Policy Schedule ‫ﺟـــﺪﻭﻝ ﺍﻟـﻮﺛــﻴــﻘــﺔ‬

Policy No: 103/0501/2025/P/004581 : ‫ﺭﻗﻢ ﺍﻟﻮﺛـﻴـﻘـﺔ‬

Type of Insurance: Individual Motor - Comprehensive : ‫ﻧـﻮﻉ ﺍﻟـﺘـﺄﻣـﻴـﻦ‬
Usage: Private ‫ﻧﻮﻉ ﺍﻻﺳﺘﺨﺪﺍﻡ‬:
Insured’s Name: AHMED MOHAMMED MONSEFF ALSAYED ELGENIDI : ‫ﺍﺳﻢ ﺍﻟﻤﺆﻣـﻦ ﻟـﻪ‬
Driver details: :‫ﺑﻴﺎﻧﺎﺕ ﺍﻟﺴﺎﺋﻖ‬
‫ﺍﻻﺳﻢ‬ ‫ﺍﻟﻌﻤﺮ‬ ‫ﺍﻟﺠﻨﺲ‬ ‫ﺭﻗﻢ ﺍﻟﺒﻄﺎﻗﺔ ﺍﻟﻤﺪﻧﻴﺔ‬
Name Age Gender ID No
AHMED MOHAMMED MONSEFF 35 Male 113394003
AHMED MOHAMMED ATTA MONSEEF
NASSAR ALDEEN OAIS
ALAMEER MOHAMMED
ABDULMONIM
Bank/Finance Details
‫ﺭﻗـﻢ ﺍﻟـﻨـﻘـﺎﻝ‬ ‫ﺭﻗـﻢ ﺍﻟﻬـﺎﺗــﻒ‬ ‫ﺍﻟـﺮﻣـﺰ ﺍﻟـﺒـﺮﻳـﺪﻱ‬ ‫ﺭﻗـﻢ ﺻﻨﺪﻭﻕ ﺍﻟـﺒـﺮﻳـﺪ‬
Address Mobile No. Telephone. No. Postal Code P.O. Box ‫ﺍﻟـﻌـﻨـﻮﺍﻥ‬
97164383 .
Occupation ‫ﺍﻟﻤـﻬـﻨــﺔ ﺃﻭ ﺍﻟﻮﻇﻴﻔﺔ‬ Geographical Area: Sultanate of Oman +UAE :‫ﺍﻟﻤﻨﻄﻘﺔ ﺍﻟﺠﻐﺮﺍﻓﻴﺔ‬
Insurance Period: From 21/04/2025 00:00:00 To 20/04/2026 23:59:59 : ‫ﻣـﺪﺓ ﺍﻟـﺘـﺄﻣـﻴــﻦ‬
Particulars of the Insured Vehicle ‫ﺃﻭﺻــﺎﻑ ﺍﻟﻤـﺮﻛـﺒـﺔ ﺍﻟﻤـﺆﻣـﻦ ﻋﻠـﻴـﻬـﺎ‬
‫ﺳﻌﺔ ﺇﺳﻄﻮﺍﻧﺔ‬
‫ﻋﺪﺩ ﺍﻟﻤﻘﺎﻋﺪ‬ ‫ﺍﻟﻤﺤﺮﻙ ﺃﻭ ﻗﻮﺓ‬
‫ﺍﻟﻤﺮﺧﺺ ﻟﻬﺎ‬ ‫ﺍﻟﻤﺤﺮﻙ‬ ‫ﻣـﺒـﻠـﻎ‬
‫ﺑﻤﺎ ﻓﻴﻬﺎ ﻣﻘﻌﺪ‬ ‫ﺑﺎﻷﺣﺼﻨﺔ ﻭﺯﻥ‬ ‫ﺭﻗﻢ ﺍﻟﺸﺎﺻﻲ‬ ‫ﺳﻨﺔ ﺍﻟﺼﻨﻊ‬ ‫ﺍﻟﻐﺮﺽ ﻣﻦ‬ ‫ﺍﻟـﺘـﺄﻣـﻴـﻦ‬ ‫ﻭﺭﻗﻢ‬
‫ﻧﻮﻉ ﺍﻟﻤﺮﻛﺒﺔ‬ ‫ﺍﻟﺴﺎﺋﻖ‬ ‫ﺍﻟﻤﺮﻛﺒﺔ‬ ‫ﺭﻗﻢ ﺍﻟﻤﺤﺮﻙ‬ ‫ﻭﻃﺮﺍﺯ ﺍﻟﻤﺮﻛﺒﺔ‬ ‫ﺍﻟﺘﺮﺧﻴﺺ‬ .‫ﻉ‬.‫)ﺭ‬ ‫ﺍﻟﺘﺴﺠﻴﻞ‬
