268

‫ﺑﻬﺫﺍ ﻧﺷﻬﺩ ﺑﺄﻧﻧﺎ ﺃﺻﺩﺭﻧﺎ ﻭﺛﻳﻘﺔ ﺗﺄﻣﻳﻥ ﻟﻠﻣﺭﻛﺑﺔ ﺍﻟﻣﻭﺻﻭﻑ ﺑﻳﺎﻧﺎﺗﻬﺎ ﺃﺩﻧﺎﻩ ﺑﻣﻭﺟﺏ ﺃﺣﻛﺎﻡ ﻭﺷﺭﻭﻁ‬
‫ﺗﺄﻣﻳﻥ ﺍﻟﻣﺳﺅﻭﻟﻳﺔ ﺍﻟﻣﺩﻧﻳﺔ ﺗﺟﺎﻩ ﺍﻟﻐﻳﺭ ﻓﻲ ﺍﻟﻣﻣﻠﻛﺔ ﺍﻟﻌﺭﺑﻳﺔ ﺍﻟﺳﻌﻭﺩﻳﺔ‬
This is to certify we issued a motor policy of below referred vehicle in
accordance with terms and conditions of Third Party Liability in Kingdom of
Saudi Arabia
Product ID A-GIGR-1-C-13-002
CERTIFICATE OF MOTOR VEHICLE : ‫ﺷﻬﺎﺩﺓ ﺗﺄﻣﻳﻥ ﺍﻟﺳﻳﺎﺭﺓ ﺭﻗﻡ‬
INSURANCE NO : 5/VX/30870/0/13 5/VX/30870/0/13
INSURED NAME : REZAYAT SPARROW A.CRANE HIRING ‫ ﺭﺿﺄﻳﺎﺕ ﺳﺑﺎﺭﻭ ﻟﺗﺄﺟﻳﺭ ﺍﻟﺭﺍﻓﻌﺎﺕ‬:‫ﺇﺳﻡ ﺍﻟﻣﺅﻣﻥ ﻟﻪ‬
MOTOR VEHICLE DETAILS : : ‫ﺗﻔﺎﺻﻳﻝ ﺍﻟﺳﻳﺎﺭﺓ‬
Registration No : EAA 7464 7464 ‫ ﺍ ﺍ ﻉ‬: ‫ﺭﻗﻡ ﺍﻟﻠﻭﺣﺔ‬
Chassis No : GR700546431 GR700546431 : ‫ﺭﻗﻡ ﺍﻟﻬﻳﻛﻝ‬
Make : Tadano CRANE CRANE ‫ ﺗﺎﺩﺍﻧﻭ‬: ‫ﻧﻭﻉ ﺍﻟﺳﻳﺎﺭﺓ‬
Year : 2008 2008 : ‫ﺍﻟﻣﻭﺩﻳﻝ‬
Custom Card ID : : ‫ﺭﻗﻡ ﺍﻟﺑﻁﺎﻗﺔ ﺍﻟﺟﻣﺭﻛﻳﺔ‬
PERIOD OF INSURANCE : : ‫ﻣﺩﺓ ﺍﻟﺗﺄﻣﻳﻥ‬
Commencement date : 13/12/1444 (H) ‫ﻫﺟﺭﻳﺔ‬ 13/12/1444: ‫ﺗﺎﺭﻳﺦ ﺍﻹﺑﺗﺩﺍء‬
Expiry date : 24/12/1445 (H) ‫ﻫﺟﺭﻳﺔ‬ 24/12/1445: ‫ﻭﻳﻧﺗﻬﻲ ﻓﻲ‬
Corresponding to : From 01/07/2023 To 30/06/2024 24/12/1445 (H) 13/12/1444 (H)
Subject always to the Limits of Liability of 10,000,000 S.R. as ‫ ﺭﺱ ﺍﻟﻣﺑﻳﻧﺔ ﻓﻲ ﺍﻟﻭﺛﻳﻘﺔ ﻭﺍﻟﻧﺎﺗﺟﺔ‬10,000,000 ‫ﻭﺫﻟﻙ ﺿﻣﻥ ﺣﺩﻭﺩ ﺍﻟﻣﺳﺅﻭﻟﻳﺔ‬
provided in the Policy arising out of the use of the insured Motor
‫ﻹﺳﺗﺧﺩﺍﻡ ﺍﻟﺳﻳﺎﺭﺓ ﺍﻟﻣﺅﻣﻧﺔ ﺩﺍﺧﻝ ﺍﻟﻣﻣﻠﻛﺔ ﺍﻟﻌﺭﺑﻳﺔ ﺍﻟﺳﻌﻭﺩﻳﺔ‬
Vehicle within Saudi Arabia .
This Certificate is deemed to be a guarantee for payment for all ‫ﻭﺗﻌﺗﺑﺭ ﻫﺫﻩ ﺍﻟﺷﻬﺎﺩﺓ ﻛﺿﻣﺎﻥ ﻟﺩﻓﻊ ﻛﺎﻓﺔ ﺍﻟﻣﺑﺎﻟﻎ ﺍﻟﺗﻲ ﻳﻛﻭﻥ ﺍﻟﻣﻠﻙ ﺍﻟﻣﺅﻣﻥ ﻟﻪ ﺃﻭ‬
amounts which the Insured Owner and/or the Authorized Driver at ‫ﺍﻟﺳﺎﺋﻖ ﺍﻟﻣﺧﻭﻝ ﻓﻲ ﻭﻗﺕ ﺍﻟﺣﺎﺩﺙ ﻣﺳﺅﻭﻟﻳﻥ ﻗﺎﻧﻭﻧﺎ ﻋﻥ ﺩﻓﻌﻬﺎ ﻛﺗﻌﻭﻳﺽ ﻋﻥ‬
the time of the accident shall become legally liable to pay as ‫ ﺍﻟﻭﻓﺎﺓ ﺃﻭ ﺍﻹﺻﺎﺑﺔ ﺍﻟﺑﺩﻧﻳﺔ ﺍﻟﺗﻲ ﺗﺣﺩﺙ ﻷﻱ ﺷﺧﺹ ﺑﻣﺎ ﻓﻲ ﺫﻟﻙ ﺭﻛﺎﺏ‬. 1
compensation for
(a) Death or bodily injury sustained by any person including ‫ﺍﻟﺳﻳﺎﺭﺓ‬
passengers of the vehicle ‫ ﺗﻠﻑ ﻣﻣﺗﻠﻛﺎﺕ ﺃﻱ ﻁﺭﻑ ﺛﺎﻟﺙ ﺧﺎﺭﺝ ﺍﻟﻣﺭﻛﺑﺔ ﺍﻟﻣﺅﻣﻧﺔ‬. 2
(b) Damage to third party property outside the Insured Vehicle

