MOTOR TAKAFUL POLICY SCHEDULE

Policy details ‫ﺗﻔﺎﺻﻴﻞ ﺍﻟﻮﺛﻴﻘﺔ‬

Contribution details RO ‫ﺑﻴﺎﻧﺎﺕ ﺍﻻﺷﺘﺮﺍﻙ‬
Policy No : P/100/1002/2022/00507 : ‫ﺭﻗﻢ ﺍﻟﻮﺛﻴﻘﺔ‬
Premium / Basic 95.000 ‫ ﺍﻻﺷﺘﺮﺍﻙ ﺍﻻﺳﺎﺱ‬/ ‫ﺍﻟﻘﺴﻂ‬
Issuing Location : Head Office : ‫ﺟﻬﺔ ﺍﻻﺻﺪﺍﺭ‬
Contribution
Policy Issue Date/Time : 21/03/2022 14:05:00 : ‫ﺗﺎﺭﻳﺦ ﺍﺻﺪﺍﺭ ﺍﻟﻮﺛﻴﻘﺔ ﻭﺍﻟﻮﻗﺖ‬ Personal Accident 0.000 ‫ﻣﻠﺤﻖ ﺍﻟﺤﻮﺍﺩﺙ ﺍﻟﺸﺨﺼﻴﺔ‬
Period of Insurance : From 31/03/2022 00:00 : ‫ﻣﻦ‬ ‫ﻓﺘﺮﺓ ﺍﻟﺘﺄﻣﻴﻦ‬ Addendum
To 30/03/2023 23:59 ‫ﺍﻟﻰ‬ Medical Expenses per 3.000 ‫ﻣﺼﺎﺭﻳﻒ ﺍﻟﻌﻼﺝ ﻟﻜﻞ ﻣﺮﻛﺒﺔ‬
Name of the Participant : SIDDHARTHA VENGA : ‫ﺍﺳﻢ ﺍﻟﻤﺸﺘﺮﻙ‬ vehicle
SARAVANAN Additional benifits (if any) 0.000 ‫ﺍﻟﻤﺰﺍﻳﺎ ﺍﻻﺿﺎﻓﻴﺔ ﺃﻥ ﻭﺟﺪﺓ‬
Mortgaged by (if any) : - : ‫ﺍﻟﺮﻫﻦ ﺍﻥ ﻭﺟﺪ‬ ‫ﺍﺟﻤﺎﻟﻲ ﺍﻻﺷﺘﺮﺍﻙ‬
Total Insurance 98.000
Address : Oman : ‫ﺍﻟﻌﻨﻮﺍﻥ‬ Contribution
Muscat
Net Insurance 98.000 ‫ﺻﺎﻓﻲ ﺍﺷﺘﺮﺍﻙ ﺍﻟﺘﺄﻣﻴﻦ‬
Po Box & P.C : : ‫ ﺍﻟﺮﻣﺰ‬/ ‫ﺻﻨﺪﻭﻕ ﺍﻟﺒﺮﻳﺪ‬ Contribution
‫ﺍﻟﺒﺮﻳﺪﻱ‬
Orange card (if any) 2.000 ‫ﺍﻟﺒﻄﺎﻗﺔ ﺍﻟﺒﺮﺗﻘﺎﻟﻴﺔ ﺍﻥ ﻭﺟﺪ‬
Mobile/Phone Number : 90164147 : ‫ ﺍﻟﻨﻘﺎﻝ‬/ ‫ﺭﻗﻢ ﺍﻟﻬﺎﺗﻒ‬ IMC Road side assistance 1.500 ‫ ﺧﺪﻣﺔ ﺍﻟﻤﺴﺎﻋﺪﺓ ﻋﻠﻰ ﺍﻟﻄﺮﻳﻖ‬IMC
Email : [email protected] : ‫ﺍﻟﺒﺮﻳﺪ ﺍﻻﻟﻜﺘﺮﻭﻧﻲ‬ cover
Type of Insurance : Motor Comprehensive : ‫ﻧﻮﻉ ﺍﻟﺘﺄﻣﻴﻦ‬ Emergency Fund Fees 1.000 ‫ ﺭﺳﻮﻡ ﺻﻨﺪﻭﻕ ﺍﻟﻄﻮﺍﺭﺉ‬%1
Vehicle details ‫ ﺑﻴﺎﻧﺎﺕ ﺍﻟﻤﺮﻛﺒﺔ‬1%
Vehicle Est.Value R.O. : 5950 ‫ﺳﻌﺮ ﺍﻟﻤﺮﻛﺒﺔ ﺑﺎﻟﺮﻳﺎﻝ‬ Control And Supervision 0.600 ‫ ﺭﺳﻮﻡ ﺍﻻﺷﺮﺍﻑ ﻭﺍﻟﺮﻗﺎﺑﺔ‬%0.60
‫ ﺍﻟﻌﻤﺎﻧﻲ‬Fees 0.60%
Cust VAT Reg No : 0.000 ‫ ﺍﻟﻄﺮﺍﺯ‬Injured service fund 0.200 ‫ ﺻﻨﺪﻭﻕ ﺧﺪﻣﺔ ﺍﻟﻤﺼﺎﺑﻴﻦ‬%0.25
Usage Type : PRIVATE ‫ ﺍﻟﻐﺮﺽ ﻣﻦ ﺍﻻﺳﺘﺨﺪﺍﻡ‬0.25%
Add VAT@ 5%
Make : HONDA ‫ ﻧﻮﻉ ﺍﻟﻤﺮﻛﺒﺔ‬Add VAT@ 5% 5.165
Contribution Paid 108.465 ‫ﻣﺠﻤﻮﻉ ﺍﻻﺟﻤﺎﻟﻲ ﻟﻼﺷﺘﺮﺍﻙ‬
: CITY
Year of Manufacture : 2020
D ‫ﺳﻨﺔ ﺍﻟﺼﻨﻊ‬
Name of the Authorized Drivers:
Sr.No Name ‫ﺍﻻﺳﻢ‬ Age ‫ﺍﻟﻌﻤﺮ‬
VE
Seating Capacity : 5 ‫ﻋﺪﺩ ﺍﻟﺮﻛﺎﺏ‬
Body Type : NCR--Saloon,4WD's & ‫ﺗﻮﻉ ﺍﻟﻬﻴﻜﻞ‬
Station Wagon
O