Make & Model Seats (incl. CC/HP Chassis No & Model & Manf Purpose of Sum Insured Reg. No
driver) Weight Engine No. Year License (RO)
Haval Jolion 1+4 1497 / LGWEE5A59RK602757 2024 & 2023 6,885.000 91057/R
/
23479020585
Insurance Premium Calculation: Rials Omani : ‫ﺍﺣﺘﺴﺎﺏ ﻗﺴـﻂ‬
‫ﺭﻳﺎﻝ ﻋﻤﺎﻧﻲ‬ ‫ﺍﻟﺘﺄﻣﻴـﻦ‬
Basic Insurance Premium 93.603 ‫ﻗﺴﻂ ﺍﻟﺘﺄﻣﻴﻦ ﺍﻷﺳﺎﺳﻲ‬
Medical Expenses Premium 3.000 ‫ﻗﺴﻂ ﺍﻟﻤﺼﺎﺭﻳﻒ ﺍﻟﻄﺒﻴﺔ‬
Personal Accidents Premium 17.000 ‫ﻗﺴﻂ ﺍﻟﺤﻮﺍﺩﺙ ﺍﻟﺸﺨﺼﻴﺔ‬
Additional Benefits Premium 50.501 ‫ﻗﺴﻂ ﺍﻟﻤﺰﺍﻳﺎ ﺍﻹﺿﺎﻓﻴﺔ‬
Total Insurance Premium 164.104 ‫ﺇﺟﻤﺎﻟﻲ ﻗﺴﻂ ﺍﻟﺘﺄﻣﻴﻦ‬
Any Loadings 0.000 ‫ﺃﻳﺔ ﻗﺴﻂ ﺇﺿﺎﻓﻲ‬
No Claim Discount 0.000 ‫ﺧﺼﻢ ﻋﺪﻡ ﻭﺟﻮﺩ ﻣﻄﺎﻟﺒﺔ‬
Special Discount 0.000 ‫ﺧﺼﻢ ﺧﺎﺹ‬
Other Discounts 9.404 ‫ﺧﺼﻮﻣﺎﺕ ﺃﺧﺮﻯ‬
Net insurance premium 154.700 ‫ﺻﺎﻓﻲ ﻗﺴﻂ ﺍﻟﺘﺄﻣﻴﻦ‬
Supervision fees 0.900 ‫ﺭﺳﻮﻡ ﺍﻹﺷﺮﺍﻑ‬
Emergency fund fee 1.500 ‫ﺭﺳﻮﻡ ﺻﻨﺪﻭﻕ ﺍﻟﻄﻮﺍﺭﺉ‬
Injured Guaranteed Fund 0.400 ‫ﺻﻨﺪﻭﻕ ﺿﻤﺎﻥ ﻣﺴﺎﻋﺪﺓ ﺍﻟﻤﺼﺎﺑﻴﻦ‬
Other Fees 5.000 ‫ﺭﺳﻮﻡ ﺃﺧﺮﻯ‬
Total Premium Payable 162.500 ‫ﺇﺟﻤﺎﻟﻲ ﺍﻟﻘﺴﻂ ﺍﻟﻤُﺴﺘﺤﻖ ﺍﻟﺪﻓﻊ‬
VAT (@5%) 8.100 ‫ﺿﺮﻳﺒﺔ ﺍﻟﻘﻴﻤﺔ ﺍﻟﻤﻀﺎﻓﺔ‬
Total Premium Including VAT 170.600 ‫ﺍﺟﻤﺎﻟﻲ ﺍﻟﻘﺴﻂ ﺍﻟﻤﺴﺘﺤﻖ ﻟﻠﺪﻓﻊ ﺷﺎﻣﻞ ﺿﺮﻳﺒﺔ ﺍﻟﻘﻴﻤﺔ‬
‫ﺍﻟﻤﻀﺎﻓﺔ‬