SIGNED : : ‫ﺍﻟﺗﻭﻗﻳﻊ‬

IMPORTANT
‫ﻣﻼﺣﻁﺎﺕ ﻫﺎﻣﺔ‬
1. This certificate of Insurance and Policy is valid only for the ‫ ﺇﻥ ﺷﻬﺎﺩﺓ ﺍﻟﺗﺄﻣﻳﻥ ﻫﺫﻩ ﺻﺎﻟﺣﺔ ﻓﻘﻁ ﻟﻠﻣﺎﻟﻙ ﺍﻟﻣﺅﻣﻥ ﻟﻪ ﻭﺍﻟﺳﺎﺋﻖ ﺍﻟﻣﺧﻭﻝ ﻟﻪ‬. 1
Insured Owner and the authorized Driver at the time of ‫ﺑﺎﻟﻘﻳﺎﺩﺓ ﻓﻲ ﺣﺎﻟﺔ ﻭﻗﻭﻉ ﺣﺎﺩﺙ ﻭﻫﻲ ﻏﻳﺭ ﻗﺎﺑﻠﺔ ﻟﻠﺗﺣﻭﻳﻝ ﺑﺩﻭﻥ ﻣﻭﺍﻓﻘﺔ‬
Accident and is NOT transferable without prior consent ‫ﻣﺳﺑﻘﺔ ﻣﻥ ﻗﺑﻝ ﺷﺭﻛﺔ ﺍﻟﺗﺄﻣﻳﻥ‬
of the Insurance Company.
2. Any Accident must be notified to the Insurance
‫ﻣﻣﻛﻥ‬ ‫ﻭﻗﺕ‬ ‫ﺃﺳﺭﻉ‬ ‫ﻓﻲ‬ ‫ﺍﻟﺷﺭﻛﺔ‬ ‫ﺇﺧﻁﺎﺭ‬ ‫ ﻋﻧﺩ ﻭﻗﻭﻉ ﺃﻱ ﺣﺎﺩﺙ ﻳﺟﺏ‬. 2
Company as soon as possible by visiting our website
:‫ﺍﻹﻟﻛﺗﺭﻭﻧﻲ‬ ‫ﻣﻥ ﺧﻼﻝ ﺯﻳﺎﺭﺓ ﻣﻭﻗﻌﻧﺎ‬
https://www.gig.sa/ar/claim-form
https://www.gig.sa/ar/claim-form
‫ ﺃﻭ ﺑﺯﻳﺎﺭﺓ ﺃﺣﺩ ﻣﻧﺎﻓﺫﻧﺎ‬920008477 ‫ﺃﻭ ﺑﺎﻹﺗﺻﺎﻝ ﻋﻠﻰ ﺍﻟﺭﻗﻡ‬
or by contacting us on 920008477 or visiting our outlets

