‫ﺷﻬﺎﺩﺓ ﺗﺎﻣﻴﻦ ﺍﻟﻤﺴﺆﻭﻟﻴﺔ ﺗﺠﺎﻩ ﺍﻟﻄﺮﻑ ﺍﻟﺜﺎﻟﺚ ﺍﻟﻨﺎﺗﺠﺔ ﻋﻦ ﺍﻟﺤﻮﺍﺩﺙ ﺍﻟﻤﺮﻭﺭﻳﺔ‬

‫ﺗﺸﻬﺪ ﺷﺮﻛﺔ ﺍﺗﺤﺎﺩ ﺍﻟﺨﻠﻴﺞ ﻟﻠﺘﺎﻣﻴﻦ ﺍﻟﺘﻌﺎﻭﻧﻲ ﺑﺎﻥ ﺍﻟﺴﻴﺎﺭﺓ ﺍﻟﻤﺬﻛﻮﺭﺓ ﺑﻴﺎﻧﺎﺗﻬﺎ ﺍﺩﻧﺎﻩ ﻣﺆﻣﻨﺔ ﻟﺪﻳﻬﺎ ﺿﺪ‬
‫ﺍﻟﻤﺴﺆﻭﻟﻴﺔ ﺍﻟﻤﺪﻧﻴﺔ ﺗﺠﺎﻩ ﺍﻟﻄﺮﻑ ﺍﻟﺜﺎﻟﺚ‬

‫‪P/916/2903/19/034125‬‬ ‫ﺭﻗﻢ ﺍﻟﻮﺛﻴﻘﺔ‬

‫‪P/916/2903/19/034125‬‬ ‫ﺭﻗﻢ ﺍﻟﻤﻠﺤﻖ‬
‫ﻋﻠﻲ ﺟﻮﻳﻌﺪ ﺍﻝ ﻣﺨﻠﺺ‬
‫ﺍﺳﻢ ﺍﻟﻤﺴﺘﺨﺪﻡ‬
‫ﻋﻠﻲ ﺟﻮﻳﻌﺪ ﺍﻝ ﻣﺨﻠﺺ‬ ‫ﺍﺳﻢ ﺍﻟﻤﺆﻣﻦ ﻟﻪ‬

‫‪30-JAN-20‬‬ ‫ﺍﻟﻲ‬ ‫‪31-JAN-19‬‬ ‫ﺗﺒﺪﺀ ﻣﻦ‬ ‫ﻣﺪﺓ ﺍﻟﺘﺎﻣﻴﻦ‬

‫‪Isuzu Truck Heavy Commercial‬‬ ‫ﻧﻮﻉ ﺍﻟﺴﻴﺎﺭﺓ‬

‫‪9405 A R A‬‬ ‫ﺃ ﺭ ﺃ ‪9405‬‬ ‫ﺭﻗﻢ ﺍﻟﻠﻮﺣﺔ‬
‫‪JALK6A13477100690‬‬ ‫ﺍﻟﺸﺎﺳﻴﻪ‬
‫‪2007‬‬
‫ﺳﻨﺔ ﺍﻟﺼﻨﻊ‬
‫ﺭﻳﺎﻝ ﻟﻼﺿﺮﺍﺭ ﺍﻟﺠﺴﺪﻳﺔ ﻭﺍﻟﻤﺎﺩﻳﺔ ﻻﻳﺔ ﻭﺍﻗﻌﺔ ﻭﺍﺣﺪﻩ ﻭﻓﻰ ﺍﻻﺟﻤﺎﻟﻲ ﺧﻼﻝ ﻓﺘﺮﺓ ﺍﻟﺘﺎﻣﻴﻦ‬
‫‪10000000‬‬ ‫ﺣﺪﻭﺩ ﻣﺴﺆﻭﻟﻴﺔ‬
‫ﺍﻟﻄﺮﻑ ﺍﻟﺜﺎﻟﺚ‬