Pol.No:103/0501/2025/P/004581 Page 1 of 6
‫‪Orange Card‬‬ ‫‪Road Side‬‬ ‫‪3020103‬‬ ‫ﺭﻗﻢ ﺑﻄﺎﻗﺔ ﺧﺪﻣﺔ ﺍﻟﻤﺴﺎﻋﺪﺓ‬
‫‪9991351‬‬ ‫ﺭﻗﻢ ﺍﻟﺒﻄﺎﻗﺔ ﺍﻟﺒﺮﺗﻘﺎﻟﻴﺔ‬ ‫‪ROP Cert. No.‬‬ ‫ﺭﻗﻢ ﺇﺳﺘﻤﺎﺭﺓ ﺍﻟﺸﺮﻃﺔ‬
‫‪No‬‬ ‫‪Assistance Card No‬‬ ‫‪229‬‬ ‫ﻋﻠﻰ ﺍﻟﻄﺮﻳﻖ‬

‫‪Pol.No:103/0501/2025/P/004581‬‬ ‫‪Page 2 of 6‬‬

‫‪Excess : The Insured Pays the following amount:‬‬ ‫‪(RO‬‬ ‫‪-‬‬ ‫)ﺭ‪.‬ﻉ ‪.‬‬ ‫ﻳﺘـﺤـﻤـﻞ ﺍﻟﻤـﺆﻣــﻦ ﻟـﻪ ﺍﻟﻤـﺒـﻠـﻎ ﺍﻟﻤـﻮﺿـﺢ‬ ‫ﺍﻟﺘـﺤـﻤـﻞ ‪:‬‬
‫ﺃﺩﻧــﺎﻩ‬
‫ﻣﺮﻛﺒﺎﺕ‬ ‫ﻣﺮﻛﺒﺎﺕ ﺗﺠﺎﺭﻳﺔ‬ ‫ﻣﺮﻛﺒﺎﺕ ﺗﺠﺎﺭﻳﺔ‬
‫‪SL‬‬ ‫‪Description‬‬ ‫ﺗﺠﺎﺭﻳﺔ‬ ‫ﺧﻔﻴﻔﺔ )ﻣﺮﻛﺒﺎﺕ‬ ‫ﺧﻔﻴﻔﺔ‬
‫‪No‬‬ ‫ﺛﻘﻴﻠﺔ ﻭ‬ ‫ﺍﻟﺘﺄﺟﻴﺮ ﺓﺗﻌﻠﻴﻢ‬ ‫(ﻋﺪﺍ ﻣﺮﻛﺒﺎﺕ ﺍﻟﺘﺄﺟﻴﺮ‬ ‫ﻣﺮﻛﺒﺎﺕ‬ ‫ﺍﻟـﺒــﻴــﺎﻥ‬ ‫ﻡ‬
‫ﻣﻌﺪﺍﺕ‬ ‫)ﺍﻟﻘﻴﺎﺩﺓ‬ ‫ﺓﺗﻌﻠﻴﻢ ﺍﻟﻘﻴﺎﺩﺓ)‬ ‫ﺧﺎﺻﺔ‬
‫‪Heavy‬‬ ‫‪Light Commercial‬‬ ‫‪Light Commercial‬‬ ‫‪Private‬‬
‫‪Commercial‬‬ ‫‪Vehicles‬‬ ‫‪Vehicle‬‬ ‫‪vehicle‬‬
‫‪Vehicles and‬‬ ‫& ‪(Rent-A-Car‬‬ ‫)‪Except Rent-A-Car‬‬
‫‪Equipment‬‬ ‫)‪Driving School‬‬ ‫& ‪Driving‬‬
‫‪1 Disclosed Drivers above 25‬‬ ‫ﺫﺍ ﻛﺎﻥ ﺍﻟﺴﺎﺋﻖ ﻣﻦ ﺍﻷﺷﺨﺎﺹ ﺍﻟﻤﺼﺮﺡ‬ ‫‪1‬‬
‫‪Years and above‬‬ ‫‪RO. 500‬‬ ‫‪RO. 150‬‬ ‫‪RO. 75‬‬ ‫‪RO. 50‬‬ ‫ﻟﻬﻢ ﺑﺎﻟﻘﻴﺎﺩﺓ ﺿﻤﻦ ﺍﻟﻘﺎﺋﻤﺔ ﺍﻟﻤﻮﺟﻮﺩﺓ ﻓﻲ‬
‫ﻃﻠﺐ ﺍﻟﺘﺄﻣﻴﻦ‪ ،‬ﻭﻋﻤﺮﻩ ‪ 25‬ﺳﻨﺔ ﻓﺄﻛﺜـﺮ‬
‫‪2 Disclosed Drivers below 25‬‬ ‫ﺫﺍ ﻛﺎﻥ ﺍﻟﺴﺎﺋﻖ ﻣﻦ ﺍﻷﺷﺨﺎﺹ ﺍﻟﻤﺼﺮﺡ‬ ‫‪2‬‬
‫‪Years‬‬ ‫‪RO. 750‬‬ ‫‪RO. 200‬‬ ‫‪RO. 100‬‬ ‫‪RO. 75‬‬ ‫ﻟﻬﻢ ﺑﺎﻟﻘﻴﺎﺩﺓ ﺿﻤﻦ ﺍﻟﻘﺎﺋﻤﺔ ﺍﻟﻤﻮﺟﻮﺩﺓ ﻓﻲ‬
‫ﻃﻠﺐ ﺍﻟﺘﺄﻣﻴﻦ‪ ،‬ﻭﻋﻤﺮﻩ ﺃﺻﻐﺮ ﻋﻦ ‪ 25‬ﺳﻨﺔ‬
‫‪3 Undisclosed Drivers above 25‬‬ ‫ﺇﺫﺍ ﻛﺎﻥ ﺍﻟﺴﺎﺋﻖ ﻣﻦ ﺍﻷﺷﺨﺎﺹ ﻏﻴﺮ‬ ‫‪3‬‬
‫‪Years and above‬‬ ‫‪RO. 1000‬‬ ‫‪RO. 150‬‬ ‫‪RO. 100‬‬ ‫‪RO. 75‬‬ ‫ﺍﻟﻤﺬﻛﻮﺭﻳﻦ ﺑﺎﻟﻘﺎﺋﻤﺔ ﻭﻋﻤﺮﻩ ‪ 25‬ﺳﻨﺔ‬
‫ﻓﺄﻛﺜﺮ‬
‫‪4 Undisclosed Drivers below 25‬‬ ‫ﺫﺍ ﻛﺎﻥ ﺍﻟﺴﺎﺋﻖ ﻣﻦ ﺍﻷﺷﺨﺎﺹ ﻏﻴﺮ‬ ‫‪4‬‬
‫‪Years‬‬ ‫‪RO. 1500‬‬ ‫‪RO. 200‬‬ ‫‪RO. 150‬‬ ‫‪RO. 100‬‬ ‫ﺍﻟﻤﺬﻛﻮﺭﻳﻦ ﺑﺎﻟﻘﺎﺋﻤﺔ ﻭﻋﻤﺮﻩ ﺃﺻﻐﺮ ﻋﻦ‬
‫ﺳﻨﺔ ‪25‬‬
‫‪5 License age is less than 3‬‬ ‫ﺗﺎﺭﻳﺦ ﺣﺼﻮﻝ ﺳﺎﺋﻖ ﺍﻟﻤﺮﻛﺒﺔ ﻋﻠﻰ‬ ‫‪5‬‬
‫‪(Three) years‬‬ ‫‪+ RO. 500‬‬ ‫‪+ RO. 50‬‬ ‫‪--‬‬ ‫ﺭﺧﺼﺔ ﺍﻟﻘﻴﺎﺩﺓ ﺃﻗﻞ ﻣﻦ ﺛﻼﺙ ﺳﻨﻮﺍﺕ‬

