‫ﺳﻴﺎﺭﺓ‬

‫ﺗﺄﺟﻴﺮﺳﻴﺎﺭﺓ‬
‫ﻋﻘﺪﺗﺄﺟﻴﺮ‬
‫ﻋﻘﺪ‬
‫‪CarLease‬‬
‫‪Car‬‬ ‫‪LeaseContact‬‬
‫‪Contact‬‬
‫)‪(1‬‬
‫)‪(1‬‬

‫‪1- Contract‬‬ ‫‪ - ۱‬ﺑﻴﺎﻧﺎﺕ ﺍﻟﻌﻘﺪ‪:‬‬

‫ﺗﺎﺭﻳﺦ ﻭﻭﻗﺖ ﻧﻬﺎﻳﺔ ﺍﻟﻌﻘﺪ‬ ‫ﺗﺎﺭﻳﺦ ﻭﻭﻗﺖ ﺑﺪﺍﻳﺔ ﺍﻟﻌﻘﺪ‬ ‫ﻣﻜﺎﻥ ﺇﺑﺮﺍﻡ ﺍﻟﻌﻘﺪ‬ ‫ﺭﻗﻢ ﺍﻟﻌﻘﺪ‬
‫‪End Date/Time of the‬‬ ‫‪Start Date/Time of the‬‬ ‫‪Contract Location‬‬ ‫‪Contract Number‬‬

‫‪2022-07-13T16:31‬‬ ‫‪2022-07-05T16:31‬‬ ‫‪14/00005614-‬ﺍﻟﺪﻣﺎﻡ‪-‬ﺍﻟﺰﻫﻮﺭ‬ ‫‪221496619385391‬‬

‫ﺗﺎﺭﻳﺦ ﻭﻭﻗﺖ ﻧﻬﺎﻳﺔ ﺍﻟﺘﻤﺪﻳﺪ‬ ‫ﺗﺎﺭﻳﺦ ﻭﻭﻗﺖ ﺑﺪﺍﻳﺔ ﺍﻟﺘﻤﺪﻳﺪ‬ ‫ﺭﻗﻢ ﺍﻟﺘﻤﺪﻳﺪ‬
‫‪End Date/Time of the‬‬ ‫‪Start Date/Time of the‬‬ ‫‪Extension Number‬‬

‫ﺣﺎﻟﺔ ﺍﻟﻌﻘﺪ‬ ‫ﻧﻮﻉ ﺍﻟﻌﻘﺪ‬ ‫ﺗﺎﺭﻳﺦ ﻭﻭﻗﺖ ﻧﻬﺎﻳﺔ ﺍﻟﻌﻘﺪ ﺍﻟﻔﻌﻠﻲ‬

‫‪Contract Status‬‬ ‫‪Contract Type‬‬ ‫‪End Date/Time of the Acutal‬‬
‫‪End of the Contract‬‬
‫‪New‬‬ ‫ﺟﺪﻳﺪ‬
‫‪Valid‬‬ ‫ﺳﺎﺭﻱ‬
‫‪Daily without driver‬‬ ‫ﺑﺎﻟﻴﻮﻡ ﺑﺪﻭﻥ ﺳﺎﺋﻖ‬

‫)‪2- Lessor Information:(First Party‬‬ ‫‪ - ۲‬ﺑﻴﺎﻧﺎﺕ ﺍﻟﻤﺆﺟﺮ‪):‬ﺍﻟﻄﺮﻑ ﺍﻷﻭﻝ(‬

‫ﺭﻗﻢ ﺍﻟﺴﺠﻞ ﺍﻟﻀﺮﻳﺒﻲ‬ ‫ﺭﻗﻢ ﺍﻟﺴﺠﻞ ﺍﻟﺘﺠﺎﺭﻱ‬ ‫ﻣﺆﺳﺴﺔ ﺣﺴﻦ ﻣﺤﻤﺪ ﺍﻟﻌﺠﻤﻲ ﻟﻠﻤﻘﺎﻭﻻﺕ‬ ‫ﺍﻻﺳﻢ‬
‫‪300042173600003‬‬ ‫‪VAT Reg. No.‬‬ ‫‪2050064090‬‬ ‫‪CR No.‬‬ ‫‪Name‬‬
‫‪Hassan Mohammed Al Ajmi‬‬

