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Receipt - 3rd Installment - April 06 2023

Dubai Insurance Company receipt details payment of the 3rd monthly installment of a medical insurance plan by Arabella Mariano Canaria. The receipt acknowledges receipt of 5 AED, with a remaining balance of 45 AED to be paid in 9 more installments. It provides key details such as the insured's ID number, COI number, installment due dates, amounts paid and outstanding. The receipt was generated electronically without a physical signature.

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Mhariyah Maldhita
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57 views1 page

Receipt - 3rd Installment - April 06 2023

Dubai Insurance Company receipt details payment of the 3rd monthly installment of a medical insurance plan by Arabella Mariano Canaria. The receipt acknowledges receipt of 5 AED, with a remaining balance of 45 AED to be paid in 9 more installments. It provides key details such as the insured's ID number, COI number, installment due dates, amounts paid and outstanding. The receipt was generated electronically without a physical signature.

Uploaded by

Mhariyah Maldhita
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as PDF, TXT or read online on Scribd
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Dubai Insurance Company Psc, Head Office, Al Rigga Road, PO Box 3027, Dubai, UAE

TRN: 100032059600003

Receipt / ‫ﺳﻨﺪ ﻗﺒﺾ‬

Receipt Number PR0001202842 ‫ﺭﻗﻢ ﺳﻨﺪ ﺍﻟﻘﺒﺾ‬


Receipt Date 06-04-2023 ‫ﺗﺎﺭﻳﺦ ﺳﻨﺪ ﺍﻟﻘﺒﺾ‬
Name of the Insured worker ARABELLA MARIANO CANARIA ‫ﺍﺳﻢ ﺍﻟﻌﺎﻣﻞ ﺍﻟﻤﺆﻣﻦ ﻋﻠﻴﻪ‬
Emirates ID No./UID number 784197931316919 ‫ ﺍﻟﺮﻗﻢ ﺍﻟﻤﻮﺣﺪ‬/ ‫ﺭﻗﻢ ﺍﻟﻬﻮﻳﺔ ﺍﻹﻣﺎﺭﺍﺗﻴﺔ‬
COI # C/01/2023/000197957 ‫ﺭﻗﻢ ﺷﻬﺎﺩﺓ ﺍﻟﺘﺄﻣﻴﻦ‬
Payment Plan (monthly/quarterly/yearly) Monthly ‫ﺩﻭﺭﻳّﺔ ﺍﻟﺴﺪﺍﺩ‬

Due Date of last installment 09-12-2023 ‫ﺗﺎﺭﻳﺦ ﺍﺳﺘﺤﻘﺎﻕ ﺍﻟﺪﻓﻌﺔ ﺍﻷﺧﻴﺮﺓ ﻣﻦ ﺍﻟﻘﺴﻂ ﺍﻟﺘﺄﻣﻴﻨﻲ‬

Instalment number 3rd ‫ﺭﻗﻢ ﺍﻟﺪﻓﻌﺔ‬


Number of instalments paid (including 3 (‫ﻋﺪﺩ ﺍﻟﺪﻓﻌﺎﺕ ﺍﻟﻤﺴﺪﺩﺓ )ﻣﺘﻀﻤﻨﺔ ﻫﺬﻩ ﺍﻟﺪﻓﻌﺔ‬
this instalment)
Number of instalments outstanding 9 ‫ﻋﺪﺩ ﺍﻟﺪﻓﻌﺎﺕ ﺍﻟﻤﺘﺒﻘﻴﺔ‬
Payment against Tax Invoice 0000197957 ‫ﺍﻟﺪﻓﻌﺔ ﺿﺪّ ﺍﻟﻔﺎﺗﻮﺭﺓ ﺍﻟﻀﺮﻳﺒﻴّﺔ ﺭﻗﻢ‬
Tax Invoice date 09-01-2023 ‫ﺗﺎﺭﻳﺦ ﺍﻟﻔﺎﺗﻮﺭﺓ ﺍﻟﻀﺮﻳﺒﻴّﺔ‬
Amount received 5.00 ‫ﺍﻟﻤﺒﻠﻎ ﺍﻟﻤُﺴﺪﺩ‬
Payment Reference Number R0000197955 ‫ﺭﻗﻢ ﺍﻟﺪﻓﻌﺔ ﺍﻟﻤﺮﺟﻌﻲ‬
Payment made through Credit Card ‫ﺁﻟﻴﺔ ﺳﺪﺍﺩ ﺍﻟﺪﻓﻌﺔ‬

Total instalments received with VAT 18.00 ‫ﺇﺟﻤﺎﻟﻲ ﺍﻟﺪﻓﻌﺎﺕ ﺍﻟﻤُﺴﺪﺩﺓ ﺷﺎﻣﻞ ﺿﺮﻳﺒﺔ ﺍﻟﻘﻴﻤﺔ ﺍﻟﻤﻀﺎﻓﺔ‬

Balance to be received in agreed 45.00 ‫ﺇﺟﻤﺎﻟﻲ ﺍﻟﺪﻓﻌﺎﺕ ﺍﻟﻤﺘﺒﻘﻴﺔ ﺍﻟﻤﺴﺘﺤﻘﺔ ﻣﻦ ﺍﻟﻘﺴﻂ‬


instalments (AED) ‫ﺍﻟﺘﺄﻣﻴﻨﻲ‬

‫ ﻭﻗﺪ‬،‫ﻻ ﻳﺤﺘﺎﺝ ﺳﻨﺪ ﺍﻟﻘﺒﺾ ﻫﺬﺍ ﺇﻟﻰ ﺧﺘﻢ ﺃﻭ ﺗﻮﻗﻴﻊ‬


This is a system generated document
ّ‫ﺻﺪﺭ ﺑﺼﻮﺭﺓ ﺇﻟﻜﺘﺮﻭﻧﻴّﺔ ﻣﻦ ﺧﻼﻝ ﺍﻟﻨﻈﺎﻡ ﺍﻹﻟﻜﺘﺮﻭﻧﻲ‬
does not need any signature

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