‫‪Important Notes‬‬ ‫ﻣﻼﺣﻈﺎﺕ ﻫﺎﻣﺔ ‪:‬‬

‫‪Please make sure that the personal data contained‬‬ ‫ﻧﻈﺮﺍ ﻷﻫﻤﻴﺔ ﺍﻟﺒﻴﺎﻧﺎﺕ ﺍﻟﺸﺨﺼﻴﺔ ﺍﻟﻮﺍﺭﺩﺓ ﻓﻲ ﻫﺬﻩ ﺍﻟﺸﻬﺎﺩﺓ ﺍﻟﺮﺟﺎﺀ‬
‫‪in the policy is correct and notify the company‬‬ ‫ﺍﻟﺘﺄﻛﺪ ﻣﻨﻬﺎ ﻭﺇﺷﻌﺎﺭ ﺍﻟﺸﺮﻛﺔ ﻓﻲ ﺣﺎﻝ ﻭﺟﻮﺩ ﺃﻱ ﺇﺧﺘﻼﻑ ﻟﺘﺼﺤﻴﺤﻬﺎ‬
‫‪should you need any corrections.‬‬

‫‪To Contacts 920029926‬‬ ‫ﻟﻠﺘﻮﺍﺻﻞ‬

‫& ‪This certificate is subject to the terms & conditions‬‬ ‫ﺗﺨﻀﻊ ﻫﺬﻩ ﺍﻟﺸﻬﺎﺩﺓ ﻟﻠﺸﺮﻭﻁ ﻭﺍﻷﺣﻜﺎﻡ ﻭﺍﻹﺳﺘﺜﻨﺎﺀﺍﺕ ﺍﻟﻌﺎﻣﺔ ﻭﺍﻟﺤﺪﻭﺩ‬
‫‪the general exceptions & limitations set forth as‬‬ ‫ﺍﻟﻤﻨﺼﻮﺹ ﻋﻠﻴﻬﺎ ﺑﺎﻟﻮﺛﻴﻘﺔ ﺍﻟﻤﻮﺣﺪﺓ ﻟﻤﻮﺳﺴﺔ ﺍﻟﻨﻘﺪ ﺍﻟﻌﺮﺑﻲ ﺍﻟﺴﻌﻮﺩﻱ‬
‫‪printed on the back of the SAMA (The Unified‬‬ ‫ﻭﺍﻟﻤﺮﻓﻘﺔ ‪ .‬ﻣﻊ ﺍﻟﺸﻬﺎﺩﺓ ﻭﺟﺪﻭﻝ ﺍﻟﻮﺛﻴﻘﺔ‬
‫‪Compulsory Motor Insurance Policy) and policy sched‬‬

‫‪920000560‬‬
‫‪Coverage Insurance of the Company attaches‬‬
‫ﺍﻟﺘﻐﻄﻴﺔ ﺍﻟﺘﺄﻣﻴﻨﻴﺔ ﺗﺒﺪﺍ ﻣﻦ ) ﺍﻟﻴﻮﻡ ﺍﻟﺘﺎﻟﻲ ( ﻣﻦ ﺗﺎﺭﻳﺦ ﺍﻻﺻﺪﺍ‬
‫‪next days from the Issue date.‬‬

‫‪In case of Accident call the above number, and‬‬ ‫ﻓﻲ ﺣﺎﻝ ﻭﻗﻮﻉ ﺣﺎﺩﺙ ﻣﺮﻭﺭﻱ ﻳﺮﺟﻰ ﺍﻹﺗﺼﺎﻝ ﻋﻠﻰ ﺍﻟﺮﻗﻢ ﺃﻋﻼﻩ ﻣﻊ‬
‫‪provide all data and information to the‬‬ ‫ﺍﻹﻟﺘﺰﺍﻡ ﺑﺘﻘﺪﻳﻢ ﺟﻤﻴﻊ ﺍﻟﺒﻴﺎﻧﺎﺕ ﻭﺍﻟﻤﻌﻠﻮﻣﺎﺕ ﻋﻨﺪ ﺗﻘﺪﻳﻢ ﺍﻟﺒﻼﻍ ﻫﺎﺗﻔﻴﺎ‬
‫‪investigating officer‬‬ ‫ﻟﻤﺤﻘﻖ ﺍﻟﺤﻮﺍﺩﺙ‬

‫ﺍﻟﺨﺘﻢ‬ ‫ﺍﻟﺘﻮﻗﻴﻊ‬