‫ﺭﻗﻢ ﻫﻮﻳﺔ ﺍﻟﻤﻨﺸﺄﺓ‬

‫‪1037435664‬‬ ‫‪Establishment ID No.‬‬

‫ﺭﻗﻢ ﺍﻟﻬﺎﺗﻒ‪/‬ﺍﻟﺠﻮﺍﻝ‬ ‫ﻓﺌﺔ ﺍﻟﺘﺮﺧﻴﺺ‬ ‫ﺭﻗﻢ ﺍﻟﺘﺮﺧﻴﺺ‬

‫‪966581136820‬‬ ‫‪B‬‬ ‫ﺏ‬ ‫‪14/00005614‬‬
‫‪Phone/Mobile‬‬ ‫‪License Category‬‬ ‫‪License No.‬‬
‫ﺑﺮﻳﺪ ﺇﻟﻜﺘﺮﻭﻧﻲ‬ ‫ﻓﺎﻛﺲ‬ ‫ﺍﻟﻌﻨﻮﺍﻥ‬
‫‪alajmihassan10@gmail.com‬‬ ‫ﺍﻟﻤﻨﻄﻘﺔ ﺍﻟﺸﺮﻗﻴﺔ‪ ,‬ﺍﻟﺪﻣﺎﻡ‪ ,‬ﺍﻟﺰﻫﻮﺭ‪,‬‬
‫‪E-mail‬‬ ‫‪Fax‬‬ ‫ﺷﺎﺭﻉ ‪32423 ,18‬‬ ‫‪Address‬‬

‫)‪2- Lessee Information:(Second Party‬‬ ‫‪ - ٣‬ﺑﻴﺎﻧﺎﺕ ﺍﻟﻤﺴﺘﺄﺟﺮ‪):‬ﺍﻟﻄﺮﻑ ﺍﻟﺜﺎﻧﻲ(‬

‫ﺍﻻﺳﻢ‬
‫‪FAEZ SAEED ABDULLAH ALAHMARI‬‬ ‫ﻓﺎﺋﺰ ﺳﻌﻴﺪ ﻋﺒﺪﺍﻟﻠﻪ ﺍﻻﺣﻤﺮﻱ‬ ‫‪Name‬‬
‫ﺗﺎﺭﻳﺦ ﺍﻧﺘﻬﺎﺀ ﺍﻟﻬﻮﻳﺔ‬ ‫ﺍﻟﻤﻤﻠﻜﺔ ﺍﻟﻌﺮﺑﻴﺔ‬ ‫ﺍﻟﺠﻨﺴﻴﺔ‬ ‫ﺗﺎﺭﻳﺦ ﺍﻟﻤﻴﻼﺩ‬
‫‪2028-10-11‬‬ ‫‪ID Expire Date‬‬ ‫‪Saudi Arabia‬‬
‫‪Nationality‬‬ ‫‪1408-08-25‬‬ ‫‪Date of Birth‬‬
‫ﺍﻟﺴﻌﻮﺩﻳﺔ‬
‫ﻣﻜﺎﻥ ﺍﻹﺻﺪﺍﺭ‬ ‫ﺭﻗﻢ ﺍﻟﻬﻮﻳﺔ‬ ‫ﻧﻮﻉ ﺍﻟﻬﻮﻳﺔ‬
‫‪DAMMAM‬‬ ‫ﺍﻟﺪﻣﺎﻡ‬ ‫‪Place of Issue‬‬ ‫‪1070118888‬‬ ‫‪ID No.‬‬ ‫‪National ID‬‬ ‫ﻫﻮﻳﺔ ﻭﻃﻨﻴﺔ‬
‫‪ID Type‬‬
‫ﺭﻗﻢ ﺍﻟﺠﻮﺍﻝ‬ ‫ﺍﻟﻨﺴﺨﺔ ﻋﺪﺩ‬
‫‪966544090559‬‬ ‫‪Mobile No.‬‬ ‫‪5‬‬ ‫‪Version No.‬‬

‫ﺗﺎﺭﻳﺦ ﺍﻧﺘﻬﺎﺀ ﺍﻟﺮﺧﺼﺔ‬ ‫ﺍﻟﻌﻨﻮﺍﻥ‬

‫‪2030-01-23‬‬ ‫‪License Expiry Date‬‬ ‫ﺍﻟﺪﻣﺎﻡ ﺣﻲ ﺍﻟﻨﻮﺭ‬ ‫‪Address‬‬

‫ﺭﻗﻢ ﺍﻟﺮﺧﺼﺔ‬ ‫ﻧﻮﻉ ﺍﻟﺮﺧﺼﺔ‬

‫ﺗﻮﻗﻴﻊ ﺍﻟﻤﺴﺘﺄﺟﺮ‬
‫‪Signature of‬‬ ‫‪1070118888‬‬ ‫‪License No.‬‬ ‫‪Private‬‬ ‫ﺧﺼﻮﺻﻲ‬ ‫‪License Type‬‬
 ‫ﻋﻘﺪ ﺗﺄﺟﻴﺮ ﺳﻴﺎﺭﺓ‬
Car Lease Contact
(2)

