ﻧﻤﻮذج اﺣﺘﺴﺎب ﻗﺪرة اﻟﻌﻤﻴﻞ ﻋﻠﻰ ﺗﺤﻤﻞ اﻟﺘﻜﺎﻟﻴﻒ وﻣﺪى ﻣﻼءﻣﺔ اﻟﻤﻨﺘﺞ
Customer Affordability/Suitability Assessment
* All fields are mandatory * ﺟﻤﻴﻊ اﻟﺤﻘﻮل إﻟﺰاﻣﻴﺔ
I, ......................................................................................................................................................................................................................................................, ،........................................................................................................................... ،أؤﻛﺪ أﻧﺎ
confirm the correctness of my monthly income, expenses and other facilities and my ﻋﻠﻰ ﺻﺤﺔ دﺧﻠﻲ اﻟﺸﻬﺮي واﻟﻤﺼﺎرﻳﻒ واﻟﺘﺴﻬﻴﻼت اﻷﺧﺮى واﻟﻘﺪرة ﻋﻠﻰ ﺗﺤﻤﻞ ﺗﻜﺎﻟﻴﻒ اﻟﺘﺴﻬﻴﻼت اﻟﻤﻘﺪﻣﺔ
affordability to bear the costs of the facilities provided to me by Sharjah Islamic Bank. .إﻟﻲ ﻣﻦ ﻣﺼﺮف اﻟﺸﺎرﻗﺔ اﻹﺳﻼﻣﻲ
ّ
Requested product اﻟﻤﻨﺘﺞ اﻟﻤﻄﻠﻮب
Personal Finance Auto Finance Home Finance Covered Card ﺑﻄﺎﻗﺔ ﻣﻐﻄﺎة ﺗﻤﻮﻳﻞ ﻋﻘﺎري ﺗﻤﻮﻳﻞ ﺳﻴﺎرة ﺗﻤﻮﻳﻞ ﺷﺨﺼﻲ
Personal Profile اﻟﺘﻔﺎﺻﻴﻞ اﻟﺸﺨﺼﻴﺔ
Age اﻟﻌﻤﺮ
Marital status Married Single Other أﺧﺮى أﻋﺰب ﻣﺘﺰوج اﻟﺤﺎﻟﺔ اﻻﺟﺘﻤﺎﻋﻴﺔ
Income profile Salaried Business ﻋﻤﻞ ﺧﺎص راﺗﺐ ﻓﺌﺔ اﻟﺪﺧﻞ
Family in the UAE Yes No ﻻ ﻧﻌﻢ ﻫﻞ ﻋﺎﺋﻠﺘﻚ ﻣﻘﻴﻤﺔ ﻓﻲ اﻟﺪوﻟﺔ
No. of dependents in the UAE ﻋﺪد اﻟﻤﻌﺎﻟﻴﻦ ﻣﻦ ﻗﺒﻠﻚ ﻓﻲ اﻟﺪوﻟﺔ
No. of children studying in the UAE at my expense ﻋﺪد اﻷﺑﻨﺎء اﻟﺬﻳﻦ ﻳﺪرﺳﻮن ﻋﻠﻰ ﻧﻔﻘﺘﻚ ﻓﻲ ﻣﺪارس اﻟﺪوﻟﺔ
Accommodation Rented Owned ﻣﻠﻚ إﻳﺠﺎر اﻟﺴﻜﻦ
With parents Provided by the employer ﻣﻤﻨﻮح ﻣﻦ رب اﻟﻌﻤﻞ ﻣﻊ اﻟﻮاﻟﺪﻳﻦ
Accommodation type Flat Villa ﻓﻴﻼ ﺷﻘﺔ ﻧﻮع اﻟﺴﻜﻦ
No. of properties owned in the UAE ﻋﺪد اﻟﻌﻘﺎرات اﻟﻤﻤﻠﻮﻛﺔ داﺧﻞ اﻟﺪوﻟﺔ