‫‪6‬‬ ‫‪License age is less than 5‬‬ ‫ﺗﺎﺭﻳﺦ ﺣﺼﻮﻝ ﺳﺎﺋﻖ ﺍﻟﻤﺮﻛﺒﺔ ﻋﻠﻰ‬ ‫‪6‬‬
‫‪(Five) years‬‬
‫‪+ RO. 250‬‬ ‫‪+ RO. 25‬‬ ‫‪--‬‬
‫ﺭﺧﺼﺔ ﺍﻟﻘﻴﺎﺩﺓ ﺃﻗﻞ ﻣﻦ ﺧﻤﺲ ﺳﻨﻮﺍﺕ‬
‫‪Higher Deductible‬‬ ‫ﻧﺴﺒﺔ ﺃﻋﻠﻰ ﻟﻠﺨﺼﻢ‬
‫‪NOT APPLICABLE‬‬
‫‪Description of Coverages‬‬ ‫‪Yes/No‬‬ ‫ﻭﺻﻒ ﺍﻟﺘﻐﻄﻴﺎﺕ ﺍﻹﺿﺎﻓﻴﺔ‬
‫‪Damage or loss to the Insured Vehicle‬‬ ‫‪Yes‬‬ ‫ﺍﻟﻔﻘﺪ ﺃﻭ ﺍﻟﻀﺮﺭ ﻋﻠﻰ ﺍﻟﻤﺮﻛﺒﺔ ﺍﻟﻤﺆﻣﻨﺔ‬

‫‪Third Party‬‬ ‫‪Yes‬‬ ‫ﻃﺮﻑ ﺛﺎﻟﺚ‬

‫)‪Personal Accident Benefit Driver Only (Limit RO 10,000‬‬ ‫‪Yes‬‬ ‫ﻣﻴﺰﺓ ﻣﻠﺤﻖ ﺍﻟﺤﻮﺍﺩﺙ ﺍﻟﺸﺨﺼﻴﺔ ﺍﻟﺴﺎﺋﻖ ﻓﻘﻂ )ﺑﺤﺪ ‪ 10000‬ﺭﻳﺎﻝ‬
‫ﻋﻤﺎﻧﻲ(‬

‫)‪Personal Accident Benefit Family/Passenger Extension (Limit RO 10,000‬‬ ‫‪Yes‬‬ ‫ﻣﻴﺰﺓ ﻣﻠﺤﻖ ﺍﻟﺤﻮﺍﺩﺙ ﺍﻟﺸﺨﺼﻴﺔ ﻻﻓﺮﺍﺩ ﺍﻻﺳﺮﺓ )ﺑﺤﺪ ‪ 10000‬ﺭﻳﺎﻝ‬
‫ﻋﻤﺎﻧﻲ(‬

‫‪Medical Expenses‬‬ ‫‪Yes‬‬ ‫ﻣﺼﺎﺭﻳﻒ ﺍﻟﻌﻼﺝ‬

‫‪UAE Cover Extension‬‬ ‫‪Yes‬‬ ‫ﺍﻟﺘﻐﻄﻴﺔ ﺍﻟﺘﺄﻣﻴﻨﻴﺔ ﻟﺪﻭﻟﺔ ﺍﻹﻣﺎﺭﺍﺕ ﺍﻟﻌﺮﺑﻴﺔ ﺍﻟﻤﺘﺤﺪﺓ‬

