A WALA 1 B 13 021: No Additional Drivers

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A‐WALA‐1‐B‐13‐021

‫ﺟﺪﻭﻝ ﻭﺛﻴﻘﺔ ﺗﺄﻣﻴﻦ ﺿﺪ ﺍﻟﻐﻴﺮ ﻟﻠﻤﺮﻛﺒﺎﺕ‬


Policy Schedule for Motor Third‐party liability

Policy number: P03/23/300/00110706 :‫ﺭﻗﻢ ﺍﻟﻮﺛﻴﻘﺔ‬

15/04/1445 3:59
Policy issuance date ‫ﺗﺎﺭﻳﺦ ﺍﺻﺪﺍﺭ ﺍﻟﻮﺛﻴﻘﺔ‬
2023‐10‐29 15:59

15/04/1445 TO 26/04/1446
Period of Coverage: :‫ﻓﺘﺮﺓ ﺍﻟﺘﻐﻄﻴﺔ‬
2023‐10‐30 TO 2024‐10‐29

Type of Insured ‫ﻧﻮﻉ ﺍﻟﻤﺆﻣﻦ ﻟﻪ‬

‫﴿ﺗﺄﻣﻴﻦ ﻣﺮﻛﺒﺎﺕ ﻃﺮﻑ ﺛﺎﻟﺚ ﴿ﺿﺪ ﺍﻟﻐﻴﺮ‬


Type of insurance ‫ﻧﻮﻉ ﺍﻟﺘﻐﻄﻴﺔ‬
Third Party

Customer information ‫ﺑﻴﺎﻧﺎﺕ ﺍﻟﻌﻤﻴﻞ‬

‫ﺍﺣﻤﺪ ﻋﻠﻮﻱ‬ ‫ﻣﺤﻤﺪ ﻧﺎ‬


Insured name: :‫ﺍﺳﻢ ﺍﻟﻤﺆﻣﻦ ﻟﻪ‬
MOHAMMED NASSER AHMED ALAWI

ID number: 2161067901 :‫ﺭﻗﻢ ﺍﻟﻬﻮﻳﺔ‬

Mobile number: 0599480591 :‫ﺭﻗﻢ ﺍﻟﻬﺎﺗﻒ ﺍﻟﺠﻮﺍﻝ‬

National address: 4124 ,7327 ,55471 ,‫ ﺣﺎﺋﻞ‬,‫ ﺣﻲ ﺍﺟﺎ‬,83 ‫ﺃﺟﺎ‬ :‫ﺍﻟﻌﻨﻮﺍﻥ ﺍﻟﻮﻃﻨﻲ‬

