Insurance Certificate (Schedule No.

5) ( 5 ‫ﺷﻬﺎﺩﺓ ﺍﻟﺗﺄﻣﻳﻥ ) ﺟﺩﻭﻝ ﺭﻗﻡ‬

Schedule Of Details Of the Insured Motor Vehicle In The Insurance policy ‫ﺟﺩﻭﻝ ﺑﻳﺎﻧﺎﺕ ﺍﻟﻣﺭﻛﺑﺔ ﺍﻟﻣﺅﻣﻥ ﻋﻠﻳﻬﺎ ﻓﻲ ﻭﺛﻳﻘﺔ ﺗﺄﻣﻳﻥ ﺍﻟﻔﻘﺩ ﻭﺍﻟﺗﻠﻑ ﻭﺍﻟﻣﺳﺅﻭﻟﻳﺔ ﺍﻟﻣﺩﻧﻳﺔ‬
Against Loss And Damage And Third Party Liability

Abu Dhabi National Takaful Company - Takaful P.S.C. declares that the ‫ ﺑﺄﻥ ﺍﻟﻣﺭﻛﺑﺔ ﺍﻟﻭﺍﺭﺩﺓ ﺑﻳﺎﻧﺎﺗﻬﺎ ﻓﻲ ﻫﺫﺍ ﺍﻟﺟﺩﻭﻝ ﻣﺅﻣﻧﺔ ﻟﺩﻳﻬﺎ ﻭﻓﻘﺎً ﻷﺣﻛﺎﻡ‬.‫ﻉ‬.‫ﻡ‬.‫ﺗﻘﺭ ﺷﺭﻛﺔ ﺃﺑﻭﻅﺑﻲ ﺍﻟﻭﻁﻧﻳﺔ ﻟﻠﺗﻛﺎﻓﻝ – ﺗﻛﺎﻓﻝ ﺵ‬
Motor Vehicle detailed above in this Schedule is insured with it according to .‫ﻫﺫﻩ ﺍﻟﻭﺛﻳﻘﺔ‬
the provisions of this Policy.

Policy Number : P/199/1/10145/2023/073072 P/199/1/10145/2023/073072 : ‫ﺭﻗﻡ ﺍﻟﻭﺛﻳﻘﺔ‬

Certificate Number : : ‫ﺭﻗﻡ ﺍﻟﺷﻬﺎﺩﺓ‬

Issued By : : ‫ﻣﺭﻛﺯ ﺍﻹﺻﺩﺍﺭ‬

Issuance Date : 20/12/2023 12:15 12:15 20/12/2023 : ‫ﺗﺎﺭﻳﺦ ﺍﻹﺻﺩﺍﺭ‬

Insurance Type : Motor Third Party Liability-Aber ‫ﻋﺎﺑﺭ‬-‫ ﺿﺩ ﺍﻟﻣﺳﺅﻭﻟﻳﺔ ﺍﻟﻣﺩﻧﻳﺔ ﻓﻘﻁ‬: ‫ﻧﻭﻉ ﺍﻟﻭﺛﻳﻘﺔ‬

Insured Name : ‫ ﻋﺑﺩﺍﻟﺭﺣﻣﻥ ﻣﺣﻣﺩ ﻏﺎﻟﺏ ﺍﻟﺷﻣﻳﺭﻯ‬: ‫ﺇﺳﻡ ﺍﻟﻣﺅﻣﻥ ﻟﻪ‬

Emirates ID No : : ‫ﺭﻗﻡ ﺍﻟﻬﻭﻳﺔ‬

Trade License No : : ‫ﺭﻗﻡ ﺍﻟﺭﺧﺻﺔ ﺍﻟﺗﺟﺎﺭﻳﺔ‬

Address : : ‫ﺍﻟﻌﻧﻭﺍﻥ‬

P.O. Box : : ‫ﺻﻧﺩﻭﻕ ﺍﻟﺑﺭﻳﺩ‬

Phone : +97455557511 +97455557511 : ‫ﺍﻟﻬﺎﺗﻑ‬

Email Address : : ‫ﺍﻟﺑﺭﻳﺩ ﺍﻹﻟﻛﺗﺭﻭﻧﻲ‬

Policy Period From: 20/12/2023 12:12 To: 03/01/2024 23:59 23:59 03/01/2024 :‫ ﺇﻟﻰ‬12:12 20/12/2023 : ‫ﻣﻥ‬ ‫ﻣﺩﺓ ﺍﻟﻭﺛﻳﻘﺔ‬