Additional Driver Information: :‫ﺑﻴﺎﻧﺎﺕ ﺍﻟﺴﺎﺋﻖ ﺍﻹﺿﺎﻓﻲ‬

‫ﺍﻻﺳﻢ‬
Name
‫ﺗﺎﺭﻳﺦ ﺍﻧﺘﻬﺎﺀ ﺍﻟﻬﻮﻳﺔ‬ ‫ﺍﻟﺠﻨﺴﻴﺔ‬ ‫ﺗﺎﺭﻳﺦ ﺍﻟﻤﻴﻼﺩ‬
ID Expire Date Nationality Date of Birth
‫ﻣﻜﺎﻥ ﺍﻹﺻﺪﺍﺭ‬ ‫ﺭﻗﻢ ﺍﻟﻬﻮﻳﺔ‬ ‫ﻧﻮﻉ ﺍﻟﻬﻮﻳﺔ‬
Place of Issue ID No. ID Type
‫ﺭﻗﻢ ﺍﻟﺠﻮﺍﻝ‬ ‫ﺍﻟﻨﺴﺨﺔ ﻋﺪﺩ‬
null Mobile No. Version No.
‫ﺗﺎﺭﻳﺦ ﺍﻧﺘﻬﺎﺀ ﺍﻟﺮﺧﺼﺔ‬ ‫ﺍﻟﻌﻨﻮﺍﻥ‬
License Expiry Date Address

‫ﺗﻮﻗﻴﻊ ﺍﻟﺴﺎﺋﻖ ﺍﻻﺿﺎﻓﻲ‬ ‫ﺭﻗﻢ ﺍﻟﺮﺧﺼﺔ‬ ‫ﻧﻮﻉ ﺍﻟﺮﺧﺼﺔ‬

Signature of Lessee License No. License Type

4- Data of Lessor's Driver in Case of Car :‫ ﺑﻴﺎﻧﺎﺕ ﺳﺎﺋﻖ ﺍﻟﻤﺆﺟﺮ ﻓﻲ ﺣﺎﻝ ﺍﻟﺘﺄﺟﻴﺮ ﺑﺴﺎﺋﻖ‬-٤
Lease with a Driver:
‫ﺍﻟﺠﻨﺴﻴﺔ‬ ‫ﺍﻻﺳﻢ‬
Nationality Name

‫ﺗﺎﺭﻳﺦ ﺍﻟﻤﻴﻼﺩ‬
Date of Birth
‫ﺗﺎﺭﻳﺦ ﺍﻧﺘﻬﺎﺀ ﺍﻟﻬﻮﻳﺔ‬ ‫ﺭﻗﻢ ﺍﻟﻬﻮﻳﺔ‬ ‫ﻧﻮﻉ ﺍﻟﻬﻮﻳﺔ‬
ID Expire Date ID No. ID Type

‫ﺗﺎﺭﻳﺦ ﺍﻧﺘﻬﺎﺀ ﺍﻟﺮﺧﺼﺔ‬ ‫ﺭﻗﻢ ﺍﻟﺮﺧﺼﺔ‬ ‫ﻧﻮﻉ ﺍﻟﺮﺧﺼﺔ‬

License Expiry Date License No. License Type

5- Car Information :‫ ﺑﻴﺎﻧﺎﺕ ﺍﻟﺴﻴﺎﺭﺓ‬-٥

‫ﺍﻟﻠﻮﻥ‬ ‫ﺳﻨﺔ ﺍﻟﺼﻨﻊ‬ ‫ﺭﻗﻢ ﺍﻟﻠﻮﺣﺔ‬ ‫ﻧﻮﻉ ﺍﻟﺴﻴﺎﺭﺓ‬
Color Manufacture Year Plate Car Type

‫ﺭﺻﺎﺻﻲ ﻏﺎﻣﻖ‬ 2020 2866 - ‫ﺩ ﻱ ﺏ‬ ‫ﻛﻮﻧﺎ ﻭﺍﺟﻦ‬ ‫ﻛﻮﻧﺎ ﻭﺍﺟﻦ‬

‫ﻧﻮﻉ ﺍﻟﻮﻗﻮﺩ‬ ‫ﺗﺎﺭﻳﺦ ﺍﻧﺘﻬﺎﺀ ﺑﻄﺎﻗﺔ ﺍﻟﺘﺸﻐﻴﻞ‬ ‫ﺭﻗﻢ ﺑﻄﺎﻗﺔ ﺍﻟﺘﺸﻐﻴﻞ‬ ‫ﻧﻮﻉ ﺍﻟﺘﺴﺠﻴﻞ‬
Fuel Type Operation Card Expiry Operation Card Registration

