UNIQUE CODE : A-MLTH-1-B-08-024 : ‫ﺍﻟﺮﻗﻢ ﺍﻟﺘﻌﺮﻳﻔﻲ‬

‫ﺟﺪﻭﻝ ﺍﻟﻮﺛﻴﻘﺔ ﺍﻟﻤﻮﺣﺪﺓ ﻟﻠﺘﺄﻣﻴﻦ ﺍﻹﻟﺰﺍﻣﻲ ﻋﻠﻰ ﺍﻟﻤﺮﻛﺒﺎﺕ‬

Schedule of the unified Compulsory Motor Insurance Policy
Policy No ‫ﺭﻗﻢ ﺍﻟﻮﺛﻴﻘﺔ‬Type of Insured ‫ﻧﻮﻉ ﺍﻟﻤﺆﻣﻦ ﻟﻪ‬

323969784 ‫ﺷﺨﺼﻲ‬

‫ﺑﻴﺎﻧﺎﺕ ﺍﻟﻤﺆﻣﻦ ﻟﻪ‬

Insured Information

Insured's ID No 2469702621 ‫ﺭﻗﻢ ﻫﻮﻳﺔ ﺍﻟﻤﺆﻣﻦ‬

Name of Insured ‫ﻓﻴﺸﻮﻧﺎﺛﻦ ﺟﻴﻴﺶ ﻓﻴﺸﻮﻧﺎﺛﻦ ﻛﺮﻳﺸﻨﺎ‬ ‫ﺍﺳﻢ ﺍﻟﻤﺆﻣﻦ‬
Phone & Mobile Number 0510532436 ‫ ﺍﻟﺠﻮﺍﻝ‬- ‫ﺭﻗﻢ ﺍﻟﻬﺎﺗﻒ‬
Building No 7849 ‫ﺭﻗﻢ ﺍﻟﻤﺒﻨﻰ‬
Street Name Street ‫ﺍﺳﻢ ﺍﻟﺸﺎﺭﻉ‬
National Address District ‫ﺣﻲ ﺛﻮﻝ‬ ‫ﺍﻟﺤﻲ‬ ‫ﺍﻟﻌﻨﻮﺍﻥ ﺍﻟﻮﻃﻨﻲ‬
City ‫ﺛﻮﺍﻝ‬ ‫ﺍﻟﻤﺪﻳﻨﺔ‬
Additional No 4661 ‫ﺍﻟﺮﻗﻢ ﺍﻻﺿﺎﻓﻲ‬
Postal Code 23953 ‫ﺻﻨﺪﻭﻕ ﺍﻟﺒﺮﻳﺪ‬
Country ‫ﺍﻟﻤﻤﻠﻜﺔ ﺍﻟﻌﺮﺑﻴﺔ ﺍﻟﺴﻌﻮﺩﻳﺔ‬ ‫ﺍﻟﺪﻭﻟﺔ‬

