‫ﻭﺛﻴﻘﺔ ﺗﺄﻣﻴﻦ ﻣﺮﻛﺒﺔ ﻣﻴﻜﺎﻧﻴﻜﻴﺔ‬

MOTOR VEHICLE INSURANCE POLICY

THIS IS TO CERTIFY that the below mentioned vehicle is ‫ﺗﺸﻬﺪ ﺑﺄﻥ ﺍﻟﻤﺮﻛﺒﺔ ﺍﻟﻤﺬﻛﻮﺭﺓ ﺃﻭﺻﺎﻓﻬﺎ ﺃﺩﻧﺎﻩ ﻣﺆﻣﻨﺔ‬
insured with our company in accordance with ministerial decree ‫ ﺑﺈﺻﺪﺍﺭ‬2010 ‫( ﻟﺴﻨﺔ‬6) ‫ﻟﺪﻳﻨﺎ ﻭﻓﻘﺎ ﻟﻠﻘﺮﺍﺭ ﺍﻟﻮﺯﺍﺭﻱ ﺭﻗﻢ‬
no(6) of the year 2010 related to the issuance of the executive ‫ﺍﻟﻼﺋﺤﺔ ﺍﻟﺘﻨﻔﻴﺬﻳﺔ ﻟﻘﺎﻧﻮﻥ ﺍﻟﻤﺮﻭﺭ ﺍﻟﺼﺎﺩﺭ ﺑﺎﻟﻤﺮﺳﻮﻡ‬
regulation for the law no (19) for the year 2007. ‫( ﻟﺴﻨﺔ‬19) ‫ ﺑﻘﺎﻧﻮﻥ ﺭﻗﻢ‬
2007

Date 26/03/2020 15:22:00

Name of Insured SIVEESH KODAPULLY SIVARAMAN ‫ﺇﺳﻢ ﺍﻟﻤﺆﻣﻦ ﻟﻪ‬

Address DOHA QATAR, ‫ﺍﻟﻌﻨﻮﺍﻥ‬

P.O.Box : 22533-Doha, State Of Qatar
Policy No. 1810016157 ‫ﺭﻗﻢ ﺍﻟﻮﺛﻴﻘﺔ‬

Insurance Period From 02/04/2020 00:00 To 01/04/2021 23:59 ‫ﻣﺪﺓ ﺍﻟﺘﺄﻣﻴﻦ ﻣﻦ‬

Type Of Cover TP + Own Damage ‫ ﺟﺴﻢ ﺍﻟﻤﺮﻛﺒﺔ‬+ ‫ ﺇﺟﺒﺎﺭﻱ ﻟﺼﺎﻟﺢ ﺍﻟﻐﻴﺮ‬- ‫ﺷﺎﻣﻞ‬ ‫ﻧﻮﻉ ﺍﻟﺘﻐﻄﻴﺔ‬
Plate No. / Plate Type 200864-‫ﺧﺼﻮﺻﻲ‬ ‫ﻧﻮﻉ ﺍﻟﻠﻮﺣﺔ‬/ ‫ﺭﻗﻢ ﻟﻮﺣﺔ‬

Make / Model /Vehicle Shape Jeep / Station / Station Wagon ‫ﻧﻮﻉ ﺍﻟﻤﺮﻛﺒﺔ‬/‫ﺍﻟﻄﺮﺍﺯ‬/‫ﺍﻟﺸﻜﻞ‬

