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accidentReport (6)
accidentReport (6)
accidentReport (6)
ﺑﻴﺎﻧﺎﺕ ﺍﻟﺤﺎﺩﺙ
ﻋﺪﺩ ﺍﻟﻤﺮﻛﺒﺎﺕ ﺍﻟﻤﺸﺘﺮﻛﺔ ﺑﺎﻟﺤﺎﺩﺙ ﺳﺒﺐ ﺍﻟﺤﺎﺩﺙ ﺍﻟﺮﺋﻴﺴﻰ 2020-11-12 ﺗﺎﺭﻳﺦ ﺍﻟﺤﺎﺩﺙ
3 ﻋﺪﻡ ﺗﺮﻙ ﻣﺴﺎﻓﺔ ﻛﺎﻓﻴﺔ
No. of Vehicles Involved Primary Cause 00:00:00.0 Accident Date
ﻣﻌﺒﺪ -ﺟﺎﻑ ﺣﺎﻟﺔ ﺳﻄﺢ ﺍﻟﻄﺮﻳﻖ ﻻ ﻳﻮﺟﺪ ﺳﺒﺐ ﺍﻟﺤﺎﺩﺙ ﺍﻟﺜﺎﻧﻮﻱ 16:48 ﻭﻗﺖ ﺍﻟﺤﺎﺩﺙ
Road Condition Secondary Cause Accident Time
Affected Party Copy ﻧﺴﺨﺔ ﺍﻟﻤﺘﻀﺮﺭ / Liable Party Copy ﻧﺴﺨﺔ ﺍﻟﻤﺘﺴﺒﺐ ﺑﺎﻟﺤﺎﺩﺙ /
ﻳﺎﺳﺮ ﻣﺤﻤﺪ ﻳﻌﻘﻮﺏ ﻋﺒﺪﺍﻟﺤﻤﻴﺪ ﺍﻟﺘﻤﻴﻤﻲ Driver Nameﻓﺮﺍﺱ ﺣﺴﺎﻥ ﺍﻟﻮﺭﻉ ﺍﺳﻢ ﺍﻟﺴﺎﺋﻖ
971508699123 971507214888 Mobile Number ﺭﻗﻢ ﺍﻟﻬﺎﺗﻒ
08/08/1977 12/12/1900 Age ﺍﻟﻌﻤﺮ
ﺫﻛﺮ Genderﺫﻛﺮ ﺍﻟﺠﻨﺲ
ﺍﻻﺭﺩﻥ Nationalityﺳﻮﺭﻳﺎ ﺍﻟﺠﻨﺴﻴﺔ
841421 75165 License No ﺭﻗﻢ ﺍﻟﺮﺧﺼﺔ
ﺩﺑﻲ License Issue Placeﺭﺍﺱ ﺍﻟﺨﻴﻤﺔ ﻣﺼﺪﺭ ﺍﻟﺮﺧﺼﺔ
13/12/2024 14/01/2025 License Expiry Date ﺗﺎﺭﻳﺦ ﺍﻧﺘﻬﺎﺀ ﺍﻟﺮﺧﺼﺔ
- - Liable Party Fine No ﺭﻗﻢ ﻣﺨﺎﻟﻔﺔ ﺍﻟﻤﺘﺴﺒﺐ
