ﻣ ﺮ ﻛ ﺒ ﺎ ت ﺗ أ ﻣ ﯿ ﻦ ﺷ ﮫ ﺎ د ة Mo To R Insurance Certificate
ﻣ ﺮ ﻛ ﺒ ﺎ ت ﺗ أ ﻣ ﯿ ﻦ ﺷ ﮫ ﺎ د ة Mo To R Insurance Certificate
ﻣ ﺮ ﻛ ﺒ ﺎ ت ﺗ أ ﻣ ﯿ ﻦ ﺷ ﮫ ﺎ د ة Mo To R Insurance Certificate
ﺑﯿ ﺎﻧ ﺎ ت اﻟﻤﺆﻣﻦ ﻟ ه
Insured Details
1021199425 ر ﻗ ﻢ ھﻮﻳﺔ اﻟﻮطﻨﯿﺔ /ا ﻹ ﻗﺎ ﻣﺔ اﻹﺳ ﻢ
Saudi ID / Iqama Number ﺳﻠﯿﻤ ﺎن ﻣﺼﻠﺢ ﺻ ﺎﻟﺢ اﻟ ﻌﻮﻓ ﻲ Name
ا ﻷ ﻣﯿ ﺮ ﻣ ﺸ ﻌﺎن -اﻟﻨﺨﯿﻞ 4866 - -42670 اﻟ ﻌﻨﻮ ان اﻟ ﺮ ﻗ ﻢ اﻟ ﻀ ﺮﻳﺒﻲ ﻟﻠ ﻌ ﻤﯿﻞ
8644 Address Insured VAT No.
42670 ﻋﻨﻮ ان ﺑ ﺮﻳﺪ و ا ﺻﻞ /اﻟ ﻌﻨﻮ ان اﻟﺒ ﺮﻳﺪ ي Kingdom of Saudi Arabia اﻟﺠﻨ ﺴﯿﺔ
Wasel Address / P.O. Box اﻟ ﻤ ﻤﻠﻜﺔ اﻟ ﻌ ﺮﺑﯿﺔ اﻟ ﺴ ﻌﻮدﻳﺔ Nationality
0550462996 /ھ اﺗﻒ اﻟ ﻤﻨ ﺰل /ﺟﻮ ال اﻟ ﻌ ﻤﻞ أﺧ ﺮ ى اﻟ ﻤﮫﻨﺔ
Home/Work/Mobile No Occupation
01-07-1380 /62 ﺗﺎرﻳ ﺦ اﻟ ﻤﯿ ﻼد /اﻟ ﻌ ﻤ ﺮ
Date of Birth / Age
ﺑﯿ ﺎﻧ ﺎ ت اﻟﻤﺮ ﻛﺒﺔ اﻟﻤﺆﻣﻨﺔ
Insured Vehicle Details
22/04/1442 ﺗﺎرﻳ ﺦ إﻧﺘﮫﺎء رﺧ ﺼﺔ اﻟ ﺴﯿ ﺮ ﺗﻮﻳﻮﺗﺎ ﻣﺎرﻛﺔ اﻟ ﻤ ﺮﻛﺒﺔ
Registration Expiry Date Vehicle Brand
RKLBB9HE1F5057488 ر ﻗ ﻢ اﻟﮫﯿﻜﻞ ﻛ ﻮر و ﻻ ﻃ ﺮ از اﻟ ﻤ ﺮﻛﺒﺔ
C hassis Number Vehicle Model
ح ق ع 4594 ر ﻗ ﻢ اﻟﻠﻮﺣﺔ اﺑ ﯿ ﺾ ﻟﻮن اﻟ ﻤ ﺮﻛﺒﺔ
Plate No. Vehicle C olor
941850410 اﻟ ﺮ ﻗ ﻢ اﻟﺘ ﺴﻠ ﺴﻠﻲ 2015 ﺳﻨﺔ اﻟ ﺼﻨﻊ
Sequence No. Manufacture Year
ر ﻗ ﻢ اﻟﺒ ﻄﺎ ﻗﺔ اﻟﺠ ﻤ ﺮﻛﯿﺔ ﺳﯿﺎرة ﺻ ﻐﯿ ﺮة 4ﺑﺎب ﻧﻮ ع ھﯿﻜﻞ اﻟ ﻤ ﺮﻛﺒﺔ
C ustom C ard No. Vehicle Body Type
29100 ﻗﯿ ﻤﺔ اﻟ ﻤ ﺮﻛﺒﺔ ﺷﺨ ﺼﻲ ﻏ ﺮ ض ا ﻹ ﺳﺘﺨﺪ ا م
Vehicle Sum Insured Type of Use
ﺳﯿﺎرة ﺧﺎ ﺻﺔ ﻧﻮ ع ﺗ ﺴﺠﯿﻞ اﻟ ﻤ ﺮﻛﺒﺔ
Type of Registration
ﻓﺘﺮ ة اﻟﺘ ﻐﻄﯿﺔ
Insurance Period
04/03/2021 ﺗﺎرﻳ ﺦ و و ﻗﺖ ا ﻹ ﺻﺪ ار
ﻧﻮ ع اﻟﻮﺛﯿ ﻘﺔ Issue Date and Time
ﺿﺪ اﻟ ﻐﯿ ﺮ Policy Type