‫‪Agency Repairs at manufacturer's/dealer?s authorized workshop‬‬ ‫‪Yes‬‬ ‫ﺍﻹﺻﻼﺡ ﻓﻲ ﺍﻟﻮﺭﺷﺔ ﺍﻟﻤﻌﺘﻤﺪﺓ ﻣﻦ ﺍﻟﺸﺮﻛﺔ ‪ /‬ﺍﻟﻮﻛﻴﻞ‬

‫‪GCC Cover Extension‬‬ ‫‪No‬‬ ‫ﺍﻟﺘﻐﻄﻴﺔ ﺍﻟﺘﺄﻣﻴﻨﻴﺔ ﻟﺪﻭﻝ ﻣﺠﻠﺲ ﺍﻟﺘﻌﺎﻭﻥ ﺍﻟﺨﻠﻴﺠﻲ‬

‫)‪Repairs At An Approved Workshop Without Paying Depreciation (Partial Loss‬‬ ‫‪No‬‬ ‫ﺍﻹﺻﻼﺡ ﻓﻲ ﺍﻟﻮﺭﺷﺔ ﺍﻟﻤﻌﺘﻤﺪﺓ ﻣﻦ ﺷﺮﻛﺔ ﻇﻔﺎﺭ ﻟﻠﺘﺄﻣﻴﻦ ﺑﺪﻭﻥ‬
‫ﺗﻄﺒﻴﻖ ﻧﺴﺒﺔ ﺍﻻﺳﺘﻬﻼﻙ )ﺍﻟﺨﺴﺎﺭﺓ ﺍﻟﺠﺰﺋﻴﺔ(‬

‫)‪Off Road Cover (limited to 4x4 Cars‬‬ ‫‪No‬‬ ‫ﺍﻟﺘﻐﻄﻴﺔ ﺍﻟﺘﺄﻣﻴﻨﻴﺔ ﺧﺎﺭﺝ ﺍﻟﻄﺮﻳﻖ‪ -‬ﻣﻘﺼﻮﺭ ﻋﻠﻰ ﻣﺮﻛﺒﺎﺕ ﺍﻟﺪﻓﻊ‬
‫ﺍﻟﺮﺑﺎﻋﻲ‬

‫‪Loss or Damage of Insured`s Personal Belongings ? Inside the Vehicle (Limit -‬‬ ‫‪No‬‬ ‫ﺗﻐﻄﻴﺔ ﺍﻟﻤﻤﺘﻠﻜﺎﺕ ﺍﻟﺸﺨﺼﻴﺔ ﻟﻠﻤﺆﻣﻦ ﻟﻪ ‪ -‬ﺩﺍﺧﻞ ﺍﻟﻤﺮﻛﺒﺔ )ﺣﺪﻭﺩ‬
‫)‪RO.250‬‬ ‫ﺍﻟﺘﻐﻄﻴﺔ ﻫﻲ ‪ 250‬ﺭﻳﺎﻝ ﻋﻤﺎﻧﻲ ﻓﻘﻂ(‬

‫)‪New Car Replacement (No Depreciation on SI for TL or CTL Claims‬‬ ‫‪No‬‬ ‫ﺍﺳﺘﺒﺪﺍﻝ ﺍﻟﺴﻴﺎﺭﺓ ﺍﻟﺠﺪﻳﺪﺓ ? ﻟﻦ ﻳﺘﻢ ﺗﻄﺒﻴﻖ ﺃﻱ ﻧﺴﺒﺔ ﺍﺳﺘﻬﻼﻙ‬
‫ﻋﻠﻰ ﺍﻟﻤﺒﻠﻎ ﺍﻟﻤﺆﻣﻦ ﻋﻠﻴﻪ ﺍﻟﻤﺘﻌﻠﻖ ﺑﺎﻟﻤﻄﺎﻟﺒﺎﺕ ﺑﺴﺒﺐ ﺍﻟﺨﺴﺎﺭﺓ‬
‫ﺍﻟﻜﻠﻴﺔ ﺃﻭ ﺍﻟﺨﺴﺎﺭﺓ ﺍﻟﻜﻠﻴﺔ ﺍﻟﺘﻘﺪﻳﺮﻳﺔ‬
‫)‪Personal Accident Benefit for the Insured & Family (PAB Limit - RO.15,000‬‬ ‫‪No‬‬ ‫ﻣﻴﺰﺓ ﻣﻠﺤﻖ ﺍﻟﺤﻮﺍﺩﺙ ﺍﻟﺸﺨﺼﻴﺔ ﻟﻠﻤﺆﻣﻦ ﻟﻪ‪ /‬ﺃﻓﺮﺍﺩ ﺍﻷﺳﺮﺓ ‪ -‬ﺍﻟﺤﺪ‬
‫‪ 15,000‬ﺭﻳﺎﻝ ﻋﻤﺎﻧﻲ‬