Named/Additional Driver information ‫ﺑﻴﺎﻧﺎﺕ ﺍﻟﺴﺎﺋﻖ ﺍ ﺿﺎﻓﻲ ﻭ ﺍﻟﻤﺴﻤﻰ‬

No Additional Drivers

Purpose of the insurance‐ ‐‫ﺍﻟﻐﺮﺽ ﻣﻦ ﺍﻟﺘﺎﻣﻴﻦ‬

Vehicle owner ID Number: 2161067901 : ‫ﺭﻗﻢ ﺍﻟﻬﻮﻳﺔ ﻣﺎﻟﻚ ﺍﻟﻤﺮﻛﺒﺔ‬


A‐WALA‐1‐B‐13‐021

Motor Vehicle information ‫ﺑﻴﺎﻧﺎﺕ ﺍﻟﻤﺮﻛﺒﺔ‬

Registration plate number: VZB 5319 ‫ﺏ ﻡ ﻯ‬ :‫ﺭﻗﻢ ﻟﻮﺣﺔ ﺍﻟﻤﺮﻛﺒﺔ‬

Chassis number: JTDBV42E3C9022066 :‫ﺭﻗﻢ ﻫﻴﻜﻞ ﺍﻟﻤﺮﻛﺒﺔ‬

Type of chassis: Sedan‐Special Category :‫ﻧﻮﻉ ﻫﻴﻜﻞ ﺍﻟﻤﺮﻛﺒﺔ‬

Vehicle make: Toyota :‫ﻃﺮﺍﺯ ﺍﻟﻤﺮﻛﺒﺔ‬

Vehicle model: Corolla :‫ﻣﺎﺭﻛﺔ ﺍﻟﻤﺮﻛﺒﺔ‬

Year of manufacture: 2012 :‫ﺳﻨﺔ ﺍﻟﺘﺼﻨﻴﻊ‬

Serial number: 233774110 :‫ﺍﻟﺮﻗﻢ ﺍﻟﺘﺴﻠﺴﻠﻲ‬

Customs card number: :‫ﺭﻗﻢ ﺍﻟﺒﻄﺎﻗﺔ ﺍﻟﺠﻤﺮﻛﻴﺔ‬

Vehicle color: ‫ﻓ‬ :‫ﻟﻮﻥ ﺍﻟﻤﺮﻛﺒﺔ‬

Use restraints: :‫ﻗﻴﻮﺩ ﺍ ﺳﺘﻌﻤﺎﻝ‬

Vehicle registration expiry date: 14‐06‐1445 :‫ﺗﺎﺭﻳﺦ ﺍﻧﺘﻬﺎﺀ ﺭﺧﺼﺔ ﺍﻟﺴﻴﺮ‬

Parking location at night: : ‫ﻣﻜﺎﻥ ﺇﻳﻘﺎﻑ ﺍﻟﻤﺮﻛﺒﺔ ﻟﻴ‬

Limits ‫ﺣﺪﻭﺩ ﺍﻟﺘﻐﻄﻴﺔ‬

indemnifying the Third Party in accordance with the provisions of this


‫ﻓﻲ ﺣﺎﻝ ﻭﻗﻮﻉ ﺣﺎﺩﺙ ﻳﺘﺮﺗﺐ ﻋﻠﻴﻪ ﺍﻟﺘﻌﻮﻳﺾ ﻟﻄﺮﻑ ﺛﺎﻟﺚ ﻭﻓﻘﺎ ﺣﻜﺎﻡ ﻫﺬﻩ ﺍﻟﻮﺛﻴﻘﺔ‬
Policy, the maximum limit of the Insurer's liability for one event and during
‫ﻟﻤﺴﺆﻭﻟﻴﺔ ﺍﻟ ﻛﺔ ﻓﻲ ﺍﻟﻮﺍﻗﻌﺔ ﺍﻟﻮﺍﺣﺪﺓ ﻭﺧ ﻝ ﻓﺘﺮﺓ ﻳﺎﻥ‬ ‫ﻓﺈﻥ ﺍﻟﺤﺪ ﺍ ﻗ‬
the lifetime of the Policy for physical damage, expenses and material
‫ﺍﺭ ﺍﻟﻤﺎﺩﻳﺔ ﻭﺍﻟﻤﺼﺎﺭﻳﻒ ﻣﻌﺎ ﻟﻦ ﺗﺘﺠﺎﻭﺯ‬ ‫ﺍﺭ ﺍﻟﺠﺴﺪﻳﺔ ﻭﺍ‬ ‫ﺍﻟﻮﺛﻴﻘﺔ ﺑﺎﻟﻨﺴﺒﺔ ﻟ‬
damages shall not exceed together a total sum of SAR 10,000,000 ﴾ten
‫ ﺭﻳﺎﻝ ﴾ ﻋ ﺓ ﻣ ﻳﻴﻦ ﺭﻳﺎﻝ ﺳﻌﻮﺩﻱ﴾ﻛﺤﺪٍ ﺃﻗ‬10.000,000 ‫ﻣﺒﻠﻐﺎ ﺇﺟﻤﺎﻟﻴﺎ ﻗﺪﺭﻩ‬
million Saudi Riyals﴿ as a maximum liability limit for coverage. Based on
..‫ﻟﻤﺴﺆﻭﻟﻴﺔ ﺍﻟ ﻛﺔ ﻭﻓﻘﺎ ﻟﺠﺪﻭﻝ ﺣﺪﻭﺩ ﺍﻟﺘﻐﻄﻴﺔ‬
coverage limits table.

‫ﺣﺪ ﺍﻟﺘﻐﻄﻴﺔ ﺍﻟﺘﺄﻣﻴﻨﻴﺔ‬


Insurance coverage ‫ﺍﻟﺘﻐﻄﻴﺔ ﺍﻟﺘﺄﻣﻴﻨﻴﺔ‬
Coverage limits

Treatment costs of physical damages caused to a ‫ﺍﺭ ﺍﻟﺠﺴﺪﻳﺔ ﺍﻟﺘﻲ ﺗﻠﺤﻖ ﺑﺎﻟﻄﺮﻑ‬ ‫ﺗﻜﺎﻟﻴﻒ ﻋ ﺝ ﺍ‬
Third Party inside or outside the vehicle for 10,000 ‫ﺍﻟﺜﺎﻟﺚ ﺩﺍﺧﻞ ﺍﻟﻤﺮﻛﺒﺔ ﺃﻭ ﺧﺎﺭﺟﻬﺎ ﻟﻤﻄﺎﻟﺒﺎﺕ ﻭﺯﺍﺭﺓ‬
ministry of health claims. .‫ﺍﻟﺼﺤﺔ‬