Tameeni اﻟ ﻔ ﺮ ع
Branch
ﻓ ﺮد Individual - ﻧﻮ ع اﻟ ﻤﺆ ﻣﻦ ﻟﻪ
05/03/2021 ﺗﺎرﻳ ﺦ /و ﻗﺖ ﺑﺪ اﻳﺔ وﻧﮫﺎﻳﺔ اﻟﺘ ﻐ ﻄﯿﺔ اﻟﺘﺄ ﻣﯿﻨﯿﺔ Insured Type
04/03/2022 Date\time cover start and End
602000251720 ر ﻗ ﻢ اﻟﻮﺛﯿ ﻘﺔ
Policy Number
اﻟﺘﺤ ﻤﻞ ﻟﻜﻞ ﺣﺎدث )ﻟﻮﺛﺎﺋ ﻖ اﻟﺘﺄ ﻣﯿﻦ ( TPL ﻧﻮ ع اﻟﺘ ﻐ ﻄﯿﺔ
اﻟ ﺸﺎ ﻣﻞ ﻓ ﻘ ﻂ C over Type
Deductible- C omp. Policy Only ﻧﻮ ع ا ﻹ ﺻ ﻼ ح )ﻟﻮﺛﺎﺋ ﻖ اﻟﺘﺄ ﻣﯿﻦ اﻟ ﺸﺎ ﻣﻞ ﻓ ﻘ ﻂ(
Repair Type - C omp. Policy Only
ﺑﯿ ﺎﻧ ﺎ ت اﻟ ﺴ ﺎﺋ ﻖ اﻹﺿ ﺎﻓ ﻲ
Additional Driver Details
ﺗﺎرﻳ ﺦ اﻟ ﻤﯿ ﻼد /اﻟ ﻌ ﻤ ﺮ إ ﺳ ﻢ اﻟ ﺴﺎﺋ ﻖ
Date of Birth / Age Driver Name
ﻧﻮ ع اﻟ ﺮﺧ ﺼﺔ ر ﻗ ﻢ ھﻮﻳﺔ اﻟ ﺴﺎﺋ ﻖ
License Type Additional Driver ID
ﺷ ﮫﺎ د ة ﺗ أ ﻣ ﯿ ﻦ ﻣ ﺮ ﻛ ﺒﺎ ت
MOTOR INSURANCE CERTIFICATE
ﻓﻰ ﺣﺎل و ﻗﻮ ع ﺣﺎدث ﻳﺘ ﺮﺗﺐ ﻋﻠﯿﻪ د ﻓﻊ ﺗ ﻌﻮﻳ ﺾ و ﻓ ﻘﺎ ﻷﺣﻜﺎ م ھﺬه اﻟﻮﺛﯿ ﻘﺔ ﻓﺈن اﻟﺤﺪ ا ﻻ ﻗ ﺼﻰ ﻟ ﻤ ﺴﺆ وﻟﯿﺔ اﻟ ﺸ ﺮﻛﺔ ﻓﻰ اﻟﻮ ا ﻗ ﻌﺔ اﻟﻮ اﺣﺪة وﺧ ﻼل ﻓﺘ ﺮة ﺳ ﺮﻳﺎن وﺛﯿ ﻘﺔ اﻟﺘﺄ ﻣﯿﻦ ﺑﺎﻟﻨ ﺴﺒﺔ ﻟ ﻸ ﺿ ﺮ ار
﷼ ) ﻋ ﺸ ﺮة ﻣ ﻼﻳﯿﻦ ﷼ ﺳ ﻌﻮد ى( ﺣﺪ ا10,000,000 اﻟ ﻤ ﻘﺪرة ﻋﻦ ا ﻻ ﺻﺎﺑﺎت و اﻟ ﻤ ﺼﺎرﻳﻒ اﻟ ﻄﺒﯿﺔ( و ا ﻻ ﺿ ﺮ ار اﻟ ﻤﺎدﻳﺔ ﻣ ﻌﺎ ﻟﻦ ﺗﺘﺠﺎ وز ﻣﺒﻠ ﻐﺎ إﺟ ﻤﺎﻟﯿﺎ ﻗﺪره. اﻟﺠ ﺴﺪﻳﺔ )ﺑ ﻤﺎ ﻓﻰ ذﻟ ﻚ اﻟﺪﻳﺎت و اﻟ ﻤﺒﺎﻟﻎ
أ ﻗ ﺼﻰ ﻟ ﻤ ﺴﺌﻮﻟﯿﺔ اﻟ ﺸ ﺮﻛﺔ
In the event of the occurance of an accident resulting in the payment of indemnity in accordance with the provisions of this policy, the maximum
limit of the company's liability for one event for both physical damage (including blood money, bodily injuries damages and medical expenses)
and material damages, shall not exceed together a total sum of SR 10,000,000(ten million Saudi riyals) as a coverage liability limit.