91 91 1444/07/21 14-00273317 PRIVATE ‫ﻧﻘﻞ ﺧﺎﺹ‬

‫ﺗﺎﺭﻳﺦ ﺍﻧﺘﻬﺎﺀ ﺍﻟﺘﺄﻣﻴﻦ‬ ‫ﺭﻗﻢ ﻭﺛﻴﻘﺔ ﺍﻟﺘﺄﻣﻴﻦ‬ ‫ﻣﻮﻋﺪ ﺍﺳﺘﺪﻋﺎﺀ‬ ‫ﻛﻤﻴﺔ ﺍﻟﻮﻗﻮﺩ ﺍﻟﻤﻮﺟﻮﺩﺓ‬
Insurance Expiry Date Insurance Policy No. Appointment Call for Maintenace Amount of Fuel Present

2022-09-06 P/300/2902/21/001197 2022-07-31 Empty ‫ﻓﺎﺭﻍ‬

‫ﺗﻐﻄﻴﺔ ﺗﺄﻣﻴﻨﻴﺔ ﺍﺿﺎﻓﻴﺔ‬ ‫ﻣﺒﻠﻎ ﺍﻟﺘﺤﻤﻞ‬ ‫ﻧﻮﻉ ﺍﻟﺘﺄﻣﻴﻦ‬
Additional Insurance Amount of Endurance Insurance Type

Full ‫ﺷﺎﻣﻞ‬

‫ﺗﻮﻗﻴﻊ ﺍﻟﻤﺴﺘﺄﺟﺮ‬
Lessee Signature
 ‫ﻋﻘﺪ ﺗﺄﺟﻴﺮ ﺳﻴﺎﺭﺓ‬
‫‪Car Lease Contact‬‬
‫)‪(3‬‬

‫‪6- Lease Information:‬‬ ‫‪ -٦‬ﺑﻴﺎﻧﺎﺕ ﺍﻹﺟﺎﺭ‪:‬‬

‫ﻋﺪﺩ ﺳﺎﻋﺎﺕ ﺍﻟﺘﺄﺧﻴﺮ‬ ‫ﻗﻴﻤﺔ ﺍﻟﻜﻴﻠﻮﻣﺘﺮ ﺍﻟﺰﺍﺋﺪ‬ ‫ﻗﻴﻤﺔ ﺍﻹﺟﺎﺭ )ﻳﻮﻡ‪/‬ﺳﺎﻋﺔ(‬ ‫ﻣﺪﺓ ﺍﻹﺟﺎﺭ‬
‫‪Hours of Delay‬‬ ‫‪Extra Kilometer Cost‬‬ ‫)‪Lease Cost (Day/Hour‬‬ ‫‪Lease Term‬‬

‫‪0.0‬‬ ‫‪0.3‬‬ ‫‪170.0‬‬ ‫‪8‬‬

‫ﻋﺪﺩ ﺍﻟﻜﻴﻠﻮﻣﺘﺮ ﺍﻟﻤﺠﺎﻧﻲ)ﻳﻮﻡ‪/‬ﺳﺎﻋﺔ(‬ ‫ﻋﺪﺩ ﺳﺎﻋﺎﺕ ﺍﻟﺘﺄﺧﻴﺮ ﺍﻟﻤﺴﻤﻮﺡ ﺑﻬﺎ‬

‫ﺃﺟﺮﺓ ﺳﺎﺋﻖ ﺍﻟﻤﺆﺟﺮ)ﻳﻮﻡ ‪/‬ﺳﺎﻋﺔ(‬ ‫ﺃﺟﺮﺓ ﺳﺎﻋﺎﺕ ﺍﻟﺘﺄﺧﻴﺮ‬
‫‪Number of Delay Hours‬‬
‫‪Lessor's Driver Fare‬‬ ‫‪Free Kilometer‬‬ ‫‪Allowed‬‬
‫‪Delay Hours Fare‬‬

‫‪0.0‬‬ ‫‪300.0‬‬ ‫‪3‬‬ ‫‪0.0‬‬

‫ﻗﻴﻤﺔ ﺍﻟﺨﺪﻣﺎﺕ ﺍﻟﺘﻜﻤﻴﻠﻴﺔ‬ ‫ﺍﻟﺨﺪﻣﺎﺕ ﺍﻟﺘﻜﻤﻴﻠﻴﺔ‬ ‫ﻗﻴﻤﺔ ﺍﻟﺘﻔﻮﻳﺾ ﺍﻟﺪﻭﻟﻲ‬ ‫ﺍﻟﻤﻨﻄﻘﺔ ﺍﻟﺠﻐﺮﺍﻓﻴﺔ ﺍﻟﻤﺴﻤﻮﺡ‬
‫‪Supplementary Services‬‬ ‫‪Supplementary‬‬ ‫‪International Aothrization Cost‬‬ ‫‪Allowed Geographical Area‬‬