Number of earning members in the family residing with you ﻋﺪد أﻓﺮاد اﻷﺳﺮة اﻟﻤﻘﻴﻤﻴﻦ ﻣﻌﻚ وﻟﺪﻳﻬﻢ راﺗﺐ
Document copy receiving method Paper Copy Electronic Copy ﻧﺴﺨﺔ إﻛﺘﺮوﻧﻴﺔ ﻧﺴﺨﺔ ورﻗﻴﺔ ﻃﺮﻳﻘﺔ اﺳﺘﻼم ﻧﺴﺨﺔ اﻟﻄﻠﺐ
Income and Expenses Amount (AED) % of Utilization ﻧﺴﺒﺔ اﻻﺳﺘﺨﺪام% (اﻟﻤﺒﻠﻎ )درﻫﻢ اﻟﺪﺧﻞ واﻟﻤﺼﺎرﻳﻒ
(A) Monthly Income اﻟﺪﺧﻞ اﻟﺸﻬﺮي ()أ
(B) Basic Monthly Expenses )ب( اﻟﻤﺼﺎرﻳﻒ اﻟﺸﻬﺮﻳﺔ اﻷﺳﺎﺳﻴﺔ
(C) Other Lifestyle Expenses ﻣﺼﺎرﻳﻒ اﻟﻤﻌﻴﺸﺔ اﻷﺧﺮى ()ج
(D) Total Monthly Payment of Credit Facilities (Personal ، اﻟﺘﻤﻮﻳﻞ اﻟﺸﺨﺼﻲ,إﺟﻤﺎﻟﻲ اﻟﺪﻓﻌﺎت اﻟﺸﻬﺮﻳﺔ )اﻟﺘﺴﻬﻴﻼت اﻻﺋﺘﻤﺎﻧﻴﺔ ()د
Finance, Credit / Covered Cards, Mortgages etc) ( واﻟﻤﺰﻳﺪ، اﻟﺘﻤﻮﻳﻼت اﻟﻌﻘﺎرﻳﺔ، ﻣﻐﻄﺎة/ ﺑﻄﺎﻗﺎت اﻻﺋﺘﻤﺎن
Monthly Disposable Income after deducting all expenses (B, C, D) ( د, ج,اﻟﺪﺧﻞ اﻟﺸﻬﺮي اﻟﻘﺎﺑﻞ ﻟﻠﺘﺼﺮف ﺑﻌﺪ ﺧﺼﻢ ﺟﻤﻴﻊ اﻟﻨﻔﻘﺎت )ب
(E) SIB proposed monthly installment )ﻫـ( اﻟﻘﺴﻂ اﻟﺸﻬﺮي اﻟﻤﻘﺘﺮح ﻣﻦ ﻣﺼﺮف اﻟﺸﺎرﻗﺔ اﻹﺳﻼﻣﻲ
Customer has the financial affordability? Yes No ﻻ ﻧﻌﻢ اﻟﻌﻤﻴﻞ ﻟﺪﻳﻪ اﻟﻘﺪرة اﻟﻤﺎﻟﻴﺔ ﻋﻠﻰ ﺗﺤﻤﻞ اﻟﺘﻜﺎﻟﻴﻒ؟
Income and Expenses Details ﺗﻔﺎﺻﻴﻞ اﻟﺪﺧﻞ واﻟﻤﺼﺎرﻳﻒ
(A) Monthly Income includes monthly salary with allowances and / or any other أو أي دﺧﻞ آﺧﺮ ﺗﻤﺖ اﻟﻤﻮاﻓﻘﺔ ﻋﻠﻰ إدراﺟﻪ ﻛﺪﺧﻞ؛/ اﻟﺪﺧﻞ اﻟﺸﻬﺮي ﻳﺸﻤﻞ اﻟﺮاﺗﺐ اﻟﺸﻬﺮي ﻣﻊ اﻟﺒﺪﻻت و ()أ
regular income approved to be included as income; based on Bank’s respective ﺑﻨﺎء ﻋﻠﻰ ﺳﻴﺎﺳﺔ اﻟﻤﺼﺮف اﻟﺨﺎﺻﺔ ﺑﺎﻟﻤﻨﺘﺞ
ً
Product Policy
(B) Basic Monthly Expenses includes: :)ب( اﻟﻤﺼﺎرﻳﻒ اﻟﺸﻬﺮﻳﺔ اﻷﺳﺎﺳﻴﺔ ﺗﺸﻤﻞ
- House rental إﻳﺠﺎر اﻟﻤﻨﺰل -
- Children education expenses ﻣﺼﺎرﻳﻒ اﻟﺘﻌﻠﻴﻢ -
- Utility expenses (Mobile bills, Electricity, Water, .etc) ( اﻟﻤﻴﺎه وإﻟﺦ، اﻟﻜﻬﺮﺑﺎء،ﻣﺼﺎرﻳﻒ اﻟﺨﺪﻣﺎت )ﻓﻮاﺗﻴﺮ اﻟﻬﺎﺗﻒ -