Registration Number : 92151A ‫ﺭﻗﻢ ﺍﻟﻠﻮﺣﺔ‬

Engine Number : L15D1400184 ‫ﺭﻗﻢ ﺍﻟﻤﺤﺮﻙ‬
R

Chassis Number : MAKGN2627M4100049 ‫ ﺍﻟﺸﺎﺻﻲ‬- ‫ﺭﻗﻢ ﺍﻟﻘﺎﻋﺪﺓ‬

CC/HP : 1498 ‫ﺳﻌﺔ ﺍﻟﻤﺤﺮﻙ‬
PP

Weight : ‫ﻭﺯﻥ ﺍﻟﻤﺮﻛﺒﺔ‬

**This policy subject to all terms and conditions of Motor Unified Insurance Policy ** ** ‫ﺗﺨﻀﻊ ﻫﺬﻩ ﺍﻟﻮﺛﻴﻘﺔ ﻟﺠﻤﻴﻊ ﺷﺮﻭﻁ ﻭﺃﺣﻜﺎﻡ ﻭﺛﻴﻘﺔ ﺍﻟﺘﺄﻣﻴﻦ ﺍﻟﻤﻮﺣﺪﺓ ﻋﻠﻰ‬
A

‫** ﺍﻟﻤﺮﻛﺒﺎﺕ‬

Cover Details ‫ﺗﻔﺎﺻﻴﻞ ﺍﻟﺘﻐﻄﻴﺔ‬

STF Natural disaster ‫ﺗﻐﻄﻴﺔ ﺍﻟﻜﻮﺍﺭﺙ ﺍﻟﻄﺒﻴﻌﻴﺔ‬
Comprehensive Own Damage cover + Compulsory insurance ‫ ﺍﻟﺘﺄﻣﻴﻦ ﺍﻻﺟﺒﺎﺭﻱ‬+ ‫ﺗﻐﻄﻴﺔ ﺷﺎﻣﻠﺔ ﻋﻠﻰ ﺍﻟﻤﺮﻛﺒﺔ ﺍﻟﻤﺆﻣﻨﺔ‬
Personal Accident Appendix(PAB) ‫ﺗﻐﻄﻴﺔ ﻣﻠﺤﻖ ﺍﻟﺤﻮﺍﺩﺙ ﺍﻟﺸﺨﺼﻴﺔ‬
Medical Expenses per vehicle ‫ﻣﺼﺎﺭﻳﻒ ﺍﻟﻌﻼﺝ ﻟﻜﻞ ﻣﺮﻛﺒﺔ‬
UAE Extension + Orange Card-6232111 ‫ ﺍﻟﺒﻄﺎﻗﺔ‬+ ‫ﺗﻐﻄﻴﺔ ﺍﻟﺤﺪﻭﺩ ﺍﻟﺠﻐﺮﺍﻓﻴﺔ ﻟﺪﻭﻟﺔ ﺍﻻﻣﺎﺭﺍﺕ ﺍﻟﻌﺮﺑﻴﺔ ﺍﻟﻤﺘﺤﺪﺓ‬
‫ﺍﻟﺒﺮﺗﻘﺎﻟﻴﺔ‬
IMC Road Side Assitance 80070808 IMC-‫ﺧﺪﻣﺔ ﺍﻟﻤﺴﺎﻋﺪﺓ ﻋﻠﻰ ﺍﻟﻄﺮﻳﻖ‬
Excess: The participant pays the following amount ‫ﻳﺘﺤﻤﻞ ﺍﻟﻤﺸﺘﺮﻙ ﺍﻟﻤﺒﻠﻎ ﺍﻟﻤﻮﺿﺢ ﺍﺩﻧﺎﻩ‬:‫ﺍﻟﺘﺤﻤﻞ‬
Private Vehicles Light Commercial Rent a Car & Heavy commercial &
Statement Vehicles Driving School equipment ‫ﺍﻟﺒﻴﺎﻥ‬
‫ﺍﻟﻤﺮﻛﺒﺎﺕ‬
‫ﺍﻟﺨﺎﺻﺔ‬ ‫ﺍﻟﻤﺮﻛﺒﺎﺕ ﺍﻟﺘﺠﺎﺭﻳﺔ‬ ‫ﻣﺮﻛﺒﺎﺕ ﺍﻟﺘﺄﺟﻴﺮ‬ ‫ﻣﺮﻛﺒﺎﺕ ﺍﻟﺘﺠﺎﺭﻳﺔ‬