‫)‪Protecting and Transporting Extension (With No Distance Limit‬‬ ‫‪No‬‬ ‫ﻣﻠﺤﻖ ﺍﻟﺤﺮﺍﺳﺔ ﻭﺳﺤﺐ ﺍﻟﻤﺮﻛﺒﺔ )ﺑﺪﻭﻥ ﺣﺪ ﻟﻠﻤﺴﺎﻓﺔ(‬

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Insured`s Property Damages (Insured's Properties Outside The Vehicle) No ‫ ﻣﻤﺘﻠﻜﺎﺕ ﺍﻟﻤﺆﻣﻦ ﻟﻪ ﺧﺎﺭﺝ ﺍﻟﻤﺮﻛﺒﺔ‬-‫ﺗﻠﻒ ﻣﻤﺘﻠﻜﺎﺕ ﺍﻟﻤﺆﻣﻦ ﻟﻪ‬

No Payment of Excess (Only for Insured and Authorised Named Drivers) No ‫ﻋﺪﻡ ﺩﻓﻊ ﺃﻱ ﻣﺴﺎﻫﻤﺔ? ﻓﻘﻂ ﻋﻨﺪ ﻗﻴﺎﺩﺓ ﺍﻟﻤﺮﻛﺒﺔ ﻣﻦ ﺟﺎﻧﺐ ﺍﻟﺸﺨﺺ‬
‫ﺍﻟﻤﺆﻣﻦ ﻋﻠﻴﻪ ﻭﻗﺎﺋﺪ ﺍﻟﻤﺮﻛﺒﺔ‬

Windscreen Damage Benefit (Limit RO.500) No ( ‫ ﺭﻳﺎﻝ‬500 ‫ﻣﻴﺰﺓ ﺍﻟﺘﻠﻒ ﻓﻲ ﺍﻟﺰﺟﺎﺝ ﺍﻷﻣﺎﻣﻲ )ﺑﺤﺪ‬

Hire Car Benefit (For A Substitute Vehicle) Limit RO. 8 Per Day Subject to No ‫ ﺭﻳﺎﻝ ﻟﻠﻴﻮﻡ ﺍﻟﻮﺍﺣﺪ‬8 ‫ﻣﻴﺰﺓ ﺗﺄﺟﻴﺮ ﻣﺮﻛﺒﺔ ? ﻟﻠﻤﺮﻛﺒﺔ ﺍﻟﺒﺪﻳﻠﺔ ) ﺑﺤﺪ‬
Maximum Period of 30 days ( ‫ ﻳﻮﻡ ﻛﺤﺪ ﺍﻗﺼﻰ‬30 ‫ﺑﺤﻴﺚ ﺍﻥ ﻻﻳﺰﻳﺪ ﻋﻦ‬

Replacement of Locks (Limit RO 300) No ( ‫ ﺭﻳﺎﻝ‬300 ‫ﺍﺳﺘﺒﺪﺍﻝ ﺍﻷﻗﻔﺎﻝ )ﺑﺤﺪ‬

No Claims Discount Protection (Max 2 Claim During Policy Period No ‫ﺣﻤﺎﻳﺔ ﺿﺪ ﺃﻱ ﻣﻄﺎﻟﺒﺎﺕ )ﺍﻟﺤﺪ ﺍﻷﻗﺼﻰ ﻟﻤﻄﺎﻟﺒﺘﻴﻦ ﺧﻼﻝ ﻓﺘﺮﺓ‬
(‫ﺍﻟﻮﺛﻴﻘﺔ‬

Cash Compensation For Consequential Loss (RO.5 for Each Day of Stoppage No 25 ‫ ﺭﻳﺎﻝ ﻋﻦ ﻛﻞ ﻳﻮﻡ ﻟﻤﺪﺓ‬5) ‫ﺍﻟﺘﻌﻮﻳﺾ ﺍﻟﻨﻘﺪﻱ ﻋﻦ ﺍﻟﺨﺴﺎﺭﺓ ﺍﻟﻤﺘﺮﺗﺒﺔ‬
Up To 25 Days Limit) ( ‫ﻳﻮﻡ ﻓﻘﻂ ﻛﺎﻗﺼﻰ ﺣﺪ‬

