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‫ﻓﺎﺗورة ﺿرﯾﺑﯾﺔ ﻣﺑﺳطﺔ‬

Simplified Tax Invoice

Invoice Number: INV-086558 :‫رﻗم اﻟﻔﺎﺗورة‬ INSURER/REINSURER: :‫ﻣﻌﯾد اﻟﺗﺄﻣﯾن‬/‫اﻟﻣؤﻣن‬


INSURER/REINSURER ADDRESS: :‫ﻋﻧوان ﻣﻌﯾداﻟﺗﺄﻣﯾن‬

Invoice ID: 112672 :‫ﻣﻌرف اﻟﻔﺎﺗورة‬ ‫رﻗم ﺿرﯾﺑﺔ اﻟﻘﯾﻣﺔ‬


Insurer/Reinsurer VAT
‫اﻟﻣﺿﺎﻓﺔ ﻟﻣﻌﯾد‬
Number:
:‫اﻟﺗﺄﻣﯾن‬
Invoice Issue Date: 2024/02/15 12:14:48 :‫ﺗﺎرﯾﺦ اﻟﻔﺎﺗورة‬
Other ID: :‫رﻗم ﻣﻌرف اﺧر‬

CLIENT: :‫اﻟﻌﻣﯾل‬
CLIENT NAME: :‫اﺳم اﻟﻌﻣﯾل‬
MOHAMED *
ADDRESS DETAILS: 0000 - LISLEBYVEIEN 179 NA FREDRIKSTAD 00000 SAUDI ARABIA ‫ اﻟﻣﻣﻠﻛﺔ اﻟﻌرﺑﯾﺔ اﻟﺳﻌودﯾﺔ‬NA NA NA 00000 - 0000 :‫ﺗﻔﺎﺻﯾل اﻟﻌﻧوان‬

VAT Number: :‫رﻗم ﺗﺳﺟﯾل ﺿرﯾﺑﺔ اﻟﻘﯾﻣﺔ اﻟﻣﺿﺎﻓﺔ‬


Other ID: :‫رﻗم ﻣﻌرف اﺧر‬
Client Code: 2366973/0 :‫رﻗم اﻟﻌﻣﯾل‬

LINE ITEMS: :‫ﺗوﺻﯾف اﻟﺳﻠﻌﺔ او اﻟﺧدﻣﺔ‬


‫رﻗم وﺛﯾﻘﺔ اﻟﺗﺄﻣﯾن‬ ‫اﻟﺗﺻﻧﯾف‬ ‫اﻟﻛﻣﯾﺔ‬ ‫اﻟﻘﺳط اﻹﺟﻣﺎﻟﻲ‬ ‫ﺿرﯾﺑﺔ اﻟﻘﯾﻣﺔ اﻟﻣﺿﺎﻓﺔ‬ ‫ﻣﺟﻣوع ﺿرﯾﺑﺔ اﻟﻘﯾﻣﺔ اﻟﻣﺿﺎﻓﺔ‬ ‫ﻣﺟﻣوع اﻟﻣﺑﻠﻎ اﻟواﺟب اﻟﺳداد‬
Policy No Category Qty Gross premium Value Added Tax Total VAT Total Due
20/XT/2004461409/0/0
Policy Period/‫ﻓﺗرة اﻟوﺛﯾﻘﺔ‬ TOURIST INSURANCE Value Added Tax
13-02-2024
1 156.52 23.48 180.00
From : ‫ﻣن‬ ‫اﻟﺗﺄﻣﯾن اﻟﺻﺣﻲ ﻟﻠﺳﺎﺋﺣﯾن‬ (15%)
To : 12-02-2025 ‫اﻟﻰ‬

TOTAL AMOUNTS: :‫ إﺟﻣﺎﻟﻲ اﻟﻣﺑﻠﻎ‬REMARKS: :‫ﻣﻼﺣظﺎت‬


Gross premium (Excluding VAT) 156.52 SAR (VAT ‫)ﻏﯾر ﺷﺎﻣل‬ ‫اﻟﻘﺳط اﻹﺟﻣﺎﻟﻲ‬
Value Added Tax (15%) 23.48 SAR ‫ﻣﺟﻣوع ﺿرﯾﺑﺔ اﻟﻘﯾﻣﺔ اﻟﻣﺿﺎﻓﺔ‬
Premium (including VAT) 180.00 SAR ‫ﻗﺳط اﻟﺗﺄﻣﯾن ﺷﺎﻣﻼً ﺿرﯾﺑﺔ اﻟﻘﯾﻣﺔ اﻟﻣﺿﺎﻓﺔ‬
Total Amount Due 180.00 SAR ‫إﺟﻣﺎﻟﻲ اﻟﻣﺑﻠﻎ اﻟواﺟب اﻟﺳداد‬
The Sum Of: ONE HUNDRED AND EIGHTY SAUDI RIYALS.
.‫ ﻣﺋﺔ و ﺛﻣﺎﻧون ﷼ ﺳﻌودي‬:‫ﻣﺑﻠﻎ وﻗدره‬
180.00 SAR

Company Seal

GULF INSURANCE GROUP ‫ﻣﺟﻣوﻋﺔ اﻟﺧﻠﯾﺞ ﻟﻠﺗﺄﻣﯾن‬


GIG VAT Registration Number 300183559500003 ٣٠٠١٨٣٥٥٩٥٠٠٠٠٣ ‫رﻗم ﺗﺳﺟﯾل ﺿرﯾﺑﺔ اﻟﻘﯾﻣﺔ اﻟﻣﺿﺎﻓﺔ‬
A Saudi joint stock company | Paid-up capital 500 Million Saudi Riyals ‫ ﷼ ﺳﻌودي‬٥٠٠,٠٠٠,٠٠٠ ‫ﺷرﻛﺔ ﻣﺳﺎھﻣﺔ ﺳﻌودﯾﺔ | رأس اﻟﻣﺎل‬
Licensed by No (TMN/25/20101) | Commercial Registration No. 1010271203 ١٠١٠٢٧١٢٠٣ ‫( | ﺳﺟل ﺗﺟﺎري رﻗم‬٢٠١٠١/٢٥ ‫ﻣرﺧص ﻟﮭﺎ ﺑرﻗم )ت م ن‬
3528 King Abdullah Bin Abdulaziz Road, Al Nuzha District ٣٥٢٨ ‫ ﺣﻲ اﻟﻧزھﺔ‬،‫طرﯾﻖ اﻟﻣﻠك ﻋﺑدﷲ ﺑن ﻋﺑداﻟﻌزﯾز‬
Unit No. 25 | Riyadh 12471-6378 ١٢٤٧١-٦٣٧٨ ‫ | اﻟرﯾﺎض‬٢٥ ‫رﻗم اﻟوﺣدة‬
Toll free 8001160020 | Website: www.gig.sa www.gig.sa :‫ | اﻟﻣوﻗﻊ اﻹﻟﻛﺗروﻧﻲ‬٨٨٠٠١١٦٠٠٢٠ ‫اﻟرﻗم اﻟﻣﺟﺎﻧﻲ‬
Regulated and Supervised by Insurance Authority ‫ﺧﺎﺿﻌﺔ ﻟرﻗﺎﺑﺔ واﺷراف ھﯾﺋﺔ اﻟﺗﺄﻣﯾن‬
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