‫‪0.0‬‬ ‫‪0.0‬‬ ‫ﺟﻤﻴﻊ ﺃﻧﺤﺎﺀ ﺍﻟﻤﻤﻠﻜﺔ‬

‫ﺍﻟﺨﺪﻣﺎﺕ ﺍﻻﺿﺎﻓﻴﺔ‬ ‫ﻗﻴﻤﺔ ﺍﻟﺨﺪﻣﺎﺕ ﺍﻹﺿﺎﻓﻴﺔ‬
‫‪Additional Services‬‬ ‫‪Additional Services‬‬
‫ﻭﺳﺎﺋﻞ ﺧﺎﺻﺔ ﻟﺬﻭﻯ ﺍﻹﻋﺎﻗﺔ‬
‫ﻧﻈﺎﻡ ﺍﻟﻤﻼﺣﺔ ﺍﻟﻜﻢ‪:‬‬ ‫ﻗﻴﻤﺔ ﺗﻮﺻﻴﻞ ﺍﻟﺴﻴﺎﺭﺓ ﺍﻟﻜﻢ‪:‬‬ ‫ﺍﻻﻧﺘﺮﻧﺖ ﺍﻟﻜﻢ‪:‬‬ ‫ﻣﻘﻌﺪ ﺍﻃﻔﺎﻝ ﺍﻟﻜﻢ‪:‬‬
‫ﺍﻟﻜﻢ‪:‬‬

‫‪0.0‬‬ ‫‪0.0‬‬ ‫‪0.0‬‬ ‫‪0.0‬‬ ‫‪0.0‬‬

‫‪0.0‬‬
‫ﺗﻮﻗﻴﻊ ﺍﻟﻤﺴﺘﺄﺟﺮ‬ ‫ﻗﻴﻤﺔ ﺗﻔﻮﻳﺾ ﺳﺎﺋﻖ ﺇﺿﺎﻓﻲ‬ ‫ﻗﻴﻤﺔ ﺗﺴﻠﻴﻢ ﺍﻟﺴﻴﺎﺭﺓ ﻓﻲ ﻣﺪﻳﻨﺔ ﺍﺧﺮﻯ‬
‫‪Lessee signature‬‬ ‫‪Additional Driver Aothrization‬‬ ‫‪Return of the Car in Another‬‬

‫‪0.0‬‬ ‫‪0.0‬‬

‫‪7- Car Receipt Information:‬‬ ‫‪ -٧‬ﺑﻴﺎﻧﺎﺕ ﺍﺳﺘﻼﻡ ﺍﻟﺴﻴﺎﺭﺓ‪:‬‬

‫ﺗﻮﻗﻴﻊ ﺍﻟﻤﺴﺘﺄﺟﺮ‬ ‫ﻣﻮﻗﻊ ﺍﻟﺨﺮﻭﺝ‬ ‫ﻗﺮﺍﺀﺓ ﺍﻟﻌﺪﺍﺩ ﻋﻨﺪ ﺍﻟﺨﺮﻭﺝ‬
‫‪Lessee Signature‬‬ ‫‪Exit Location‬‬ ‫‪Otometer Reading at‬‬

‫‪14/00005614-‬ﺍﻟﺪﻣﺎﻡ‪-‬ﺍﻟﺰﻫﻮﺭ‬ ‫‪32575.0‬‬

‫‪8- Car Return Information:‬‬ ‫‪ -٨‬ﺑﻴﺎﻧﺎﺕ ﺗﺴﻠﻴﻢ ﺍﻟﺴﻴﺎﺭﺓ‪:‬‬

‫ﺗﻮﻗﻴﻊ ﺍﻟﻤﺴﺘﺄﺟﺮ‬ ‫ﻣﻮﻗﻊ ﺍﻟﻮﺻﻮﻝ‬ ‫ﻗﺮﺍﺀﺓ ﺍﻟﻌﺪﺍﺩ ﻋﻨﺪ ﺍﻟﺪﺧﻮﻝ‬
‫‪Lessee Signature‬‬ ‫‪Arrival Location‬‬ ‫‪Otometer Reading at‬‬

‫‪8- Car Return Information:‬‬ ‫‪14/00005614-‬ﺍﻟﺪﻣﺎﻡ‪-‬ﺍﻟﺰﻫﻮﺭ‬ ‫‪32575.0‬‬

‫‪9- Leasing Policy‬‬ ‫‪ -٩‬ﺳﻴﺎﺳﺔ ﺍﻟﺘﺄﺟﻴﺮ‪:‬‬

‫ﺩﻓﻊ ﻗﻴﻤﺔ ﺍﻟﺘﺄﺟﻴﺮ ﺍﻟﻔﻌﻠﻴﺔ‬ ‫ﺳﻴﺎﺳﺔ ﺇﻋﺎﺩﺓ ﺍﻟﺴﻴﺎﺭﺓ ﻗﺒﻞ ﺍﻧﺘﻬﺎﺀ ﻣﺪﺓ ﺍﻟﻌﻘﺪ‬
‫‪Policy of Returning the Car Before the Contract Expiry‬‬

