VAT CERTIFICATE NO 300001626800003 :‫ﺭﻗﻢ ﺷﻬﺎﺩﺓ ﺿﺮﻳﺒﺔ ﺍﻟﻘﻴﻤﺔ ﺍﻟﻤﻀﺎﻓﺔ‬

INVOICE

SUFI KHAN MOHAMMED YAHYA :‫ﺭﻗﻢ ﺍﻟﻔﺎﺗﻮﺭﺓ‬

Name of Client: :‫ﺍﺳﻢ ﺍﻟﻌﻤﻴﻞ‬
Invoice No. DNU65-700/91829
:‫ﺗﺎﺭﻳﺦ ﺍﻟﻔﺎﺗﻮﺭﺓ‬
Address: - :‫ﺍﻟﻌﻨﻮﺍﻥ‬
Invoice Date . 04/08/2021

VAT Certificate : - :‫ﺷﻬﺎﺩﺓ ﺍﻟﻘﻴﻤﻪ‬ Policy No. 97240451 :‫ﺭﻗﻢ ﺍﻟﻮﺛﻴﻘﺔ‬

‫ﺍﻟﻤﻀﺎﻓﺔ‬

Account No : 154100-005000410 :‫ﺭﻗﻢ ﺍﻟﺤﺴﺎﺏ‬ Endorsement No. 0 :‫ﺭﻗﻢ ﺍﻟﻤﻠﺤﻖ‬

Product Name Comprehensive :‫ﺍﺳﻢ ﺍﻟﻤﻨﺘﺞ‬

Please note that we have DEBITED your account as follows:

Amount in
Description
Saudi Riyal
Being policy premium amount for policy ‫ﻗﻴﻤﺔ ﻗﺴﻂ ﺍﻟﺘﺄﻣﻴﻦ ﻟﻠﻮﺛﻴﻘﺔ ﺭﻗﻢ‬
97240451 1,371.40

Admin Charges For Policy .00

97240451 :‫ﺍﻟﺮﺳﻮﻡ ﺍﻻﺩﺍﺭﻳﺔ ﻟﻮﺛﻴﻘﺔ ﺭﻗﻢ‬

Period from: 05/08/2021 :‫ﺍﻟﻔﺘﺮﺓ ﻣﻦ‬

Period To : 04/08/2022 :‫ﺍﻟﻔﺘﺮﺓ ﺍﻟﻰ‬

Insured Name : SUFI KHAN MOHAMMED YAHYA :‫ﺍﺳﻢ ﺍﻟﻤﺆﻣﻦ ﻟﻪ‬

Insured Code : 3870067 :‫ﺭﻗﻢ ﺍﻟﻤﺆﻣﻦ ﻟﻪ‬

1371.4
Total Amount Due In Saudi Riyal ‫ﺍﻟﻤﺠﻤﻮﻉ ﺑﺎﻟﺮﻳﺎﻝ‬
(% 15 ) ‫ﻗﻴﻤﺔ ﺿﺮﻳﺒﺔ ﺍﻟﻘﻴﻤﺔ ﺍﻟﻤﻀﺎﻓﺔ ﺑﻨﺴﺒﺔ‬ 205.71
‫ﺍﺟﻤﺎﻟﻲ ﺍﻟﻤﺒﻠﻎ ﺍﻟﻤﺴﺘﺤﻖ ﻋﻠﻲ ﺍﻟﻌﻤﻴﻞ ﺷﺎﻣﻞ ﺿﺮﻳﺒﺔ ﺍﻟﻘﻴﻤﺔ ﺍﻟﻤﻀﺎﻓﺔ‬ 1577.11
ONE THOUSAND FIVE HUNDRED SEVENTY-SEVEN &ELEVEN ONLY
.‫ﺃﻟﻒ ﻭﺧﻤﺴﺔ ﻣﺎﺋﺔ ﻭﺳﺒﻌﺔ ﻭﺳﺒﻌﻮﻥ ﺭﻳﺎﻝ ﺳﻌﻮﺩﻯ ﻭﺇﺣﺪﻯﻋﺸﺮﺓ ﻫﻠﻠﻪ ﻓﻘﻂ ﻻ ﻏﻴﺮ‬

For and behalf of

Malath Cooperative Insurance Co.

Prepared By APPSUSER ----------------------------------------

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