Gulf Insurance Group Company CR-No 1010271203 P.O.Box 4539 Al 31952 ‫ ﺍﻟﺧﺑﺭ‬4539 ‫ ﺹ ﺏ‬1010271203 : ‫ﺷﺭﻛﺔ ﺟﻲ ﺃﻱ ﺟﻲ ﻟﻠﺗﺄﻣﻳﻥ ﺍﻟﺗﻌﺎﻭﻧﻲ ﺱ ﺕ‬
Khobar 31952, Al Maflah Building, 7th(off King Adbul Aziz)Street, KSA. ‫ ﺍﻟﺳﻌﻭﺩﻳﺔ‬,‫ ﺍﻟﺷﺎﺭﻉ ﺍﻟﺳﺎﺑﻊ )ﻣﻥ ﺷﺎﺭﻉ ﺍﻟﻣﻠﻙ ﻋﺑﺩ ﺍﻟﻌﺯﻳﺯ( ﺍﻟﺧﺑﺭ‬،‫ﻣﺑﻧﻰ ﺍﻟﻣﻔﻠﺢ‬
Telephone : 8001160020 00966 (13) 8945053 : ‫ﻓﺎﻛﺱ‬
Fax : 00966 (13) 8945035 8001160020 : ‫ﻫﺎﺗﻑ‬
Email :motorclaims.reg-ksa@gig.sa www.gig.sa : ‫ﺍﻟﻣﻭﻗﻊ ﺍﻹﻟﻛﺗﺭﻭﻧﻲ‬
Website :www.gig.sa motorclaims.reg-ksa@gig.sa :‫ﺍﻟﺑﺭﻳﺩ ﺍﻻﻟﻛﺗﺭﻭﻧﻲ‬
A company registered with the Ministry of Commerce and Industry of the Kingdom of Saudi Arabia ‫ ﻭﺗﺣﻣﻝ ﺭﺧﺻﺔ ﺗﺄﻣﻳﻥ ﺭﻗﻡ‬1010271203 ‫ﺷﺭﻛﺔ ﻣﺳﺟﻠﺔ ﻓﻲ ﻭﺯﺍﺭﺓ ﺍﻟﺻﻧﺎﻋﺔ ﻭﺍﻟﺗﺟﺎﺭﺓ ﻟﻠﻣﻣﻠﻛﺔ ﺍﻟﻌﺭﺑﻳﺔ ﺍﻟﺳﻌﻭﺩﻳﺔ ﺑﺳﺟﻝ ﺗﺟﺎﺭﻱ ﺭﻗﻡ‬
under Commercial Registration No. 1010271203 and holding Insurance license No. TMN/25/20101 TMN/25/20101 ‫ ﺻﺎﺩﺭﺓ ﻣﻥ ﻗﺑﻝ ﻣﺅﺳﺳﺔ ﺍﻟﻧﻘﺩ ﺍﻟﻌﺭﺑﻲ ﺍﻟﺳﻌﻭﺩﻱ‬.
issued by the Saudi Arabian Monetary Agency
Inspection
Certificate
PASS
CERTIFICATE INFORMATION