Roadside Assistance Service Yes ‫ﺧﺪﻣﺔ ﺍﻟﻤﺴﺎﻋﺪﺓ ﻋﻠﻰ ﺍﻟﻄﺮﻳﻖ‬

Damage or Loss at Work Site (Tool of Trade) No ‫ﻝ ﻣﻮﻗﻊ ﻓﻲ ﺍﻟﻀﺮﺭ ﺃﻭ ﺍﻟﻔﻘﺪ‬

Death Due to Any Cause No ‫ﺍﻟﻮﻓﺎﺓ ﻷﻱ ﺳﺒﺐ‬

Critical Illness No ‫ﺍﻟﻤﺮﺽ ﺍﻟﺤﺮﺝ‬

Laha Additional Coverages (during accident claims): No :(‫ﺗﻐﻄﻴﺎﺕ ﻟَﻬﺎ ﺍﻹﺿﺎﻓﻴﺔ )ﺃﺛﻨﺎﺀ ﻣﻄﺎﻟﺒﺎﺕ ﺍﻟﺤﻮﺍﺩﺙ‬
Handbag and Child Seat: Coverage up to OMR 200 per policy period. ‫ ﺭﻳﺎﻝ ﻋُﻤﺎﻧﻲ‬200 ‫ ﺗﻐﻄﻴﺔ ﺗﺼﻞ ﺇﻟﻰ‬:‫ﺍﻟﺤﻘﻴﺒﺔ ﺍﻟﻴﺪﻭﻳﺔ ﻭ ﻣﻘﻌﺪ ﺍﻟﻄﻔﻞ‬
Mobile Phone Damage: Coverage up to OMR 200 per policy period. .‫ﻟﻜﻞ ﻓﺘﺮﺓ ﺑﻮﻟﻴﺼﺔ‬
‫ ﺭﻳﺎﻝ ﻋُﻤﺎﻧﻲ ﻟﻜﻞ ﻓﺘﺮﺓ‬200 ‫ ﺗﻐﻄﻴﺔ ﺗﺼﻞ ﺇﻟﻰ‬:‫ﺗﻠﻒ ﺍﻟﻬﺎﺗﻒ ﺍﻟﻤﺤﻤﻮﻝ‬
.‫ﺑﻮﻟﻴﺼﺔ‬

Insurer and Insured may agree other than the covers stated in the above table provided both parties agree in writing
.‫ ﺃﻥ ﻳﺘﻔﻘﺎ ﻛﺘﺎﺑﻴﺎ ﻋﻠﻰ ﺗﻐﻄﻴﺎﺕ ﻏﻴﺮ ﺍﻟﻤﺬﻛﻮﺭﺓ ﻓﻲ ﺍﻟﺠﺪﻭﻝ ﺃﻋﻼﻩ‬، ‫ﺑﺈﻣﻜﺎﻥ ﺍﻟﻤﺆﻣﻦ ﻭﺍﻟﻤﺆﻣﻦ ﻋﻠﻴﻪ‬.