‫ﺑﻴﺎﻧﺎﺕ ﺍﻟﻤﺮﻛﺒﺔ‬
Vehicle Details
Owner's ID No 2469702621 ‫ﺭﻗﻢ ﻫﻮﻳﺔ ﺍﻟﻤﺎﻟﻚ‬
Owner's Name VISWANATHAN JAYESH VISWANATHAN KRISHNAN ‫ﺍﺳﻢ ﺍﻟﻤﺎﻟﻚ‬
Registration Plate No 4405 ‫ﺱ‬ ‫ﻕ‬ ‫ﺡ‬ ‫ﺭﻗﻢ ﺍﻟﻠﻮﺣﺔ‬
Chassis No MALAM51B6FM592279 ‫ﺭﻗﻢ ﺍﻟﻬﻴﻜﻞ‬
Vehicle Color ‫ﺭﺻﺎﺻﻲ‬ ‫ﺍﻟﻠﻮﻥ‬
Vehicle Registration Expiry Date 01/10/2023 ‫ﺗﺎﺭﻳﺦ ﺍﻧﺘﻬﺎﺀ ﺍﻻﺳﺘﻤﺎﺭﺓ‬
Type of Chassis ‫ﺳﻴﺪﺍﻥ‬ ‫ﻧﻮﻉ ﻫﻴﻜﻞ ﺍﻟﻤﺮﻛﺒﺔ‬
Sequence No 837869310 ‫ﺍﻟﺮﻗﻢ ﺍﻟﺘﺴﻠﺴﻠﻲ‬
Customs Card No ‫ﺭﻗﻢ ﺍﻟﺒﻄﺎﻗﺔ ﺍﻟﺠﻤﺮﻛﻴﺔ‬
Vehicle Make ‫ﻫﻮﻧﺪﺍﻱ‬ ‫ﻣﺎﺭﻛﺔ ﺍﻟﻤﺮﻛﺒﺔ‬
Vehicle Model I 20 ‫ﻃﺮﺍﺯ ﺍﻟﻤﺮﻛﺒﺔ‬
Year of Manufacture 2015 ‫ﺳﻨﺔ ﺍﻟﺘﺼﻨﻴﻊ‬
Purpose of use ‫ﺧﺎﺹ‬ ‫ﻏﺮﺽ ﺍﻹﺳﺘﻌﻤﺎﻝ‬
Type of Registration Plate ‫ﺳﻴﺎﺭﺓ ﺧﺎﺻﺔ‬ ‫ﻧﻮﻉ ﺗﺴﺠﻴﻞ ﺍﻟﻤﺮﻛﺒﺔ‬
Type of Insurance ‫ ﺿﺪ ﺍﻟﻐﻴﺮ‬-‫ﺍﻟﻤﺴﺆﻭﻟﻴﺔ ﺍﻟﻤﺪﻧﻴﺔ ﺗﺠﺎﻩ ﺍﻟﻐﻴﺮ‬ ‫ﻧﻮﻉ ﺍﻟﺘﻐﻄﻴﺔ‬
Names of authorized drivers under the age of 18 ‫ﺃﺳﻤﺎﺀ ﺍﻟﺴﺎﺋﻘﻴﻦ ﺍﻟﻤﺴﻣﻴﻦ ﺍﻟﺬﻳﻦ ﺗﻘﻞ ﺃﻋﻤﺎﺭﻫﻢ ﻋﻦ‬
(with driving licenses numbers) 18 ‫ﺳﻨﺔ‬
(‫)ﻣﻊ ﺭﻗﻢ ﺭﺧﺺ ﺍﻟﻘﻴﺎﺩﺓ ﺍﻟﺨﺎﺻﺔ ﺑﻬﻢ‬
Geographic borders On Saudi Arabia Territories ‫ﺩﺍﺧﻞ ﺣﺪﻭﺩ ﺍﻟﻤﻠﻜﺔ ﺍﻟﻌﺮﺑﻴﺔ ﺍﻟﺴﻌﻮﺩﻳﺔ‬ ‫ﺍﻟﻤﻨﻄﻘﺔ ﺍﻟﺠﻐﺮﺍﻓﻴﺔ‬
‫ﻳﺠﺐ ﻋﻠﻰ ﺍﻟﻤﺆﻣﻦ ﻟﻪ ﺍﻥ ﻻ ﻳﺴﺘﺨﺪﻡ ﺍﻟﻤﺮﻛﺒﺔ ﺇﻻ ﻟﻠﻐﺮﺽ ﺍﻟﻤﺮﺧﺼﺔ ﻣﻦ ﺃﺟﻠﻪ‬
Use Restrains The Insured should not use the vehicle for other than the ‫ﻗﻴﺪ ﺍﻻﺳﺘﻌﻤﺎﻝ‬
authorized purpose
Premium amount 952.48 ‫ﻣﺒﻠﻎ ﺍﻟﻘﺴﻂ‬
Policy issuance date FRIDAY 12-04-2024 1445-10-03 ‫ﺍﻟﺠﻤﻌﺔ‬ ‫ﺗﺎﺭﻳﺦ ﺍﺻﺪﺍﺭ ﺍﻟﻮﺛﻴﻘﺔ‬
Coverage Period From SUNDAY 21-04-2024 1445-10-12 ‫ﺍﻻﺣﺪ‬ ‫ﻣﻦ‬ ‫ﻓﺘﺮﺓ ﺍﻟﺘﻐﻄﻴﺔ‬
To SUNDAY 20-04-2025 1446-10-22 ‫ﺍﻻﺣﺪ‬ ‫ﺇﻟﻰ‬