ﺍﻟﺸﺮﻛﺔ ﺍﻟﻮﻃﻨﻴﺔ ﻟﻠﺘﺄﻣﻴﻨﺎﺕ ﺍﻟﻌﺎﻣﺔ )ﺷﺮﻛﺔ ﻣﺴﺎﻫﻤﺔ ﻋﺎﻣﺔ( Insurance Companyﺷﺮﻛﺔ ﺍﻟﻮﺛﺒﺔ ﺍﻟﻮﻃﻨﻴﺔ ﻟﻠﺘﺎﻣﻴﻦ ﺷﺮﻛﺔ ﺍﻟﺘﺄﻣﻴﻦ
11MCS/20/00290 40/9017/90/2019/20415 Policy No ﺭﻗﻢ ﺍﻟﺒﻮﻟﻴﺼﺔ
13/05/2021 30/01/2021 Ins. Expiry Date ﺗﺎﺭﻳﺦ ﺍﻧﺘﻬﺎﺀ ﺍﻟﺒﻮﻟﻴﺼﺔ
91066ﺩﺑﻲ ﺧﺼﻮﺻﻲ D 78156 Plate Detailsﺩﺑﻲ ﺧﺼﻮﺻﻲ T ﺑﻴﺎﻧﺎﺕ ﺍﻟﻠﻮﺣﺔ
ﺍﺟﺮﻱ ﺯﻭﻥ ﻟﻠﺘﺠﺎﺭﺓ ﺵ.ﺫ.ﻡ.ﻡ Owner Nameﻛﺮﻳﺴﺘﻰ ﻣﺎﻻﻳﻮ ﺗﻴﻠﻴﺞ ﺍﺳﻢ ﺍﻟﻤﺎﻟﻚ
- -TOYOTA - COROLLAﺍﺑﻴﺾ 2014 - - - MERCEDES Make-Model-Color-Yearﻓﻀﻲ 2001 - ﺍﻟﻨﻮﻉ-ﺍﻟﻄﺮﺍﺯ-ﺍﻟﻠﻮﻥ-ﺍﻟﺴﻨﺔ
13/04/2021 30/12/2020 Reg. Expiry Date ﺗﺎﺭﻳﺦ ﺍﻧﺘﻬﺎﺀ ﺍﻟﻤﻠﻜﻴﺔ
ﺑﺴﻴﻄﺔ -ﺍﻟﻤﻘﺪﻣﺔ ﻭﺍﻟﻤﺆﺧﺮﺓ Level of Damagesﺑﺴﻴﻄﺔ -ﺍﻟﻤﻘﺪﻣﺔ ﺩﺭﺟﺔ ﺍﻷﺿﺮﺍﺭ
ﻣﻼﺣﻈﺎﺕ ﻫﺎﻣﺔ:
ﺗﻘﺪﻡ ﺗﻘﺎﺭﻳﺮ ﺗﻜﺎﻟﻴﻒ ﺗﺼﻠﻴﺢ ﻣﺮﻛﺒﺎﺕ ﺍﻷﻃﺮﺍﻑ ﺍﻟﻤﺘﻀﺮﺭﺓ ﺇﻟﻰ ﺷﺮﻛﺔ ﺍﻟﺘﺄﻣﻴﻦ .ﻭ ﻓﻴﻲ ﺣﺎﻟﺔ ﻋﺪﻡ ﻗﺒﻮﻟﻬﺎ ﻣﻦ ﻗﺒﻞ ﺍﻟﺸﺮﻛﺔ ﺍﻟﻤﺨﺘﺼﺔ ﺗﺤﺎﻝ ﺇﻟﻰ ﺍﻟﺸﺮﻃﺔ ﻻﻋﺘﻤﺎﺩﻫﺎ. .1
ﻻ ﻣﺎﻧﻊ ﻣﻦ ﺗﺼﻠﻴﺢ ﺍﻷﺿﺮﺍﺭ ﺍﻟﺘﻲ ﺣﺼﻠﺖ ﻓﻲ ﺍﻟﻤﺮﻛﺒﺎﺕ ﺍﻟﻤﺸﺘﺮﻛﺔ ﻓﻲ ﺍﻟﺤﺎﺩﺙ ﺍﻟﻤﺪﻭﻧﺔ ﺗﻔﺎﺻﻴﻠﻪ ﺃﻋﻼﻩ. .2
ﻟﻐﺎﻳﺔ ﺍﻹﻋﺘﺮﺍﺽ ﻋﻠﻰ ﺍﻟﺘﻘﺮﻳﺮﻳﺮﺟﻰ ﺯﻳﺎﺭﺓ ﺍﻟﻤﺮﻛﺰ ﺍﻟﻤﻌﻨﻲ ﺧﻼﻝ 24ﺳﺎﻋﺔ. .3