Mortgaged To : : ‫ﺟﻬﺔ ﺍﻟﺭﻫﻥ‬

Contribution : AED 210.00 ‫ ﺩﺭﻫﻡ‬210.00 : ‫ﻗﻳﻣﺔ ﺍﻹﺷﺗﺭﺍﻙ‬

Specification Of The Insured Vehicle ‫ﺃﻭﺻﺎﻑ ﺍﻟﻣﺭﻛﺑﺔ ﺍﻟﻣﺅﻣﻥ ﻋﻠﻳﻬﺎ‬

‫ﺭﻗﻡ ﺍﻟﻘﺎﻋﺩﺓ‬ ‫ﺭﻗﻡ ﺍﻟﻠﻭﺣﺔ‬ ‫ﻧﻭﻉ ﺍﻟﻣﺭﻛﺑﺔ‬

Chassis No. Plate Number Type of Vehicle

SALEA7BU6P2198893 907330 ‫ﻗﻁﺭ‬ LAND ROVER -DEFENDER 110

‫ﺭﻗﻡ ﺍﻟﻣﺣﺭﻙ‬ ‫ﻟﻭﻥ ﺍﻟﻣﺭﻛﺑﺔ‬ ‫ﺷﻛﻝ ﺍﻟﻬﻳﻛﻝ‬

Engine No. Vehicle Color Type of Body

BLACK ‫ﻣﺭﻛﺑﺔ ﺧﺎﺻﺔ‬

‫ﻓﺋﺔ ﺍﻟﻣﺭﻛﺑﺔ‬ ‫ﺳﻧﺔ ﺍﻟﺻﻧﻊ‬ ‫ﺻﻔﺔ ﺍﻻﺳﺗﻌﻣﺎﻝ‬ ‫ﺻﻔﺔ ﺍﻟﺗﺳﺟﻳﻝ‬

Motor Vehicle Year of Manufacture Registration Of Use Registration Type
Classification

‫ﻣﺭﻛﺑﺔ ﺧﺎﺻﺔ‬ 2023 Private Vehicle

‫ﺑﻠﺩ ﺻﻧﻊ ﺍﻟﻣﺭﻛﺑﺔ‬ ‫ﺍﻟﺣﻣﻭﻟﺔ ﺃﻭ ﺍﻟﻭﺯﻥ‬ ‫ﻋﺩﺩ ﺍﻟﺭﻛﺎﺏ ﻣﻊ ﺍﻟﺳﺎﺋﻖ‬ ‫ﺳﻌﺔ ﺍﺳﻁﻭﺍﻧﺎﺕ ﺍﻟﻣﺣﺭﻙ‬
Country Of Manufacture Tonnage Or Weight Number Of Passengers With Driver Cylinder Capacity

The maximum liability of the company's for damage to items : AED 2,000,000 ‫ ﺩﺭﻫﻡ‬2,000,000 : ‫ﺃﻗﺻﻰ ﺣﺩﻭﺩ ﻣﺳﺅﻭﻟﻳﺔ ﺍﻟﺷﺭﻛﺔ ﻋﻥ ﺍﻷﺿﺭﺍﺭ ﺍﻟﺗﻲ ﺗﺻﻳﺏ ﺍﻷﺷﻳﺎء ﻭﺍﻟﻣﻣﺗﻠﻛﺎﺕ ﺣﺳﺏ ﺍﻟﺑﻧﺩ ﺝ ﻣﻥ‬
and properties under Section C of paragraph 1 of the chapter (‫ ﺑﺄﺣﻛﺎﻡ ﺍﻟﻔﺻﻝ ﺍﻟﺛﺎﻧﻲ )ﺍﻟﺗﺯﺍﻣﺎﺕ ﺷﺭﻛﺔ ﺍﻟﺗﺄﻣﻳﻥ‬1 ‫ﺍﻟﻔﻘﺭﺓ‬
two (Obligations of the insurance company)

