ‬ ‫ﺍﻟﻮﺛﻴﻘﺔ ﺍﻟﻤﺒﺪﺋﻴﺔ‪Initial Policy/‬‬ ‫ﻧﻮﻉ ﺍﻻﻋﺘﻤﺎﺩ‬
‫‪DHA HCV Fees‬‬ ‫‪Total Premiums‬‬
‫‪Net Premium‬‬
‫)‪(Taxable‬‬ ‫‪DHA BASMAH Fees‬‬ ‫)‪(Taxable Supply‬‬
‫)‪(Taxable‬‬ ‫‪VAT Amount‬‬ ‫‪Total Amount‬‬
‫‪Bill Ref.‬‬ ‫‪Premium Days‬‬ ‫)‪(AED‬‬ ‫)‪(Taxable‬‬ ‫)‪(AED‬‬
‫‪Member Name‬‬ ‫‪Card No‬‬ ‫‪Relation‬‬ ‫‪Principal No‬‬ ‫‪Staff No‬‬ ‫‪Sex‬‬ ‫‪Age‬‬ ‫‪Visa‬‬ ‫‪Effective Date‬‬ ‫)‪(AED‬‬ ‫)‪(AED‬‬ ‫)‪(AED‬‬
‫ﺍﻟﺮﻗﻢ ﺍﻟﻤﺮﺟﻌﻲ‬ ‫‪Calculation‬‬ ‫ﺭﺳﻮﻡ ﻫﻴﺌﺔ ﺍﻟﺼﺤﺔ ﺩﺑﻲ‬ ‫)‪(AED‬‬ ‫ﺇﺟﻤﺎﻟﻲ ﺍﻷﻗﺴﺎﻁ ﺍﻟﺘﺄﻣﻴﻨﻴﺔ‬
‫ﺍﺳﻢ ﺍﻟﻤﺸﺘﺮﻙ‬ ‫ﺭﻗﻢ ﺍﻟﺒﻄﺎﻗﺔ‬ ‫ﺻﻠﺔ ﺍﻟﻘﺮﺍﺑﺔ‬ ‫ﺭﻗﻢ ﺍﻟﻤﺸﺘﺮﻙ ﺍﻟﺮﺋﻴﺴﻲ‬ ‫ﺭﻗﻢ ﺍﻟﻤﻮﻇﻒ‬ ‫ﺍﻟﺠﻨﺲ‬ ‫ﺍﻟﻌﻤﺮ‬ ‫ﺍﻹﻗﺎﻣﺔ‬ ‫ﺗﺎﺭﻳﺦ ﺑﺪﺍﻳﺔ ﺍﻟﺴﺮﻳﺎﻥ‬ ‫ﺍﻟﻘﺴﻂ ﺍﻟﺘﺄﻣﻴﻨﻲ‬ ‫ﻣﺒﻠﻎ ﺿﺮﻳﺒﺔ ﺍﻟﻘﻴﻤﺔ ﺍﻟﻤﻀﺎﻓﺔ‬ ‫ﺇﺟﻤﺎﻟﻲ ﺍﻟﻤﺒﻠﻎ‬
‫ﻟﻠﻔﺎﺗﻮﺭﺓ‬ ‫ﻋﺪﺩ ﺃﻳﺎﻡ ﺍﻟﻘﺴﻂ ﺍﻟﺘﺄﻣﻴﻨﻲ‬ ‫ﻟﺒﺮﻧﺎﻣﺞ ‪) HCV‬ﺧﺎﺿﻊ‬ ‫ﺭﺳﻮﻡ ﻫﻴﺌﺔ ﺍﻟﺼﺤﺔ ﺩﺑﻲ ﻟﺒﺮﻧﺎﻣﺞ‬ ‫)ﺍﻟﺘﻮﺭﻳﺪﺍﺕ ﺍﻟﺨﺎﺿﻌﺔ‬
‫)ﺧﺎﺿﻊ ﻟﻠﻀﺮﻳﺒﺔ(‬ ‫)ﺩ‪.‬ﺇ(‬ ‫)ﺩ‪.‬ﺇ(‬
‫ﻟﻠﻀﺮﻳﺒﺔ(‬ ‫ﺑﺴﻤﺔ )ﺧﺎﺿﻊ ﻟﻠﻀﺮﻳﺒﺔ( )ﺩ‪.‬ﺇ(‬ ‫ﻟﻠﻀﺮﻳﺒﺔ(‬
‫)ﺩ‪.‬ﺇ(‬
‫)ﺩ‪.‬ﺇ(‬ ‫)ﺩ‪.‬ﺇ(‬