ﻧﺴﺨﺔ ﺍﻟﻤﺘﺴﺒﺐ ﺑﺎﻟﺤﺎﺩﺙ ﺍﻟﺮﻗﻢ ﺍﻟﺴﺮﻱ Security Code / ﺭﻗﻢ ﺍﻟﺘﻘﺮﻳﺮ Report Number /
Liable Party Copy 2001 220010119315
ﻣﺮﻛﺰ ﺷﺮﻃﺔ ﺍﻟﻘﺼﻴﺺ ﺍﻟﻤﺮﻛﺰ 00:00:00.0 2020-11-12 ﺗﺎﺭﻳﺦ ﺍﻟﺘﻘﺮﻳﺮ Report Date /
ﺑﻴﺎﻧﺎﺕ ﺍﻟﺤﺎﺩﺙ
ﻋﺪﺩ ﺍﻟﻤﺮﻛﺒﺎﺕ ﺍﻟﻤﺸﺘﺮﻛﺔ ﺑﺎﻟﺤﺎﺩﺙ ﺳﺒﺐ ﺍﻟﺤﺎﺩﺙ ﺍﻟﺮﺋﻴﺴﻰ 2020-11-12 ﺗﺎﺭﻳﺦ ﺍﻟﺤﺎﺩﺙ
3 ﻋﺪﻡ ﺗﺮﻙ ﻣﺴﺎﻓﺔ ﻛﺎﻓﻴﺔ
No. of Vehicles Involved Primary Cause 00:00:00.0 Accident Date
ﻣﻌﺒﺪ -ﺟﺎﻑ ﺣﺎﻟﺔ ﺳﻄﺢ ﺍﻟﻄﺮﻳﻖ ﻻ ﻳﻮﺟﺪ ﺳﺒﺐ ﺍﻟﺤﺎﺩﺙ ﺍﻟﺜﺎﻧﻮﻱ 16:48 ﻭﻗﺖ ﺍﻟﺤﺎﺩﺙ
Road Condition Secondary Cause Accident Time
Affected Party Copy ﻧﺴﺨﺔ ﺍﻟﻤﺘﻀﺮﺭ / Liable Party Copy ﻧﺴﺨﺔ ﺍﻟﻤﺘﺴﺒﺐ ﺑﺎﻟﺤﺎﺩﺙ /
ﻛﻤﺮﺍﻥ ﺧﺎﻥ ﺻﺎﺩﻕ ﺧﺎﻥ Driver Nameﻓﺮﺍﺱ ﺣﺴﺎﻥ ﺍﻟﻮﺭﻉ ﺍﺳﻢ ﺍﻟﺴﺎﺋﻖ
971504564281 971507214888 Mobile Number ﺭﻗﻢ ﺍﻟﻬﺎﺗﻒ
01/01/1990 12/12/1900 Age ﺍﻟﻌﻤﺮ
ﺫﻛﺮ Genderﺫﻛﺮ ﺍﻟﺠﻨﺲ
ﺑﺎﻛﺴﺘﺎﻥ Nationalityﺳﻮﺭﻳﺎ ﺍﻟﺠﻨﺴﻴﺔ
3555958 75165 License No ﺭﻗﻢ ﺍﻟﺮﺧﺼﺔ
ﺩﺑﻲ License Issue Placeﺭﺍﺱ ﺍﻟﺨﻴﻤﺔ ﻣﺼﺪﺭ ﺍﻟﺮﺧﺼﺔ
27/08/2025 14/01/2025 License Expiry Date ﺗﺎﺭﻳﺦ ﺍﻧﺘﻬﺎﺀ ﺍﻟﺮﺧﺼﺔ