Date Printing: 20/12/2023 12:15 12:15 20/12/2023 : ‫ﺗﺎﺭﻳﺦ ﺍﻟﻁﺑﺎﻋﺔ‬

Geographic Area : UAE ‫ ﺩﻭﻟﺔ ﺍﻹﻣﺎﺭﺍﺕ ﺍﻟﻌﺭﺑﻳﺔ ﺍﻟﻣﺗﺣﺩﺓ‬: ‫ﺍﻟﺣﺩﻭﺩ ﺍﻟﺟﻐﺭﺍﻓﻳﺔ‬

Notes : : ‫ﻣﻼﺣﻅﺎﺕ‬

Additional coverage : : ‫ﺗﻐﻁﻳﺎﺕ ﺍﺿﺎﻓﻳﺔ‬

- It is agreed upon that the company's liability (the insurer) for damages to third parties: :‫ ﻣﻥ ﺍﻟﻣﻔﻬﻭﻡ ﻭﺍﻟﻣﺗﻔﻖ ﻋﻠﻳﻪ ﺍﻥ ﻣﺳﺅﻭﻟﻳﺔ ﺍﻟﺷﺭﻛﺔ )ﺍﻟﻣﺅﻣﻥ ﻟﺩﻳﻬﺎ( ﻋﻥ ﺍﻻﺿﺭﺍﺭ ﺍﻟﺣﺎﺻﻠﺔ ﻟﻠﻐﻳﺭ‬-
Death or bodily injury for each claim or series of claims arising is 'unlimited' per .‫ﺍﻟﻭﻓﺎﺓ ﺃﻭ ﺍﻻﺿﺭﺍﺭ ﺍﻟﺟﺳﺩﻳﺔ 'ﻏﻳﺭ ﻣﺣﺩﻭﺩﺓ' ﻋﻥ ﻛﻝ ﻁﻠﺏ ﺃﻭ ﺳﻠﺳﻠﺔ ﻣﻥ ﺍﻟﻣﻁﺎﻟﺑﺎﺕ ﺍﻟﻧﺎﺷﺋﺔ ﻋﻥ ﺣﺎﺩﺛﺔ ﻭﺍﺣﺩﺓ‬
incident. .‫ ﺩﺭﻫﻡ ﻋﻥ ﻛﻝ ﻁﻠﺏ ﺃﻭ ﺳﻠﺳﻠﺔ ﻣﻥ ﺍﻟﻣﻁﺎﻟﺑﺎﺕ ﺍﻟﻧﺎﺷﺋﺔ ﻋﻥ ﺣﺎﺩﺛﺔ ﻭﺍﺣﺩﺓ‬2,000,000 ‫ﻟﻠﻣﻣﺗﻠﻛﺎﺕ ﺍﻟﻣﺎﺩﻳﺔ‬
For property damage, for each claim or series of claims is AED 2,000,000 per ‫ﻳﻘﺭ ﺍﻟﻣﺅﻣﻥ ﻟﻪ ﺑﺄﻧﻪ ﻗﺩ ﺍﻁﻠﻊ ﻋﻠﻰ ﺷﺭﻭﻁ ﻭﺍﺣﻛﺎﻡ ﻋﻘﺩ ﺍﻟﺗﺄﻣﻳﻥ ﺑﻅﺎﻫﺭ ﻫﺫﻩ ﺍﻟﻭﺛﻳﻘﺔ )ﺑﺎﻋﺗﺑﺎﺭﻫﺎ ﺍﻳﺿﺎﺣﺎ ﻟﻣﺎ ﻭﺭﺩ ﻓﻲ ﻫﺫﺍ ﺍﻟﺷﺄﻥ ﻟﻌﻘﺩ‬
incident. ‫ ﺻﺭﺍﺣﺔ ﺑﻳﻥ ﻁﺭﻓﻲ ﺍﻟﻌﻘﺩ ﺑﺄﻧﻪ )ﺍﻱ ﺍﻟﻣﺅﻣﻥ ﻟﻪ( ﻗﺩ ﻗﺑﻝ ﻋﻧﺩ ﺍﻟﺗﻌﺎﻗﺩ ﺑﺄﻥ ﺣﻘﻪ ﻓﻲ‬- ‫ﺍﻟﺗﺄﻣﻳﻥ( ﻭﺑﻧﺎء ﻋﻠﻳﻪ ﻓﺎﻧﻪ ﻣﻥ ﺍﻟﻣﺗﻔﻖ ﻋﻠﻳﻪ‬
The insured acknowledges that he has reviewed the terms and conditions (as a .‫ﺍﻟﻣﻁﺎﻟﺑﺔ ﺑﺎﻟﺗﻌﻭﻳﺽ ﻋﻥ ﺃﻱ ﺣﺎﺩﺙ ﺑﻣﻭﺟﺏ ﻋﻘﺩ ﺍﻟﺗﺄﻣﻳﻥ ﻳﺳﻘﻁ ﺍﺫﺍ ﻟﻡ ﻳﺳﺗﻭﻓﻲ ﺍﻻﺟﺭﺍءﺍﺕ ﺍﺳﺗﻳﻔﺎء ﻛﺎﻣﻼ‬
clarifications of what mentioned through the insurance contract), accordingly it is ‫ﺧﺩﻣﺔ ﺍﻻﺳﻌﺎﻑ ﺍﻟﻭﻁﻧﻲ‬
expressly agreed upon between both parties of the contract that the insured has
accepted upon contracting that his right to claim any compensation for any accident
under the insurance contract 'Policy' is forfeited if the required procedures haven't
fulfilled.
National Ambulance Cover