‫ﺍﻟﺨﻔﻴﻔﺔ‬ ‫ﻭﺗﻌﻠﻴﻢ ﺍﻟﻘﻴﺎﺩﺓ‬ ‫ﺍﻟﺜﻘﻴﻠﺔ‬
RO 50 RO 75 RO 150 RO 500 ‫ﺇﺫﺍ ﻛﺎﻥ ﺍﻟﺴﺎﺋﻖ ﻣﻦ ﺍﻷﺷﺨﺎﺹ ﺍﻟﻤﺼﺮﺡ ﻟﻬﻢ‬
If the driver is one of the persons
authorized to drive the vehicle in the list ‫ﺑﺎﻟﻘﻴﺎﺩﺓ ﺿﻤﻦ ﺍﻟﻘﺎﺋﻤﺔ ﺍﻟﻤﻮﺟﻮﺩﺓ ﻓﻲ ﻃﻠﺐ ﺍﻟﺘﺄﻣﻴﻦ‬
stated in the insurance application and age ‫ ﺳﻨﺔ ﻓﺄﻛﺜﺮ‬٢٥ ‫ﻭﻋﻤﺮﻩ‬
is 25 years or more.
If the driver is one of the persons RO 75 RO 100 RO 200 RO 750 ‫ﺫﺍ ﻛﺎﻥ ﺍﻟﺴﺎﺋﻖ ﻣﻦ ﺍﻷﺷﺨﺎﺹ ﺍﻟﻤﺼﺮﺡ ﻟﻬﻢ‬
authorized to drive the vehicle in the list ‫ﺑﺎﻟﻘﻴﺎﺩﺓ ﺿﻤﻦ ﺍﻟﻘﺎﺋﻤﺔ ﺍﻟﻤﻮﺟﻮﺩﺓ ﻓﻲ ﻃﻠﺐ ﺍﻟﺘﺄﻣﻴﻦ‬
stated in the insurance application and age ‫ ﺳﻨﺔ‬٢٥ ‫ﻭﻋﻤﺮﻩ ﺃﻗﻞ ﻋﻦ‬
is less than 25 years.
RO 75 RO 100 RO 150 RO 1000 ‫ﺇﺫﺍ ﻛﺎﻥ ﺍﻟﺴﺎﺋﻖ ﻣﻦ ﺍﻷﺷﺨﺎﺹ ﻏﻴﺮ ﺍﻟﻤﺬﻛﻮﺭﻳﻦ‬
If the driver is not one of the persons
indicated in the list and age is 25 years or ‫ ﺳﻨﺔ ﻓﺄﻛﺜﺮ‬٢٥ ‫ﺑﺎﻟﻘﺎﺋﻤﺔ ﻭﻋﻤﺮﻩ‬
more.
RO 100 RO 150 RO 200 RO 1500
If the driver is not one of the persons ‫ﺇﺫﺍ ﻛﺎﻥ ﺍﻟﺴﺎﺋﻖ ﻣﻦ ﺍﻷﺷﺨﺎﺹ ﻏﻴﺮ ﺍﻟﻤﺬﻛﻮﺭﻳﻦ‬
indicated in the list and age is less than 25 ‫ ﺳﻨﺔ‬٢٥ ‫ﺑﺎﻟﻘﺎﺋﻤﺔ ﻭﻋﻤﺮﻩ ﺃﻗﻞ ﻋﻦ‬
years.
- RO 50+ - RO 250+
License age is less than 3 years. ‫ﺗﺎﺭﻳﺦ ﺣﺼﻮﻝ ﺳﺎﺋﻖ ﺍﻟﻤﺮﻛﺒﺔ ﻋﻠﻰ ﺭﺧﺼﺔ ﺍﻟﻘﻴﺎﺩﺓ ﺃﻗﻞ‬
‫ﻣﻦ ﺛﻼﺙ ﺳﻨﻮﺍﺕ‬