- - Liable Party Fine No ﺭﻗﻢ ﻣﺨﺎﻟﻔﺔ ﺍﻟﻤﺘﺴﺒﺐ
ﺷﺮﻛﺔ ﻋﻤﺎﻥ ﻟﻠﺘﺎﻣﻴﻦ )ﺵ ﻡ ﻉ( Insurance Companyﺷﺮﻛﺔ ﺍﻟﻮﺛﺒﺔ ﺍﻟﻮﻃﻨﻴﺔ ﻟﻠﺘﺎﻣﻴﻦ ﺷﺮﻛﺔ ﺍﻟﺘﺄﻣﻴﻦ
0102010101533946 40/9017/90/2019/20415 Policy No ﺭﻗﻢ ﺍﻟﺒﻮﻟﻴﺼﺔ
13/08/2021 30/01/2021 Ins. Expiry Date ﺗﺎﺭﻳﺦ ﺍﻧﺘﻬﺎﺀ ﺍﻟﺒﻮﻟﻴﺼﺔ
85357ﺩﺑﻲ ﺧﺼﻮﺻﻲ H 78156 Plate Detailsﺩﺑﻲ ﺧﺼﻮﺻﻲ T ﺑﻴﺎﻧﺎﺕ ﺍﻟﻠﻮﺣﺔ
ﺍﻧﻴﻞ ﺩﻫﻨﺮﺍﺝ ﺑﻮﺩﻫﺮﺍﻧﻲ Owner Nameﻛﺮﻳﺴﺘﻰ ﻣﺎﻻﻳﻮ ﺗﻴﻠﻴﺞ ﺍﺳﻢ ﺍﻟﻤﺎﻟﻚ
- -TOYOTA - INNOVAﻓﻀﻲ 2012 - - - MERCEDES Make-Model-Color-Yearﻓﻀﻲ 2001 - ﺍﻟﻨﻮﻉ-ﺍﻟﻄﺮﺍﺯ-ﺍﻟﻠﻮﻥ-ﺍﻟﺴﻨﺔ
13/07/2021 30/12/2020 Reg. Expiry Date ﺗﺎﺭﻳﺦ ﺍﻧﺘﻬﺎﺀ ﺍﻟﻤﻠﻜﻴﺔ
ﺑﺴﻴﻄﺔ -ﺍﻟﻤﺆﺧﺮﺓ Level of Damagesﺑﺴﻴﻄﺔ -ﺍﻟﻤﻘﺪﻣﺔ ﺩﺭﺟﺔ ﺍﻷﺿﺮﺍﺭ
ﻣﻼﺣﻈﺎﺕ ﻫﺎﻣﺔ:
ﺗﻘﺪﻡ ﺗﻘﺎﺭﻳﺮ ﺗﻜﺎﻟﻴﻒ ﺗﺼﻠﻴﺢ ﻣﺮﻛﺒﺎﺕ ﺍﻷﻃﺮﺍﻑ ﺍﻟﻤﺘﻀﺮﺭﺓ ﺇﻟﻰ ﺷﺮﻛﺔ ﺍﻟﺘﺄﻣﻴﻦ .ﻭ ﻓﻴﻲ ﺣﺎﻟﺔ ﻋﺪﻡ ﻗﺒﻮﻟﻬﺎ ﻣﻦ ﻗﺒﻞ ﺍﻟﺸﺮﻛﺔ ﺍﻟﻤﺨﺘﺼﺔ ﺗﺤﺎﻝ ﺇﻟﻰ ﺍﻟﺸﺮﻃﺔ ﻻﻋﺘﻤﺎﺩﻫﺎ. .1
ﻻ ﻣﺎﻧﻊ ﻣﻦ ﺗﺼﻠﻴﺢ ﺍﻷﺿﺮﺍﺭ ﺍﻟﺘﻲ ﺣﺼﻠﺖ ﻓﻲ ﺍﻟﻤﺮﻛﺒﺎﺕ ﺍﻟﻤﺸﺘﺮﻛﺔ ﻓﻲ ﺍﻟﺤﺎﺩﺙ ﺍﻟﻤﺪﻭﻧﺔ ﺗﻔﺎﺻﻴﻠﻪ ﺃﻋﻼﻩ. .2
ﻟﻐﺎﻳﺔ ﺍﻹﻋﺘﺮﺍﺽ ﻋﻠﻰ ﺍﻟﺘﻘﺮﻳﺮﻳﺮﺟﻰ ﺯﻳﺎﺭﺓ ﺍﻟﻤﺮﻛﺰ ﺍﻟﻤﻌﻨﻲ ﺧﻼﻝ 24ﺳﺎﻋﺔ. .3