Passengers are covered under section 2 of the unified wording ‫ﺍﻟﺗﻐﻁﻳﺔ ﺗﺷﻣﻝ ﺍﻟﺭﻛﺎﺏ ﺗﺣﺕ ﻗﺳﻡ ﺍﻟﻣﺳﺅﻭﻟﻳﺔ ﺍﻟﻣﺩﻧﻳﺔ ﻣﻥ‬
‫ﺍﻟﻭﺛﻳﻘﺔ ﺍﻟﻣﻭﺣﺩﺓ‬

FOR Abu Dhabi National Takaful Company - Takaful P.S.C. . ‫ ﺗﻛﺎﻓﻝ‬- ‫ ﺵ ﻡ ﻉ‬-‫ ﺷﺭﻛﺔ ﺃﺑﻭﻅﺑﻲ ﺍﻟﻭﻁﻧﻳﺔ ﻟﻠﺗﻛﺎﻓﻝ‬: ‫ﻋﻥ‬

Authorized Signatory ‫ﺍﻟﺗﻭﻗﻳﻊ ﺍﻟﻣﻌﺗﻣﺩ‬

I declare that I read and accept the Sharia Introduction attached/shown in the company’s website ,in addition to the terms, conditions, ‫ﺃﺻﺭﺡ ﺑﺄﻧﻲ ﺍﻁﻠﻌﺕ ﻭﻭﺍﻓﻘﺕ ﻋﻠﻰ ﺍﻟﻣﻘﺩﻣﺔ ﺍﻟﺷﺭﻋﻳﺔ ﺍﻟﻣﺭﻓﻘﺔ ﺃﻭ‬
exclusions, Insurance Certificate and Additional coverages of the Insurance Policy. ،‫ﺍﻟﻣﺑﻳﻧﺔ ﻓﻲ ﺍﻟﻣﻭﻗﻊ ﺍﻻﻟﻛﺗﺭﻭﻧﻲ ﻟﻠﺷﺭﻛﺔ‬
‫ﺑﺎﻹﺿﺎﻓﺔ ﺇﻟﻰ ﺍﻟﺷﺭﻭﻁ ﻭﺍﻷﺣﻛﺎﻡ ﻭﺍﻹﺳﺗﺛﻧﺎءﺍﺕ ﻭﺷﻬﺎﺩﺓ ﺍﻟﺗﺎﻣﻳﻥ‬
‫ﻭﺍﻟﺗﻐﻁﻳﺎﺕ ﺍﻹﺿﺎﻓﻳﺔ ﻟﻭﺛﻳﻘﺔ ﺍﻟﺗﺄﻣﻳﻥ‬

Insured's / Proposer Name & Signature : : ‫ﺍﺳﻡ ﻭ ﺗﻭﻗﻳﻊ ﺍﻟﻣﺅﻣﻥ ﻟﻪ ﺃﻭ ﻁﺎﻟﺏ ﺍﻟﺗﺄﻣﻳﻥ‬

Date Printing: 20/12/2023 12:15 12:15 20/12/2023 : ‫ﺗﺎﺭﻳﺦ ﺍﻟﻁﺑﺎﻋﺔ‬