(C) Lifestyle Expenses other than basic expenses and credit / lending related : اﻟﺴﻠﻒ ﺑﻤﺎ ﻓﻲ ذﻟﻚ/ ﻣﺼﺎرﻳﻒ اﻟﻤﻌﻴﺸﺔ ﺑﺎﺳﺘﺜﻨﺎء اﻟﻤﺼﺎرﻳﻒ اﻷﺳﺎﺳﻴﺔ واﻟﺪﻓﻌﺎت اﻻﺋﺘﻤﺎﻧﻴﺔ ()ج
payments including but not limited to:
، ﻣﺼﺎرﻳﻒ اﻟﺒﺘﺮول، ﻣﺘﻮﺳﻂ ﻧﻔﻘﺎت اﻟﺮﻋﺎﻳﺔ اﻟﺼﺤﻴﺔ، رواﺗﺐ اﻟﻌﻤﺎﻟﺔ اﻟﻤﻨﺰﻟﻴﺔ،ﻣﺼﺎرﻳﻒ اﻟﻄﻌﺎم اﻟﺸﻬﺮﻳﺔ -
- Monthly food expenses, wages paid to the domestic workers, average ( اﻟﻤﻤﺘﻠﻜﺎت، اﻟﺤﻴﺎة، اﻟﺼﺤﺔ، اﻟﺘﻜﺎﻓﻞ )اﻟﺴﻴﺎرات/ دﻓﻌﺎت اﻟﺘﺄﻣﻴﻦ،ﻣﺼﺎرﻳﻒ اﻟﺴﻔﺮ
healthcare expenses, petrol expenses, travel expenses, insurance / Takaful ﺗﻜﺎﻟﻴﻒ اﻟﺼﻴﺎﻧﺔ وﺧﺪﻣﺎت اﻟﻤﻤﺘﻠﻜﺎت اﻷﺧﺮى )إن وﺟﺪت( و -
payments (cars, health, life, property) ﺑﻠﺪ اﻷم أو أﻳﺔ ﻧﻔﻘﺎت/ أي ﺗﻜﺎﻟﻴﻒ أو ﻧﻔﻘﺎت أﺧﺮى ﻓﻲ دوﻟﺔ اﻹﻣﺎرات اﻟﻌﺮﺑﻴﺔ اﻟﻤﺘﺤﺪة أو ﻓﻲ اﻟﺨﺎرج -
- Costs of maintaining services of other owned properties (if any); and أو ﺧﺼﻢ ﺑﻤﻮﺟﺐ أﺣﻜﺎم ﻗﻀﺎﺋﻴﺔ
- Any other costs or expenses both in UAE or overseas / home country or any
expenses or deduction under court rulings
SIB/CUST/202-VI/Aug 2022
(D) Any payment towards other credit lending of personal finance, mortgage اﻟﻤﻐﻄﺎة أو اﻟﺴﺤﺐ/ أي دﻓﻌﺎت ﺷﻬﺮﻳﺔ ﻟﻠﺘﻤﻮﻳﻞ اﻟﺸﺨﺼﻲ أو اﻟﺘﻤﻮﻳﻞ اﻟﻌﻘﺎري أو ﺑﻄﺎﻗﺎت اﻻﺋﺘﻤﺎن ()د
finance, credit / covered cards, overdraft or any other repayments to either a / ﻟﻦ ﻳﺘﻢ إﺿﺎﻓﺔ اﻟﺘﻤﻮﻳﻼت.ﻋﻠﻰ اﻟﻤﻜﺸﻮف أو أي دﻓﻌﺎت أﺧﺮى إﻣﺎ ﻟﻤﺆﺳﺴﺔ ﻣﺎﻟﻴﺔ أو ﻟﺼﺎﺣﺐ اﻟﻌﻤﻞ
financial institution or to the employer to be included. Finances / Facilities which اﻟﺘﺴﻬﻴﻼت اﻟﺘﻲ ﻳﺘﻢ ﺷﺮاؤﻫﺎ ﻣﻦ ﻗﺒﻞ ﻣﺼﺮف اﻟﺸﺎرﻗﺔ اﻹﺳﻼﻣﻲ
are being bought out by Sharjah Islamic Bank will not be included
(E) SIB proposed monthly installment )ﻫـ( اﻟﻘﺴﻂ اﻟﺸﻬﺮي اﻟﻤﻘﺘﺮح ﻣﻦ ﻣﺼﺮف اﻟﺸﺎرﻗﺔ اﻹﺳﻼﻣﻲ