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 ‫ﺍﻟﺘﻐﻄﻴﺔ ﺍﻷﺳﺎﺳﻴﺔ‬
Basic Coverage
‫ﻓﻲ ﺣﺎﻝ ﻭﻗﻮﻉ ﺣﺎﺩﺙ ﻳﺘﺮﺗﺐ ﻋﻠﻴﻪ ﺍﻟﺘﻌﻮﻳﺾ ﻟﻄﺮﻑ ﺛﺎﻟﺚ ﻭﻓﻘﺎ ﻷﺣﻜﺎﻡ ﻫﺬﻩ ﺍﻟﻮﺛﻴﻘﺔ ﻓﺈﻥ ﺍﻟﺤﺪ ﺍﻷﻗﺼﻰ ﻟﻤﺴﺆﻭﻟﻴﺔ ﺍﻟﺸﺮﻛﺔ ﻓﻲ ﺍﻟﻮﺍﻗﻌﺔ ﺍﻟﻮﺍﺣﺪﺓ ﻭﺧﻼﻝ ﻓﺘﺮﺓ ﺳﺮﻳﺎﻥ ﺍﻟﻮﺛﻴﻘﺔ ﺑﺎﻟﻨﺴﺒﺔ ﻟﻸﺿﺮﺍﺭ‬
‫)ﻋﺸﺮﺓ ﻣﻼﻳﻴﻦ ﺭﻳﺎﻝ ﺳﻌﻮﺩﻱ( ﻛﺤﺪ ﺃﻗﺼﻰ ﻟﻤﺴﺆﻭﻟﻴﺔ ﺍﻟﺸﺮﻛﺔ ﻭﻓﻖ ﺍﻟﻤﻠﺤﻖ‬10,000,000 ‫ﺃ" ﺍﻟﻤﺮﻓﻖ ﻓﻲ" ﺍﻟﺠﺴﺪﻳﺔ ﻭﺍﻷﺿﺮﺍﺭ ﺍﻟﻤﺎﺩﻳﺔ ﻭﺍﻟﻤﺼﺎﺭﻳﻒ ﻣﻌﺎ ﻟﻦ ﺗﺘﺠﺎﻭﺯ ﻣﺒﻠﻐﺎ ﺇﺟﻤﺎﻟﻴﺎ ﻗﺪﺭﻩ‬
‫ﻧﺺ ﺍﻟﻮﺛﻴﻘﺔ‬
Third Party ‫ﺍﻟﻤﺴﺆﻭﻟﻴﺔ ﺗﺠﺎﻩ ﺍﻟﻐﻴﺮ‬
Liability In the event of an accident occuring and resulting in indemnifying the Third Party in accordance with the provisions if this Policy,
the maximum limit of the Insurer's liability for one event and during the lifetime of the Policy for physical damage, expenses and
material damages shall not exceed together a total sum of SAR 10,000,000 (ten million Saudi Riyals) as a maximum liability
limit for coverage. Based on the appendix (A) attached to the Policy Wording.

‫ﺍﻟﻤﻨﺎﻓﻊ ﺍﻹﺿﺎﻓﻴﺔ‬
Additional Extensions

Death and physical injuries and Medical expenses for the Insured or Named ‫ﻟﻢ ﺗﺘﻢ ﺍﻹﺿﺎﻓﺔ‬ ‫ﺍﻟﻮﻓﺎﺓ ﻭﺍﻹﺻﺎﺑﺔ ﺍﻟﺠﺴﺪﻳﺔ ﻭﺍﻟﻤﺼﺎﺭﻳﻒ ﺍﻟﻄﺒﻴﺔ ﻟﻠﻤﺆﻣﻦ ﻟﻪ ﺃﻭ ﺍﻟﺴﺎﺋﻖ ﺍﻟﻤﺴﻤﻰ‬
Driver
Other Requested Material Facts by the Company ‫ﺍﻟﺤﻘﺎﺋﻖ ﺍﻟﺠﻮﻫﺮﻳﺔ ﺍﻷﺧﺮﻯ ﺍﻟﺘﻲ ﺗﻄﻠﺒﻬﺎ ﺍﻟﺸﺮﻛﺔ‬

12/04/2024 ‫ﺗﺎﺭﻳﺦ ﺇﺻﺪﺍﺭ ﺍﻟﺘﻘﺮﻳﺮ‬

‫ﻧﻴﺎﺑﺔ ﻋﻦ ﺷﺮﻛﺔ ﻣﻼﺫ ﻟﻠﺘﺄﻣﻴﻦ‬

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