‫ﺗﻤﺪﻳﺪ ﺍﻟﻌﻘﺪ‬
‫ﺗﻘﺪﻳﻢ ﻃﻠﺐ ﺗﻤﺪﻳﺪ ﺍﻟﻌﻘﺪ ﻗﺒﻞ ﺍﻧﺘﻬﺎﺀ ﻣﺪﺗﻪ ﺑـ ‪ 24‬ﺳﺎﻋﺔ\ﺳﺎﻋﺎﺕ‬ ‫‪Contract Extension‬‬

‫ﺍﻟﺰﻣﻦ ﺍﻟﻼﺯﻡ ﻟﺘﻘﺪﻳﻢ ﻃﻠﺐ ﺍﻟﺘﻤﺪﻳﺪ‬

‫ﻣﻦ ﺧﻼﻝ ﺭﺳﺎﻟﺔ ﻧﺼﻴﺔ ﻋﻠﻰ ﺍﻟﻬﺎﺗﻒ ﺍﻟﻤﺤﻤﻮﻝ ﺭﻗﻢ ‪966593777701 :‬‬ ‫‪Time Required to Submit an Extension Request‬‬

‫ﻣﻦ ﺧﻼﻝ ﺍﻟﺒﺮﻳﺪ ﺍﻹﻟﻜﺘﺮﻭﻧﻲ ﺍﻟﺘﺎﻟﻲ ‪alajmihassan10@gmail.com :‬‬ ‫ﺁﻟﻴﺔ ﺍﻷﺑﻼﻍ ﻋﻦ ﺍﻟﺤﻮﺍﺩﺙ ﺃﻭ ﺍﻷﻋﻄﺎﻝ‬
‫‪Mechanism of Reporting Accidents or Malfunctions‬‬
‫ﻣﻦ ﺧﻼﻝ ﺭﺳﺎﻟﺔ ﻧﺼﻴﺔ ﻋﻠﻰ ﺍﻟﻬﺎﺗﻒ ﺍﻟﻤﺤﻤﻮﻝ ﺭﻗﻢ ‪966593777701 :‬‬

‫ﺇﻋﺎﺩﺓ ﺍﻟﺴﻴﺎﺭﺓ ﺑﺄﻱ ﻛﻤﻴﺔ ﻭﻗﻮﺩ ﺩﻭﻥ ﺗﺤﻤﻞ ﺗﻜﻠﻔﺔ ﻣﺎﻟﻴﺔ ﺇﺿﺎﻓﻴﺔ‬
‫ﺇﻋﺎﺩﺓ ﺍﻟﻮﻗﻮﺩ‬
‫‪Fuel Return Mechanism‬‬

‫ﺗﻮﻗﻴﻊ ﺍﻟﻤﺴﺘﺄﺟﺮ‬
‫‪Lessee Signature‬‬
 ‫ﻋﻘﺪ ﺗﺄﺟﻴﺮ ﺳﻴﺎﺭﺓ‬
Car Lease Contact
(4)

10- Car Technical Condtion: :‫ ﺍﻟﺤﺎﻟﺔ ﺍﻟﻔﻨﻴﺔ ﻟﻠﺴﻴﺎﺭﺓ‬- ۱۰

‫ﻋﻨﺪ ﺍﻟﺘﺴﻠﻴﻢ‬ ‫ﻋﻨﺪ ﺍﻟﺘﺄﺟﻴﺮ‬ ‫ﺍﻟﻌﻨﺎﺻﺮ‬
At Return At Lease Elements

Excellent ‫ﻣﻤﺘﺎﺯ‬ ‫ﺣﺎﻟﺔ ﺍﻟﺘﻜﻴﻴﻒ‬

Excellent ‫ﻣﻤﺘﺎﺯ‬ A/C Condtion
‫ﺍﻟﻤﺴﺠﻞ‬/‫ﺣﺎﻟﺔ ﺍﻟﺮﺍﺩﻳﻮ‬
Excellent ‫ﻣﻤﺘﺎﺯ‬ Excellent ‫ﻣﻤﺘﺎﺯ‬ Radio/Recorder