Certificate Number: VEHICLE DATA

3530403144506370105
Inspection Date: Plate Number: 7464 EAA ­ Public Transport Chassis No: GR700546431
19-09-2023 | 4-3-1445 Make: OTHERS Model Year: 2008
Service:
Vehicle Model: M­CRANE Color: RED
Vehicles Periodic Inspection

Vehicle Testing Center: Odometer: 7072 Sequence No: 0954625800

Motor Vehicles Periodic Inspection
Inspection Site: INSPECTION RESULT DETAILS
Yanbu Station

Lane:
01 Side Slip Inspection
Inspector Number:
66529, 70319 Standard Name Reading Pass Degree

Sticker Number: Side Slip Result ≤ 7.0 M/KM

2301790935

Attempt:
1 Brake Inspection
Certificate Expiry Date: Standard Name Reading Pass Degree Standard Name Reading Pass Degree
19-09-2024 | 16-3-1446
Front brake efficiency ≥ 45.0 Centre 1 brake efficiency ≥ 45.0

INSPECTION RESULTS Front brake imbalance Centre 1 brake imbalance

Front brake drag ≤ 20.0 Centre 1 brake drag ≤ 20.0

Visual Inspection: PASS
Rear brake efficiency ≥ 45.0 Centre 2 brake efficiency ≥ 45.0
Side Slip: PASS
Brake: PASS Rear brake imbalance Centre 2 brake imbalance

HeadLight: Caution Rear brake drag ≤ 20.0 Centre 2 brake drag ≤ 20.0
Emission Gas / Diesel Smoke: PASS
Parking brake efficiency ≥ 20.0
Under Carriage: PASS

HeadLight Inspection
IMPORTANT NOTE
Standard Name Reading Pass Degree Standard Name Reading Pass Degree

The vehicle’s owner has the Intensity of right light Intensity of left light

right of two re­inspections Deviation of right light (Up/Down) Deviation of left light (Up/Down)

within 14 working days Deviation of right light (Right/Left) Deviation of left light (Right/Left)

starting from the date and time

of the first inspection. Emission Gas / Diesel Smoke Inspection

‫ﻳﺤﻖ ﻟﻤﺎﻟﻚ اﻟﻤﺮﻛﺒﺔ ﻓﺮﺻﺘﻴﻦ‬ Standard Name Reading Pass Degree Standard Name Reading Pass Degree

‫ﻹﻋﺎدة اﻟﻔﺤﺺ ﺧﻼل‬ Vehicle CO Reading Vehicle HC Reading

‫ ﻳﻮم ﻋﻤﻞ ﻣﻦ ﺗﺎرﻳﺦ ووﻗﺖ‬1 4 Vehicle Opacity Reading

.‫اﻟﻔﺤﺺ اﻷول‬

You can see all the inspection

points through the following
link vi.vsafety.sa

‫ﻟﻠﺸﻜﺎوي واﻻﻗﺘﺮاﺣﺎت‬

0112461220

www.saso.gov.sa
 Report Date 1444-07-09

Resident's Information Operator ID 2251436925

Location Muqeem Portal

Person Information - Head of Household

Iqama Number 2538166576 Version Number 1 Gender Male

Name MOHAMMAD ASIF ALI

Translated Name ‫ﻣﺤﻤﺪ ﺁﺻﻒ ﻋﻠﻲ‬

Birth Date 1395-04-19 Birth Country India Martial Status SINGLE

Religion Islam Occupation Heavy truck Driver

Status Valid Entry Date 1444-06-18 Entry Location King Fahd

Passport Information

Number S1216889 Nationality India

Issue Date 1439-03-25 Expiry Date 1449-07-14 Issue Location ‫ﻧﻴﻮﺩﻟﻬﻲ‬

Iqama Information

Issue Date 1444-07-07 Expiry Date 1445-09-20 Issue Location Company Science

Employer Information

Number 7000158167

Name ‫ﺷﺮﻛﺔ ﺭﺿﺎﻳﺎﺕ ﺳﺒﺎﺭﻭ ﺍﻟﻌﺮﺑﻴﺔ ﻟﺘﺎﺟﻴﺮ ﺍﻟﺮﺍﻓﻌﺎﺕ ﺍﻟﻤﺤﺪﻭﺩﺓ‬