‫_____‬ ‫‪MOHAMMED AMER‬‬ ‫‪5308131‬‬ ‫‪PRINCIPAL‬‬ ‫‪5308131‬‬ ‫‪17801386‬‬ ‫‪M‬‬ ‫‪26‬‬ ‫‪ABU DHABI‬‬ ‫‪13/12/2022‬‬ ‫‪365‬‬ ‫‪2,875.13‬‬ ‫‪0.00‬‬ ‫‪0.00‬‬ ‫‪2,875.13‬‬ ‫‪143.76‬‬ ‫‪3,018.89‬‬

‫‪Total Members per Event‬‬ ‫)‪Total(AED‬‬

‫‪1‬‬ ‫‪2,875.13‬‬ ‫‪0.00‬‬ ‫‪0.00‬‬ ‫‪2,875.13‬‬ ‫‪143.76‬‬ ‫‪3,018.89‬‬
‫ﺇﺟﻤﺎﻟﻲ ﺍﻟﻤﺸﺘﺮﻛﻴﻦ ﻟﻜﻞ ﺣﺮﻛﺔ‬ ‫ﺍﻹﺟﻤﺎﻟﻲ )ﺩ‪.‬ﺇ(‬

‫)‪VAT Rounding Off (AED‬‬ ‫‪0.00‬‬ ‫‪0.00‬‬

‫ﺗﻘﺮﻳﺐ ﻗﻴﻤﺔ ﺿﺮﻳﺒﺔ ﺍﻟﻘﻴﻤﺔ ﺍﻟﻤﻀﺎﻓﺔ )ﺩ‪.‬ﺇ(‬

‫‪Health Insurance Premium Amount in AED‬‬ ‫‪2,875.13‬‬ ‫ﻣﺒﻠﻎ ﻗﺴﻂ ﺍﻟﺘﺄﻣﻴﻦ ﺍﻟﺼﺤﻲ ﺑﺎﻟﺪﺭﻫﻢ ﺍﻻﻣﺎﺭﺍﺗﻲ‬

‫‪Dubai Health Authority – BASMAH Patient Support Program Enrolment Fee in AED‬‬
‫‪0.00‬‬ ‫ﻫﻴﺌﺔ ﺍﻟﺼﺤﺔ ﺩﺑﻲ‪ -‬ﺭﺳﻮﻡ ﺍﻹﺩﺭﺍﺝ ﺑﺒﺮﻧﺎﻣﺞ ﺑﺴﻤﺔ ﻟﺪﻋﻢ ﺍﻟﻤﺮﺿﻰ ﺑﺎﻟﺪﺭﻫﻢ ﺍﻻﻣﺎﺭﺍﺗﻲ )ﺗﻮﺭﻳﺪﺍﺕ ﺧﺎﺿﻌﺔ ﻟﻠﻀﺮﻳﺒﺔ(‬
‫)‪(Taxable Supply‬‬

‫‪Dubai Health Authority – HCV Patient Support Program Enrolment Fee in AED‬‬ ‫ﻫﻴﺌﺔ ﺍﻟﺼﺤﺔ ﺩﺑﻲ‪ -‬ﺭﺳﻮﻡ ﺍﻹﺩﺭﺍﺝ ﺑﺒﺮﻧﺎﻣﺞ ﺍﺗﺶ ﻓﻲ ﺳﻲ ﻟﺪﻋﻢ ﺍﻟﻤﺮﺿﻰ ﺑﺎﻟﺪﺭﻫﻢ ﺍﻻﻣﺎﺭﺍﺗﻲ )ﺗﻮﺭﻳﺪﺍﺕ ﺧﺎﺿﻌﺔ‬
‫‪0.00‬‬
‫)‪(Taxable Supply‬‬ ‫ﻟﻠﻀﺮﻳﺒﺔ(‬

‫‪Total Taxable Supply in AED‬‬ ‫‪2,875.13‬‬ ‫ﺇﺟﻤﺎﻟﻲ ﺍﻟﺘﻮﺭﻳﺪﺍﺕ ﺍﻟﺨﺎﺿﻌﺔ ﻟﻠﻀﺮﻳﺒﺔ ﺑﺎﻟﺪﺭﻫﻢ ﺍﻻﻣﺎﺭﺍﺗﻲ‬