‫ﻣﻤﺘﺎﺯ‬ ‫ﺣﺎﻟﺔ ﺍﻟﺸﺎﺷﺔ ﺍﻟﺪﺍﺧﻠﻴﺔ‬

Excellent ‫ﻣﻤﺘﺎﺯ‬ Excellent Interior Screen
‫ﺣﺎﻟﺔ ﻋﺪﺍﺩ ﺍﻟﺴﺮﻋﺔ‬
Working ‫ﻳﻌﻤﻞ‬ Working ‫ﻳﻌﻤﻞ‬ Speedometer Condtion
‫ﺣﺎﻟﺔ ﺍﻟﻔﺮﺵ ﺍﻟﺪﺍﺧﻠﻲ‬
Clean ‫ﻧﻈﻴﻒ‬ Clean ‫ﻧﻈﻴﻒ‬ Interior Upholstery
‫ﻣﻌﺪﺍﺕ ﺍﻟﻜﻔﺮ ﺍﻻﺣﺘﻴﺎﻃﻴﺔ‬
Exists ‫ﻳﻮﺟﺪ‬ Exists ‫ﻳﻮﺟﺪ‬ Spare Tire Equipment
‫ﺣﺎﻟﺔ ﺍﻟﻌﺠﻼﺕ‬
Excellent ‫ﻣﻤﺘﺎﺯ‬ Excellent ‫ﻣﻤﺘﺎﺯ‬ Wheels Condtion
‫ﺣﺎﻟﺔ ﺍﻟﻌﺠﻠﺔ ﺍﻻﺣﺘﻴﺎﻃﻴﺔ‬
Excellent ‫ﻣﻤﺘﺎﺯ‬ Excellent ‫ﻣﻤﺘﺎﺯ‬ Spare Wheel Condtion

‫ﺣﺎﻟﺔ ﺣﻘﻴﺒﺔ ﺍﻻﺳﻌﺎﻓﺎﺕ ﺍﻷﻭﻟﻴﺔ‬

Exists ‫ﻳﻮﺟﺪ‬ Exists ‫ﻳﻮﺟﺪ‬ Fist Aid Kit Condtion
‫ﻣﻮﻋﺪ ﺗﻐﻴﻴﺮ ﺍﻟﺰﻳﺖ‬
2022-07-31 2022-07-31 Oil change Time
‫ﺣﺎﻟﺔ ﺍﻟﻤﻔﺘﺎﺡ‬
Working ‫ﻳﻌﻤﻞ‬ Working ‫ﻳﻌﻤﻞ‬ Key Condtion
‫ﺗﻮﻓﺮ ﻃﻔﺎﻳﺔ ﺍﻟﺤﺮﻳﻖ‬
Exists ‫ﻳﻮﺟﺪ‬ Exists ‫ﻳﻮﺟﺪ‬ First Extinguisher
‫ﺗﻮﻓﺮ ﺍﻟﻤﺜﻠﺚ ﺍﻟﻌﺎﻛﺲ‬
Exists ‫ﻳﻮﺟﺪ‬ Exists ‫ﻳﻮﺟﺪ‬ Availability of Triangle
‫ﺃﺧﺮﻯ‬
Other
‫ﺃﺧﺮﻯ‬
Other

‫ﻣﻼﺣﻈﺎﺕ‬
Car Technical Condtion
‫ﺗﻮﻗﻴﻊ ﺍﻟﻤﺆﺟﺮ‬ ‫ﺗﻮﻗﻴﻊ ﺍﻟﻤﺆﺟﺮ‬
Lessor Signature Lessor Signature
‫ﺗﻮﻗﻴﻊ ﺍﻟﻤﺴﺘﺄﺟﺮ‬ ‫ﺗﻮﻗﻴﻊ ﺍﻟﻤﺴﺘﺄﺟﺮ‬
Lessee Signature Lessee Signature
 ‫ﻋﻘﺪ ﺗﺄﺟﻴﺮ ﺳﻴﺎﺭﺓ‬
Car Lease Contact
(5)

11- Main Financial Data: :‫ ﺍﻟﺒﻴﺎﻧﺎﺕ ﺍﻟﻤﺎﻟﻴﺔ ﺍﻟﺮﺋﻴﺴﻴﺔ‬-١١

‫ﺇﺟﻤﺎﻟﻲ ﻗﻴﻤﺔ ﺍﻟﺘﺄﺧﻴﺮ‬ ‫ﺇﺟﻤﺎﻟﻲ ﺃﺟﺮﺓ ﺍﻟﺴﺎﺋﻖ‬ ‫ﻗﻴﻤﺔ ﺗﻔﻮﻳﺾ ﺳﺎﺋﻖ ﺍﺿﺎﻓﻲ‬ ‫ﺇﺟﻤﺎﻟﻲ ﻗﻴﻤﺔ ﺍﻟﺘﺎﺟﻴﺮ‬
Additional Chauffeur Authorization
Total Delay Cost Total Driver Fare Value Total Lease Cost