Terms and Conditions apply
*ﺗﻄﺒﻖ اﻟﺸﺮوط واﻷﺣﻜﺎم
Signature of Customer: :ﺗﻮﻗﻴﻊ اﻟﻌﻤﻴﻞ
Date: | DD | MM | YY | | | ﻳﻮم | ﺷﻬﺮ | ﺳﻨﺔ:اﻟﺘﺎرﻳﺦ
Sharjah Islamic Bank is licensed by the Central Bank of the UAE. . ﻫﻮ ﺟﻬﺔ ﻣﺮﺧﺼﺔ ﻣﻦ ﻗﺒﻞ ﻣﺼﺮف اﻹﻣﺎرات اﻟﻤﺮﻛﺰي.ﻣﺼﺮف اﻟﺸﺎرﻗﺔ اﻹﺳﻼﻣﻲ
Declaration إﻗﺮار
• I hereby confirm that the above mentioned details of my monthly income, وﻏﻴﺮﻫﺎ ﻣﻦ، واﻟﻤﺼﺮوﻓﺎت،أؤﻛﺪ ﺑﻤﻮﺟﺒﻪ أن اﻟﺘﻔﺎﺻﻴﻞ اﻟﻤﺬﻛﻮرة أﻋﻼه ﻋﻦ اﻟﺪﺧﻞ اﻟﺸﻬﺮي •
expenses, other liabilities and affordability for the applied facility with Sharjah اﻻﻟﺘﺰاﻣﺎت واﻟﻘﺪرة ﻋﻠﻰ ﺗﺤﻤﻞ اﻟﺘﻜﺎﻟﻴﻒ ﻟﻠﺘﺴﻬﻴﻼت اﻟﻤﻄﻠﻮﺑﺔ ﻣﻦ ﻣﺼﺮف اﻟﺸﺎرﻗﺔ اﻹﺳﻼﻣﻲ
Islamic Bank are correct and complete to the best of my knowledge ﺻﺤﻴﺤﺔ وﻛﺎﻣﻠﺔ ﻋﻠﻰ ﺣﺪ ﻋﻠﻤﻲ
• I have carefully read, understood and acknowledge: the nature of the ،اﻟﻬﻴﻜﻠﺔ/ وﻣﺰاﻳﺎ اﻟﺨﺪﻣﺔ، واﻟﺘﺴﻌﻴﺮ،اﻟﺨﺪﻣﺔ/ﻟﻘﺪ ﻗﺮأت ﺑﻌﻨﺎﻳﺔ وﻓﻬﻤﺖ وأﻗﺮ ﺑﺄن ﻃﺒﻴﻌﺔ اﻟﻤﻨﺘﺞ •
product/ service features, pricing, fees any other risk related to profit/rental وأي ﻣﺨﺎﻃﺮ أﺧﺮى ﺗﺘﻌﻠﻖ ﺑﻨﺴﺐ اﻷرﺑﺎح ﺧﺎﺿﻌﺔ ﻟﻠﺘﻐﻴﻴﺮ واﻟﻤﺮاﺟﻌﺔ،واﻟﺮﺳﻮم
rate are subject to changes and revisions
• If applicable, I hereby declare and confirm that I have discussed and agreed أﻗﺮ ﺑﻤﻮﺟﺐ ﻫﺬا وأؤﻛﺪ أﻧﻨﻲ ﻧﺎﻗﺸﺖ وواﻓﻘﺖ ﻋﻠﻰ ﺧﻔﺾ ﻣﺼﺎرﻳﻔﻲ ﻟﺘﻜﻮن،إن إﻗﺘﻀﻰ اﻷﻣﺮ •
to reduce my expenses to be less than the total monthly disposable income. ﺳﺘﻨﻄﺒﻖ ﺗﻐﻴﻴﺮات ﻧﻤﻂ اﻟﺤﻴﺎة ﻫﺬه ﻋﻠﻰ اﻟﻤﺼﺮوﻓﺎت.أﻗﻞ ﻣﻦ إﺟﻤﺎﻟﻲ اﻟﺪﺧﻞ اﻟﺸﻬﺮي اﻟﻤﺘﺎح
These lifestyle changes will apply to Basic Monthly Expenses (B), Other .(اﻟﺸﻬﺮﻳﺔ اﻷﺳﺎﺳﻴﺔ )ب( وﻣﺼﺎرﻳﻒ اﻟﻤﻌﻴﺸﺔ اﻷﺧﺮى )ج( واﻟﺘﺴﻬﻴﻼت اﻻﺋﺘﻤﺎﻧﻴﺔ )د
Lifestyle Expenses (C) & Credit Facilities (D).