اﻟ ﺸﺮوط
Conditions
ﺗ ﻘ ﺮﻳ ﺮ اﻟ ﻤ ﺮ ور و ور ﻗﺔ ا ﻹ ﺻ ﻼ ح إﻟ ﺰ ا ﻣﯿﺔ ﻟ ﻘﺒﻮل اﻟ ﻤ ﻄﺎﻟﺒﺔ ﻋﺎ ﻣﺎً ھﺠ ﺮﻳﺎً ﻣﺎ ﻟ ﻢ ﻳﻜﻦ ھﻮ اﻟ ﻤﺆ ﻣﻦ ﻟﻪ و ﻣﺎ ﻟ ﻢ ﻳ ﺮد18 ﻗﯿﺎدة أ ي ﺷﺨ ﺺ ﻳ ﻘﻞ ﻋ ﻤ ﺮه ﻋﻦ
Police report and repair permission is essential for any claims to ﺳﻨﺔ ﻓﻲ ﺟﺪ ول18 إ ﺳ ﻤﻪ ﺿ ﻤﻦ أ ﺳ ﻤﺎء اﻟ ﺴﺎﺋ ﻘﯿﻦ اﻟ ﻤ ﺴ ﻤﯿﻦ اﻟﺬﻳﻦ ﺗ ﻘﻞ أ ﻋ ﻤﺎر ھ ﻢ ﻋﻦ
settle. . اﻟﻮﺛﯿ ﻘﺔ
Exclude Drivers below 18 years (by the Hijiri Date) unless he is the
insured or mentioned in Policy schedule as additional driver under 18
years.
ﺗ ﻘﻮ م ﺷﮫﺎدة اﻟﺘﺄ ﻣﯿﻦ ھﺬه ﺑ ﻤ ﻘﺎ م ﺳﻨﺪ ﺳﺪ اد ﻣﺒﻠﻎ اﻟ ﻘ ﺴ ﻂ اﻟ ﻤ ﺴﺘﺤ ﻖ و اﻟ ﻤﺬﻛﻮر أ ﻋ ﻼه ﻓﻲ ﺣﺎل ﻋﺪ م وﺟﻮد اﻟ ﺴ ﻌ ﺮ ﻋﻠﻰ اﻟﻮﺛﯿ ﻘﺔ ر ﻗ ﻤﺎ وﻛﺘﺎﺑﺘﺔ ﻧ ﺮﺟﻮ ﻣﻨﻜ ﻢ اﻟﺘﻮ ا ﺻﻞ ﻣ ﻌﻨﺎ ﻋﻠﻰ
This certificate is considered as Payment receipt of the above ٩٢٠٠٢٣٣٥٥ اﻟ ﺮ ﻗ ﻢ
mentioned premium In case the Premium is not mentioned on the certificate in digits and
words please contact us on 920023355
ﺗ ﻌﺘﺒ ﺮ ﺷﮫﺎدة اﻟﺘﺄ ﻣﯿﻦ ھﺬه ﺟ ﺰء ﻻ ﻳﺘﺠ ﺰ أ ﻣﻦ اﻟﻮﺛﯿ ﻘﺔ اﻟ ﻤﻮﺣﺪة ﻟﻠﺘﺄ ﻣﯿﻦ ا ﻹﻟ ﺰ ا ﻣﻲ ﻋﻠﻰ ﺳﺎ ﻋﺔ ﻣﻦ ﺗﺎرﻳ ﺦ و و ﻗﺖ إ ﺻﺪ ار اﻟﺘﺄ ﻣﯿﻦ أ و ﻣﻦ اﻟﺘﺎرﻳ ﺦ اﻟ ﻤﺤﺪد ﻣﻦ24 ﺗ ﺴ ﺮ ي اﻟﺘ ﻐ ﻄﯿﺔ ﺑ ﻌﺪ
اﻟ ﻤ ﺮﻛﺒﺎت . ﻗﺒﻞ اﻟ ﻌ ﻤﯿﻞ ﻋﻨﺪ إ ﺻﺪ ار اﻟﻮﺛﯿ ﻘﺔ وﻟﻦ ﻳﺘ ﻢ ﻗﺒﻮل أ ي ﻣ ﻄﺎﻟﺒﺔ ﻗﺒﻞ ﺗﺎرﻳ ﺦ و و ﻗﺖ اﻟ ﺴ ﺮﻳﺎن
This C ertificate is a part of the Unified C ompulsory Motor Insurance C over effective date is after 24 Hours from Issuance Date and Time
Policy or as per the date selected by the insured at issuance and no claim
will be entertained before the inception.