0.0 0.0 0.0 1360.0

‫ﺍﻟﺨﺼﻢ‬ ‫ﻗﻴﻤﺔ ﺗﺴﻠﻴﻢ ﺍﻟﺴﻴﺎﺭﺓ ﻓﻲ ﻣﺪﻳﻨﺔ ﺃﺧﺮﻯ‬ ‫ﻗﻴﻤﺔ ﺍﻟﺘﻔﻮﻳﺾ ﺍﻟﺪﻭﻟﻲ‬ ‫ﻗﻴﻤﺔ ﺍﻟﺨﺪﻣﺎﺕ ﺍﻹﺿﺎﻓﻴﺔ‬
Cost of Returning the Car in Another Additional Services
Discount City
International Authorization

0.0 0.0 0.0 0.0

‫ﺍﻟﻀﺮﻳﺒﺔ ﺍﻟﻤﻀﺎﻓﺔ‬
VAT

204.0
‫ﻃﺮﻳﻘﺔ ﺍﻟﺪﻓﻊ‬ ‫ﺍﻟﻤﺘﺒﻘﻲ‬ ‫ﺍﻟﻤﺪﻓﻮﻉ‬ ‫ﺍﻹﺟﻤﺎﻟﻲ‬
Payment Method Remaining Amount Paid Total

1564.0 0.0 1564.0

12- Other Financial Data: :‫ ﺍﻟﺒﻴﺎﻧﺎﺕ ﺍﻟﻤﺎﻟﻴﺔ ﺍﻷﺧﺮﻯ‬-١٢

‫ﻗﻴﻤﺔ ﻗﻄﻊ ﺍﻟﻐﻴﺎﺭ‬ ‫ﻗﻴﻤﺔ ﺍﻟﺨﺪﻣﺎﺕ ﺍﻟﺘﻜﻤﻴﻠﻴﺔ‬ ‫ﻗﻴﻤﺔ ﻣﺒﻠﻎ ﺍﻟﺘﺤﻤﻞ‬ ‫ﺇﺟﻤﺎﻟﻲ ﻗﻴﻤﺔ ﺍﻟﻜﻴﻠﻮﻣﺘﺮﺍﺕ‬
Spare Parts Cost Supplementary Services Deductable Amount Value Total Cost of Extra

0.0 0.0
‫ﺍﻟﺨﺼﻢ‬ ‫ﻗﻴﻤﺔ ﺗﻐﻴﻴﺮ ﺍﻟﺰﻳﺖ‬ ‫ﻗﻴﻤﺔ ﺗﻘﻴﻴﻢ ﺃﺿﺮﺍﺭ ﺍﻟﺴﻴﺎﺭﺓ‬ ‫ﻗﻴﻤﺔ ﺳﺤﺐ ﺍﻟﺴﻴﺎﺭﺓ‬
Discount Oil Change Cost Car Damage Assessment Car Towing Cost

0.0 0.0 0.0 0.0

‫ﺍﻟﻤﺪﻓﻮﻉ‬ ‫ﺍﻹﺟﻤﺎﻟﻲ‬ ‫ﺍﻟﻀﺮﻳﺒﺔ ﺍﻟﻤﻀﺎﻓﺔ‬ ‫ﻗﻴﻤﺔ ﺍﻟﻮﻗﻮﺩ‬

Paid Total VAT Fuel Cost

0.0 0.0 0.0

‫ﻃﺮﻳﻘﺔ ﺍﻟﺪﻓﻊ‬ ‫ﺍﻟﻤﺘﺒﻘﻲ‬
Payment Method Remaining Amount

0.0
 ‫ﻋﻘﺪ ﺗﺄﺟﻴﺮ ﺳﻴﺎﺭﺓ‬
‫‪Car Lease Contact‬‬
‫)‪(9‬‬

‫ﻟﻌﺮﺽ ﺗﻔﺎﺻﻴﻞ ﺍﻟﻌﻘﺪ ﻛﺎﻣﻼً ﻳﺮﺟﻰ ﻣﺴﺢ ﺍﻟﺒﺎﺭﻛﻮﺩ‬

‫ﻳﻘﺮ ﺃﻃﺮﺍﻑ ﺍﻟﻌﻘﺪ ﺑﻘﺮﺍﺀﺓ ﺍﻟﺒﻨﻮﺩ ﺍﻟﺴﺎﺑﻘﺔ ﻭﺍﻹﻟﺘﺰﺍﻡ ﺑﻬﺎ‬

‫‪Signature of the Second Party‬‬ ‫ﺗﻮﻗﻴﻊ ﺍﻟﻄﺮﻑ ﺍﻟﺜﺎﻧﻲ‬ ‫‪Signature of the First Party‬‬ ‫ﺗﻮﻗﻴﻊ ﺍﻟﻄﺮﻑ ﺍﻷﻭﻝ‬