• I further understand and acknowledge that this suitability, affordability ﻛﻤﺎ أﻓﻬﻢ وأﻗﺮ أن ﻫﺬا اﻟﺘﻘﻴﻴﻢ اﻟﺨﺎص ﺑﻤﺪى ﻣﻼءﻣﺔ اﻟﻤﻨﺘﺞ اﻻﺋﺘﻤﺎﻧﻲ واﻟﻘﺪرة ﻋﻠﻰ ﺗﺤﻤﻞ •
and/or appropriateness assessment is an essential document, which is . أو ﻣﻼءﻣﺘﻪ ﻫﻮ ﻣﺴﺘﻨﺪ أﺳﺎﺳﻲ وﻳﺨﻀﻊ ﻟﺘﻘﺪﻳﺮ ﻣﺼﺮف اﻟﺸﺎرﻗﺔ اﻹﺳﻼﻣﻲ/ ﺗﻜﺎﻟﻴﻔﻪ و
subject to SIB discretion.
• According to the aforesaid, I request Sharjah Islamic Bank, to proceed with ﻣﺘﺎﺑﻌﺔ ﻃﻠﺒﻲ ﻟﻠﺤﺼﻮل ﻋﻠﻰ اﻟﺘﻤﻮﻳﻞ ﻣﻊ، أﻃﻠﺐ ﻣﻦ ﻣﺼﺮف اﻟﺸﺎرﻗﺔ اﻹﺳﻼﻣﻲ،وﻓﻘﺎً ﻟﻤﺎ ﺳﺒﻖ •
my request for finance considering the stated information. .اﻷﺧﺬ ﻓﻲ اﻻﻋﺘﺒﺎر اﻟﻤﻌﻠﻮﻣﺎت اﻟﻤﺬﻛﻮرة
Name of Customer: :اﺳﻢ اﻟﻌﻤﻴﻞ
Signature of Customer: :ﺗﻮﻗﻴﻊ اﻟﻌﻤﻴﻞ
Date: | DD | MM | YYYY | | | ﻳﻮم | ﺷﻬﺮ | ﺳﻨﺔ:اﻟﺘﺎرﻳﺦ
For Bank Use Only ﻻﺳﺘﻌﻤﺎل اﻟﻤﺼﺮف ﻓﻘﻂ
Branch: :اﻟﻔﺮع
Authorized Staff: :اﻟﻤﺨﻮل
ّ اﻟﻤﻮﻇﻒ
Signature: :اﻟﺘﻮﻗﻴﻊ
Date: | DD | MM | YYYY | | | ﻳﻮم | ﺷﻬﺮ | ﺳﻨﺔ:اﻟﺘﺎرﻳﺦ
Sharjah Islamic Bank is licensed by the Central Bank of the UAE. . ﻫﻮ ﺟﻬﺔ ﻣﺮﺧﺼﺔ ﻣﻦ ﻗﺒﻞ ﻣﺼﺮف اﻹﻣﺎرات اﻟﻤﺮﻛﺰي.ﻣﺼﺮف اﻟﺸﺎرﻗﺔ اﻹﺳﻼﻣﻲ
