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Royal & Sun Alliance Insurance (Middle East) B.S.C.

(c)
)‫ب (مقفلة‬.‫م‬.‫رويال آند صن أللاينس للتأمين (الشرق الأوسط) ش‬
PO Box 28648 Dubai UAE Tel +971 (4) 302 9800/334 4474 Fax +971 (4) 337 7230
PO Box 676 Abu Dhabi UAE Tel +971 (2) 635 1800 Fax +971 (2) 635 1808
PO Box 3761 Sharjah UAE Tel +971 (6) 563 1819 Fax +971 (6) 563 1850
www.rsagroup.ae

Terms and Conditions:

 Funds will be transferred within 7 working days from the time RSA receives this form with complete
details.
 Refund will only be transferred to the Insured Person’s bank account.
 This form must be filled out with signature in it.

Registered under UAE Federal Law No. (6) of 2007, Registration No, 65, Incorporated in Bahrain CR No. 24136, Registered Office PO Box 11871,
Manama, Kingdom of Bahrain. Capital: Authorized US$ 54,311,800 Issued and Paid Up US$ 54,311,800

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