ﻋﻨﺪ اﺧﺘ ﻼ ف اﻟﻨ ﺺ ﺑﯿﻦ اﻟﻠ ﻐﺘﯿﻦ ﻳ ﻌﺘ ﻤﺪ اﻟﻨ ﺺ ﺑﺎﻟﻠ ﻐﺔ اﻟ ﻌ ﺮﺑﯿﺔ. ﻻ ﻳﺘ ﻢ إرﺟﺎ ع أ ي ﻣﺒﺎﻟﻎ ﻣﺎﻟﯿﺔ ﻓﻲ ﺣﺎل ﺗ ﻘﺪﻳ ﻢ طﻠﺐ إﻟ ﻐﺎء ﻟ ﻤ ﺮﻛﺒﺔ ﺗﻮﺟﺪ ﻋﻠﯿﮫﺎ ﻣ ﻄﺎﻟﺒﺎت ﻓﻲ
In the event of discrepancy, the Arabic text prevails the English. ﺣﺎل ﺗﺠﺎ وزت ﻗﯿ ﻤﺔ اﻟ ﻤ ﻄﺎﻟﺒﺔ ﻗﯿ ﻤﺔ اﻟ ﻤﺒﻠﻎ اﻟ ﻤ ﺴﺘ ﺮد
No refund for deletion of vehicle on which claim has been reported in
case amout is higher than the refund amount
ﻳ ﻤﻜﻨ ﻚ زﻳﺎرة اﻟ ﻤﻮ ﻗﻊ ا ﻹﻟﻜﺘ ﺮ وﻧﻲ ﻟ ﺸ ﺮﻛﺔ ﺳ ﻼ ﻣﺔ ﻟﻠﺘﺄ ﻣﯿﻦ اﻟﺘ ﻌﺎ وﻧﻲ ﻟ ﻺط ﻼ ع ﻋﻠﻰ اﻟ ﺼﯿﺎ ﻏﺔ ﺗ ﻐﯿﯿ ﺮ ﺑﯿﺎﻧﺎﺗﻪ/ﺗ ﻌﺪﻳﻠﮫﺎ/ﺗ ﻌﺘﺒ ﺮ ھﺬه اﻟ ﺸﮫﺎدة ﻻ ﻏﯿﺔ ﻓﻲ ﺣﺎل ﺗ ﻢ ﺷ ﻄﺒﮫﺎ
اﻟﻜﺎ ﻣﻠﺔ ﻟﻠﻮﺛﯿ ﻘﺔ اﻟﺘﺄ ﻣﯿﻦ This certificate deemed Null and void in case of written
You May visit Salama Insurance C o. web site to view the C omplete off/Modified/C hange.