License age is less than 5 year. - RO 25+ - RO 250+ ‫ﺗﺎﺭﻳﺦ ﺣﺼﻮﻝ ﺳﺎﺋﻖ ﺍﻟﻤﺮﻛﺒﺔ ﻋﻠﻰ ﺭﺧﺼﺔ ﺍﻟﻘﻴﺎﺩﺓ ﺃﻗﻞ‬
‫ﻣﻦ ﺧﻤﺲ ﺳﻨﻮﺍﺕ‬
Policy issued by : JAISMONJ Approved by : JAISMONJ
I acknowledge having read the contents and schedules of the insurance policy and agree entirely with its terms and ‫ﻟﻘﺪ ﺍﻃﻠﻌﺖ ﻋﻠﻰ ﻣﺤﺘﻮﻳﺎﺕ ﻭﺟﺪﻭﻝ ﻭﺛﻴﻘﺔ ﺍﻟﺘﺄﻣﻴﻦ ﻭﺃﺗﻔﻖ‬
conditions. I also confirm that the information I provided to insurer are true. ‫ﻛﻤﺎ ﺃﺅﻛﺪ‬,‫ﺗﻤﺎﻣﺍ ﻣﻊ ﻣﺎ ﻭﺭﺩ ﺑﻬﺎ ﻣﻦ ﺷﺮﻭﻁ ﻭﺍﻟﺘﺰﺍﻣﺎﺕ‬
‫ﺃﻥ ﺍﻟﻤﻌﻠﻮﻣﺎﺕ ﺍﻟﺘﻲ ﻗﺪﻣﺘﻬﺎ ﺍﻟﻰ ﺍﻟﺸﺮﻛﺔ ﺍﻟﻤﺆﻣﻨﺔ ﺻﺤﻴﺤﺔ‬.

Signed on behalf of
‫ﺗﻮﻗﻴﻊ ﺍﻟﻤﺼﺮﺡ‬
Takaful Oman Insurance SAOG,

Authorized Signatory
Participant signature
‫ﺗﻮﻗﻴﻊ ﺍﻟﻤﺸﺘﺮﻙ‬ Tax Card No : 8062297

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 Policy No : P/100/1002/2022/00507 Continued...

Date Authorized Signatory Participant Signature

PolicyDigitalInfo

For Renewal Complaints/Suggestions/Feedback

D
VE
O
R
PP
A

Signed on behalf of
‫ﺗﻮﻗﻴﻊ ﺍﻟﻤﺼﺮﺡ‬
Takaful Oman Insurance SAOG,

Authorized Signatory
Participant signature
‫ﺗﻮﻗﻴﻊ ﺍﻟﻤﺸﺘﺮﻙ‬ Tax Card No : 8062297

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