Year of Manufacture 2017 ‫ﺳﻨﺔ ﺍﻟﺼﻨﻊ‬

Chassis No. 1C4NJDCB9HD180106 ‫ﺭﻗﻢ ﺍﻟﻘﺎﻋﺪﺓ‬

Engine No. ‫ﺭﻗﻢ ﺍﻟﻤﺤﺮﻙ‬

C.C / Cylinders 4 ‫ ﻋﺪﺩ ﺍﻻﺳﻄﻮ‬/ ‫ﺳﻌﺔ ﺍﻟﻤﺤﺮﻙ‬

No of Passengers Covered 5 ‫ﻋﺪﺩ ﺍﻟﺮﻛﺎﺏ ﺍﻟﻤﺆﻣﻦ ﻋﻠﻴﻬﻢ‬

Agency Repair Yes ‫ﺇﺻﻼﺡ ﺍﻟﻮﻛﺎﻟﺔ‬

Value of Insured Vehicle QAR 68,000.00 ‫ﺍﻟﻘﻴﻤﺔ ﺍﻟﺘﺄﻣﻴﻨﻴﺔ ﻟﻠﻤﺮﻛﺐ‬

Premium QAR 2,280.00 ‫ﺍﻟﻘﺴﻂ‬

Deductibles : ‫ﻗﻴﻤﺔ ﺍﻟﺘﺤﻤﻞ‬

Remarks :

Covers Detail : Own Damage, Passenger Liability, Agency Repairs, Third Party Liability, Road Side Assistance(Call 44810500
/44810400)
Warranted that own damage insurance is not valid for private vehicles ‫ﻣﻦ ﺍﻟﻤﺘﻔﻖ ﻋﻠﻴﻪ ﺃﻥ ﺗﺄﻣﻴﻦ ﺟﺴﻢ ﺍﻟﻤﺮﻛﺒﺔ ﻻ ﻳﺴﺮﻱ ﻋﻠﻰ‬
used for hire or reward; unless clearly specified on the policy of ‫ﺍﻟﺴﻴﺎﺭﺍﺕ ﺍﻟﺨﺎﺻﺔ ﺃﺛﻨﺎﺀ ﺗﺄﺟﻴﺮﻫﺎ ﺃﻭ ﺍﺳﺘﻌﻤﺎﻟﻬﺎ ﻟﻠﻨﻘﻞ‬
insurance and the appropriate Contribution paid. ‫ﺑﺄﺟﺮ ﺇﻻ ﺇﺫﺍ ﺫﻛﺮ ﺫﻟﻚ ﺻﺮﺍﺣﺔ ﻓﻲ ﻭﺛﻴﻘﺔ ﺍﻟﺘﺄﻣﻴﻦ ﻭﻣﻘﺎﺑﻞ‬
‫ﺳﺪﺍﺩ ﺍﻟﻘﺴﻂ ﺍﻟﺨﺎﺹ ﺑﺬﻟﻚ‬

The Company is licensed by the Central Bank of ‫ﺍﻟﺸﺮﻛﺔ ﻣﺮﺧﺺ ﻟﻬﺎ ﻣﻦ ﻣﺼﺮﻑ ﻗﻄﺮ ﺍﻟﻤﺮﻛﺰﻱ ﻭﻓﻘﺎ ﻷﺣﻜﺎﻡ‬
Qatar(13/2009) in accordance with the provisions of the ‫ﻗﺎﻧﻮﻥ ﻣﺼﺮﻑ ﻗﻄﺮ ﺍﻟﻤﺮﻛﺰﻱ ﻭﺗﻨﻈﻴﻢ ﺍﻟﻤﺆﺳﺴﺎﺕ ﺍﻟﻤﺎﻟﻴﺔ‬
Central Bank of Qatar Law and the Regulation of Financial ‫ ﻟﺴﻨﺔ‬13 ‫ﺍﻟﺼﺎﺩﺭ ﺑﺎﻟﻘﺎﻧﻮﻥ ﺭﻗﻢ‬
Institutions promulgated by Law No. 13 of 2012. 2012

Date and Time of issue : 26/03/2020 15:22:00 26/03/2020 15:22:00 ‫ﺗﺎﺭﻳﺦ ﻭﻭﻗﺖ ﺍﻹﺻﺪﺍﺭ‬
Issued By/Emp No Customer Signature

Computer Card No: (13062300) DOHA BRANCH (13062300) ‫ﻗﻴﺪ ﺍﻟﻤﻨﺸﺄﺓ ﺭﻗﻢ‬