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S.N. Policy Number Employee No. Cover Make Type Plate No. Model year Chassis Number No.

Chassis Number No. of Passengers P.A Driver Agency Repair (Y/N) Sum Insured (SR) Sequence No. Custom No. Vehicle Owner ID Owner Name Vehicle User ID Vehicle User Name Saudi-Y/N Insured Age Veh_Area Building No. Additional No. Street Name City Unit No. PO Box No. POSTAL Code ZIP Code Neighborhood Address Identifier Owner Mobile No. Country of Nationality Gregorian Owner DOB Hijri Istimara Expiry Date Vehicle Color Effective Date Remarks Email Address Division
THUWAL
1 13704 DRIVER 2008 2008 2008 2008 JHMFD16248S406715 5 1 N 0.00 2343581092 IRFAN HASHIM 2343581092 IRFAN HASHIM N 35 THUWAL CAMP MEDINAH HIGHWA THUWAL KAUST 542578949 PAKISTAN 1439/08/29 WHITE 10/26/2017 NEW
JEDDAH
IRFANH@NESMA.COM CSD
day/month/year year/month/day

NOTE: PLEASE FILL IN ALL BOXES WITH REQUIRED INFORMATION

BELOW IS A SAMPLE FORMAT


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