Policy wording
أ و ﻣ ﺮﻛﺒﺎت/ أ و ا ﻹﻳﺠﺎر اﻟﯿﻮ ﻣﻲ و/ﺟ ﻤﯿﻊ اﻟ ﻤ ﺮﻛﺒﺎت اﻟ ﻤ ﺴﺘﺨﺪ ﻣﺔ أ و ﻣ ﺴﺠﻠﺔ ﻓﻲ اﻟﻨ ﻘﻞ اﻟ ﻌﺎ م و وﺟﻮد رﺧ ﺼﺔ ﻗﯿﺎدة ﺳﺎرﻳﺔ ﻋﻨﺪ ﻗﯿﺎدة اﻟ ﻤ ﺮﻛﺒﺔ اﻟ ﻤﺆ ﻣﻨﺔ أ و و ﻗﻮ ع ﻣ ﻄﺎﻟﺒﺔ
أﺟ ﺮة ﻣ ﺴﺘﺜﻨﺎة ﻣﻦ اﻟﺘ ﻐ ﻄﯿﺔ وﻟﻦ ﻳﺘ ﻢ ﻗﺒﻮل أ ي ﻣ ﻄﺎﻟﺒﺔ ﻣﺘ ﺼﻠﺔ ﻣﻊ ا ﻷﻧﻮ ا ع اﻟﻨ ﻘﻞ اﻟ ﻤﺬﻛﻮرة. Valid Driving License at time of driving or claim is a must
أ ﻋ ﻼه
All Vehicles used in general transportation or Rent A C ar or
Limousines are excluded from the cover and no claim will be
entertained related to this type of vehicles
ﺗ ﻄﺒ ﻖ ﺷ ﺮ وط و إ ﺳﺘﺜﻨﺎء ات اﻟﻮﺛﯿ ﻘﺔ اﻟ ﻤﻮﺣﺪة ﻟﺘﺄ ﻣﯿﻦ اﻟ ﻤ ﺮﻛﺒﺎت ا ﻹﻟ ﺰ ا ﻣﻲ ﻋﻠﻰ طﻠﺒﺎت ا ﻹﻟ ﻐﺎء.
Policy C ancellation terms/conditions as per the Unified C ompulsory
Motor Insurance
This Policy cover any loss or damage not excluded, for the ھﺬه اﻟﻮﺛﯿ ﻘﺔ ﺗ ﻐ ﻄﻲ أ ي ﺣﺎدث أ و ﺿ ﺮر ﻏﯿ ﺮ ﻣ ﺴﺘﺜﻨﻰ ﻟﻠ ﻤﺆ ﻣﻦ ﻟﻪ أ و اﻟ ﺴﺎﺋ ﻖ اﻟ ﻤ ﺴ ﻤﻰ
Policyholder and/or Named driver (additional) mentioned in the policy وﺗ ﻘﯿﺪ اﻟ ﻤ ﻄﺎﻟﺒﺔ,) ا ﺿﺎ ﻓﻲ( ﻛ ﻤﺎ ھﻮ ﻣﺬﻛﻮر ﻓﻲ ﺟﺪ ول اﻟﻮﺛﯿ ﻘﺔ ﻓ ﻘ ﻂ ﻋﻦ و ﻗﻮ ع اﻟﺤﺎدث
schedule only, and exclude from the cover if an unnamed driver was اﻟﺘﺄ ﻣﯿﻨﯿﺔ ﻋﻠﻰ ﺳﺠﻞ وﻳ ﺴﺘﺜﻨﻰ ﻏﯿ ﺮ ذﻟ ﻚ ﻣﻦ اﻟﺘ ﻐ ﻄﯿﺔ ﻓﻲ ﺣﺎل ﻛﺎن اﻟ ﺴﺎﺋ ﻖ ﻏﯿ ﺮ ﻣ ﺴ ﻤﻰ
responsible of the accident and register the claim on the policyholder ﻣ ﺴﺆ و ﻻ اﻟ ﻤﺆ ﻣﻦ ﻟﻪ وﻟﯿﺲ ﻋﻠﻰ ﺳﺠﻞ اﻟ ﺴﺎﺋ ﻖ اﻟ ﻐﯿ ﺮ ﻣ ﺴ ﻤﻰ ﻣ ﻤﺎ ﻳﺆﺛ ﺮ ﻋﻠﻰ إ ﺳﺘﺤ ﻘﺎ ﻗﻪ
record which may will affect his NC D ﻟﺨ ﺼ ﻢ ﻋﺪ م وﺟﻮد ﻣ ﻄﺎﻟﺒﺎت
Salam a Tower 12th Floor Madina Rd P.O Box 4020, custom er.care@salam a.com .sa 4020 – طﺮﻳﻖ اﻟﻤﺪﻳ ﻨﺔ ص ب12 اﻟﺮﺋ ﯿ ﺴﻲ ﺑﺮج ﺳﻼﻣﺔ – اﻟﻄﺎﺑﻖ
Jeddah 21491, Saudi Arabia www.salam a.com .sa اﻟﻤﻤ ﻠﻜﺔ اﻟﻌﺮﺑ ﯿﺔ اﻟ ﺴﻌﻮ دﻳﺔ, ﺟﺪة
T +966(12) 684 5666 @salam acic +966 (12) 684 5666 : ھﺎﺗﻒ
T +966(12) 6970470 salam acic +966 (12) 6970470 ﻓﺎﻛﺲ
Unified No 920023355 920023355 اﻟﺮﻗﻢ اﻟﻤﻮ ﺣﺪ