‫‪VAT Amount in AED‬‬ ‫‪143.76‬‬ ‫ﻣﺒﻠﻎ ﺿﺮﻳﺒﺔ ﺍﻟﻘﻴﻤﺔ ﺍﻟﻤﻀﺎﻓﺔ ﺑﺎﻟﺪﺭﻫﻢ ﺍﻻﻣﺎﺭﺍﺗﻲ‬

‫‪Total Non-Taxable Supply in AED‬‬ ‫‪0.00‬‬ ‫ﺇﺟﻤﺎﻟﻲ ﺍﻟﺘﻮﺭﻳﺪﺍﺕ ﻏﻴﺮ ﺍﻟﺨﺎﺿﻌﺔ ﻟﻠﻀﺮﻳﺒﺔ ﺑﺎﻟﺪﺭﻫﻢ ﺍﻻﻣﺎﺭﺍﺗﻲ‬

‫‪Grand Total Amount in AED‬‬ ‫‪3,018.89‬‬ ‫ﺇﺟﻤﺎﻟﻲ ﺍﻟﻤﺒﻠﻎ ﺑﺎﻟﺪﺭﻫﻢ ﺍﻻﻣﺎﺭﺍﺗﻲ‬

‫‪National Health Insurance Company - Daman (PJSC) POB. 128888,AUH, UAE │ 07221R10 │ DAMAN CONFIDENTIAL │ 3 of 4‬‬
BILL SUMMARY PER DEPARTMENT ‫ﻣﻠﺨﺺ ﺍﻟﻔﺎﺗﻮﺭﺓ ﻟﻜﻞ ﺇﺩﺍﺭﺓ‬
Department Name ND ‫ﺍﺳﻢ ﺍﻹﺩﺍﺭﺓ‬ Department Code ND ‫ﺭﻣﺰ ﺍﻹﺩﺍﺭﺓ‬

Total Premium and

DHA HCV Fee and BASMAH
Principal Fee VAT Amount
Effective (Taxable Supply) Total Amount (AED)
Event Type Member Name Card No Relation No Staff No Sex Age Visa (5%)
Date ‫ﺇﺟﻤﺎﻟﻲ ﺍﻟﻘﺴﻂ ﺍﻟﺘﺄﻣﻴﻨﻲ ﻭﺭﺳﻮﻡ ﻫﻴﺌﺔ‬ ‫ﺇﺟﻤﺎﻟﻲ ﺍﻟﻤﺒﻠﻎ‬
‫ﻧﻮﻉ ﺍﻟﺤﺮﻛﺔ‬ ‫ﺍﺳﻢ ﺍﻟﻤﺸﺘﺮﻙ‬ ‫ﺭﻗﻢ ﺍﻟﺒﻄﺎﻗﺔ‬ ‫ﺻﻠﺔ ﺍﻟﻘﺮﺍﺑﺔ‬ ‫ﺭﻗﻢ ﺍﻟﻤﺸﺘﺮﻙ‬ ‫ﺭﻗﻢ ﺍﻟﻤﻮﻇﻒ‬ ‫ﺍﻟﺠﻨﺲ‬ ‫ﺍﻟﻌﻤﺮ‬ ‫ﺍﻹﻗﺎﻣﺔ‬ ‫ﻣﺒﻠﻎ ﺿﺮﻳﺒﺔ ﺍﻟﻘﻴﻤﺔ ﺍﻟﻤﻀﺎﻓﺔ‬
‫ﺗﺎﺭﻳﺦ ﺑﺪﺍﻳﺔ ﺍﻟﺴﺮﻳﺎﻥ‬ (‫ﺇ‬.‫)ﺩ‬
‫ﺍﻟﺮﺋﻴﺴﻲ‬ ‫ﺍﻟﺼﺤﺔ ﺩﺑﻲ ﻟﺒﺮﻧﺎﻣﺞ ﺇﺗﺶ ﺳﻲ ﻓﻲ ﻭﺑﺮﻧﺎﻣﺞ‬ (5%)
(‫ﺑﺴﻤﺔ )ﺍﻟﺘﻮﺭﻳﺪﺍﺕ ﺍﻟﺨﺎﺿﻌﺔ ﻟﻠﻀﺮﻳﺒﺔ‬
(‫ﺇ‬.‫)ﺩ‬
1780138
Initial Policy MOHAMMED AMER 5308131 PRINCIPAL 5308131 M 26 ABU DHABI 13/12/2022 2,875.13 143.76 3,018.89
6
Total Members per Department Total(AED)
1 2,875.13 143.76 3,018.89
‫ﺇﺟﻤﺎﻟﻲ ﻋﺪﺩ ﺍﻟﻤﺸﺘﺮﻛﻴﻦ ﻟﻜﻞ ﺇﺩﺍﺭﺓ‬ (‫ﺇ‬.‫ﺍﻹﺟﻤﺎﻟﻲ )ﺩ‬

National Health Insurance Company - Daman (PJSC) POB. 128888,AUH, UAE │ 07221R10 │ DAMAN CONFIDENTIAL │ 4 of 4