Treatment costs of physical damages caused to a ‫ﺍﺭ ﺍﻟﺠﺴﺪﻳﺔ ﺍﻟﺘﻲ ﺗﻠﺤﻖ ﺑﺎﻟﻄﺮﻑ‬ ‫ﺗﻜﺎﻟﻴﻒ ﻋ ﺝ ﺍ‬
Third Party inside or outside the vehicle for non‐ 10,000,000 ‫ﺍﻟﺜﺎﻟﺚ ﺩﺍﺧﻞ ﺍﻟﻤﺮﻛﺒﺔ ﺃﻭ ﺧﺎﺭﺟﻬﺎ ﻟﻐﻴﺮ ﻣﻄﺎﻟﺒﺎﺕ ﻭﺯﺍﺭﺓ‬
ministry of health claims. .‫ﺍﻟﺼﺤﺔ‬

Material damages inflicted on a Third Party ‫ﺍﺭ ﺍﻟﻤﺎﺩﻳﺔ ﺍﻟﺘﻲ ﺗﻠﺤﻖ ﺑﺎﻟﻄﺮﻑ ﺍﻟﺜﺎﻟﺚ ﺧﺎﺭﺝ‬ ‫ﺍ‬
10,000,000
outside the Vehicle. .‫ﺍﻟﻤﺮﻛﺒﺔ‬

Expenses. 10,000,000 ‫ﺍﻟﻤﺼﺎﺭﻳﻒ‬

No Additional Benefits
‫ﺍﻟﻤﺒﻠﻎ ﺑﺎﻟﺮﻳﺎﻝ ﺍﻟﺴﻌﻮﺩﻱ‬
Optional Coverage ‫ﺍﻟﺘﻐﻄﻴﺎﺕ ﺍﺧﺘﻴﺎﺭﻳﺔ‬
Amount in SR
‫‪A‐WALA‐1‐B‐13‐021‬‬

‫‪Geographic borders‬‬ ‫‪:‬ﺍﻟﺤﺪﻭﺩ ﺍﻟﺠﻐﺮﺍﻓﻴﺔ‬

‫‪On Saudi Arabia territories‬‬ ‫ﺍﻟﻤﻤﻠﻜﺔ ﺍﻟﻌﺮﺑﻴﺔ ﺍﻟﺴﻌﻮﺩﻳﺔ‬ ‫ﺩﺍﺧﻞ ﺃﺭﺍ‬

‫‪Use Restrains‬‬ ‫ﻗﻴﺪ ﺍ ﺳﺘﻌﻤﺎﻝ‬

‫‪The Insured should not use the vehicle for other than the authorized‬‬
‫ﻳﺠﺐ ﻋﻠﻰ ﺍﻟﻤﺆﻣﻦ ﻟﻪ ﺃ ً ﻳﺴﺘﺨﺪﻡ ﺍﻟﻤﺮﻛﺒﺔ ﺇ ً ﻟﻠﻐﺮﺽ ﺍﻟﻤﺮﺧﺼﺔ ﺟﻠﻪ ‪.‬‬
‫‪purpose:‬‬

‫‪Premium Amount‬‬ ‫ﻗﺴﻂ ﺍﻟﺘﺎﻣﻴﻦ‬

‫‪Basic Premium‬‬ ‫‪1250.00‬‬ ‫ﺍﻟﻘﺴﻂ ﺍ ﺳﺎ‬

‫‪Total before VAT:‬‬ ‫‪1125‬‬ ‫ﻳﺒﺔ ﺍﻟﻘﻴﻤﺔ ﺍﻟﻤﻀﺎﻓﺔ‪:‬‬ ‫ﺍﻟﻤﺠﻤﻮﻉ ﻗﺒﻞ ﺍﻟ‬

‫‪VAT amount:‬‬ ‫‪168.75‬‬ ‫ﻳﺒﺔ ﺍﻟﻘﻴﻤﺔ ﺍﻟﻤﻀﺎﻓﺔ‪:‬‬ ‫ﻣﺒﻠﻎ‬

‫‪Total premium including VAT:‬‬ ‫‪1293.75‬‬ ‫ﻳﺒﺔ ﺍﻟﻘﻴﻤﺔ ﺍﻟﻤﻀﺎﻓﺔ‪:‬‬ ‫ﻣﺠﻤﻮﻉ ﻗﺴﻂ ﺍﻟﺘﺄﻣﻴﻦ ﺑﻌﺪ ﺍﻟ‬

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