‫ﺍﻟﻤﺆﻣﻦ ﻟﻪ‬ ‫ﺍﻟﺘﺎﺭﻳﺦ‬ ‫ﻉ‬.‫ﻉ‬.‫ﻡ‬.‫ﺷﺮﻛﺔ ﻇﻔﺎﺭ ﻟﻠﺘﺄﻣﻴﻦ ﺵ‬

Signature of Insured Date Dhofar Insurance Company SAOG

Clauses
The insured amount indicated in the Policy Schedule shall be determined -: ‫ﻳﺤﺪﺩ ﻣﺒﻠﻎ ﺍﻟﺘﺄﻣﻴـﻦ ﺍﻟﻤﻮﺿﺢ ﻓﻲ ﺟﺪﻭﻝ ﺍﻟﻮﺛﻴﻘﺔ ﻭﻓﻘﺎ ﻟﻤﺎ ﻳﻠﻲ‬
as follows:
1) The cash value of the vehicle on the purchase date is determined ‫ﺗﺤﺪﺩ ﻗﻴﻤﺔ ﺍﻟﻤﺮﻛﺒﺔ ﻧﻘﺪﺍ ﻋﻨﺪ ﺍﻟﺸﺮﺍﺀ ﺣﺴﺐ ﻓﺎﺗﻮﺭﺓ ﺷﺮﺍﺀ ﺍﻟﻤﺮﻛﺒﺔ ﻷﻭﻝ‬ (1
according to its first purchase invoice. If this purchase invoice is not ‫ ﻓﺈﺫﺍ ﻟﻢ ﺗﺘﻮﻓﺮ ﻓﺎﺗﻮﺭﺓ ﺍﻟﺸﺮﺀ ﺍﻟﻤﺬﻛﻮﺭﺓ ﻓﺘﻄﻠﺐ ﺷﻬﺎﺩﺓ ﻣﻦ ﺍﻟﻮﻛﺎﻟﺔ ﺑﺎﻟﻘﻴﻤﺔ‬.‫ﻣﺮﺓ‬
available, a certificate shall be requested from the Agency stating the ‫ﺍﻟﻔﻌﻠﻴﺔ ﻟﻠﻤﺮﻛﺒﺔ ﻧﻘﺪﺍ ﻓﻲ ﺗﺎﺭﻳﺦ ﺍﻟﺸﺮﺍﺀ ﻷﻭﻝ ﻣﺮﺓ‬.
actual value of the vehicle on the purchase date.
2) Depreciation shall be computed as per Approved Depreciation (1) ‫( ﻣﻦ ﺍﻟﻤﻠﺤﻖ ﺭﻗﻢ‬2 ‫ ﺃﻭ‬1) ‫ﻳﺤﺴـﺐ ﺍﻻﺳﺘﻬﻼﻙ ﺣﺴﺐ ﺟﺪﻭﻝ ﺍﻻﺳﺘﻬﻼﻙ ﺍﻟﻤﻌﺘﻤﺪ‬ (2
Schedule 1 or 2 of Appendix 1
3) The difference between item 1 and item 2 is considered to be the ‫( ﻳﻌﺘﺒﺮ ﺍﻟﻘﻴﻤﺔ ﺍﻟﺘﺄﻣﻴﻨﻴﺔ ﻟﻠﻤﺮﻛﺒﺔ ﻋﻨﺪ ﺑﺪﺀ‬2 ‫ ﺍﻟﺒﻨﺪ‬، 1 ‫ﺍﻟﻔﺮﻕ ﺑﻴﻦ )ﺍﻟﺒﻨﺪ‬ (3
insurance value of the vehicle at the beginning of insurance during the ‫ﺍﻟﺘﺄﻣﻴﻦ ﻓﻲ ﺍﻟﺴﻨﻮﺍﺕ ﺍﻟﺘﺎﻟﻴﺔ ﻟﻠﺴﻨﺔ ﺍﻷﻭﻟﻰ ﻭﻫﻮ ﺍﻷﺳﺎﺱ ﺍﻟﺬﻱ ﻳﻌﺘﺪ ﺑﻪ ﻓﻲ‬
years following the first year, and it is the basis of compensation ‫ﺗﺴﻮﻳﺔ ﻣﺒﻠﻎ ﺍﻟﺘﻌﻮﻳﺾ ﻓﻲ ﺣﺎﻟﺔ ﻭﻗﻮﻉ ﺣﺎﺩﺙ‬.
settlement in case of accident
4) Where purchase invoice or agency certificate is not available to ‫ﻓﻲ ﺣﺎﻟﺔ ﺗﻌﺬﺭ ﺍﻟﺤﺼﻮﻝ ﻋﻠﻰ ﻓﺎﺗﻮﺭﺓ ﺍﻟﺸﺮﺍﺀ ﺃﻭ ﺷﻬﺎﺩﺓ ﻣﻦ ﺍﻟﻮﻛﺎﻟﺔ ﺍﻟﻤﻌﻨﻴﺔ‬ (4
determine the value of the vehicle, then the insurance amount shall be ‫ ﻓﺈﻧﻪ ﻳﺘﻢ ﺇﺣﺘﺴﺎﺏ ﻣﺒﻠﻎ ﺍﻟﺘﺄﻣﻴﻦ ﻋﻠﻰ ﺃﺳﺎﺱ ﺍﻟﻘﻴﻤﺔ‬،‫ﻟﺘﺤﺪﻳﺪ ﻗﻴﻤﺔ ﺍﻟﻤﺮﻛﺒﺔ‬
computed on the basis of market value of the vehilce as per the rules set ‫ﺍﻟﺴﻮﻗﻴﺔ ﻟﻠﻤﺮﻛﺒﺔ ﻭﻓﻖ ﺍﻟﻀﻮﺍﺑﻂ ﺍﻟﺘﻲ ﺗﻀﻌﻬﺎ ﺍﻟﻬﻴﺌﺔ‬.
out by Capital Market Authority.
5) As an exception from the above regulations, the insured amount may ‫ ﻳﺠﻮﺯ ﺗﺤﺪﻳﺪ ﻣﺒﻠﻎ ﺍﻟﺘﺄﻣﻴﻦ‬،‫ﺍﺳﺘﺜﻨﺎﺀً ﻣﻦ ﺍﻟﻘﻮﺍﻋﺪ ﺍﻟﻤﻨﺼﻮﺹ ﻋﻠﻴﻬﺎ ﺃﻋﻼﻩ‬ (5
be higher than the value stated in the aforesaid rules. ‫ﺑﻘﻴﻤﺔ ﺃﻋﻠﻰ ﻣﻦ ﺍﻟﻘﻴﻤﺔ ﺍﻟﺘﻲ ﺗﺤﺪﺩﻫﺎ ﺍﻟﻘﻮﺍﻋﺪ ﺍﻟﺴﺎﺑﻘﺔ‬
Restrictions on use: : ‫ﻗﻴﻮﺩ ﺍﻻﺳﺘﻌﻤﺎﻝ‬
The Insured shall not use the vehicle for any purpose other than what is ‫ ﻭﻓﻲ ﺣﺎﻟﺔ ﺍﺳﺘﻌﻤﺎﻝ‬،‫ﻳﺠﺐ ﻋﻠﻰ ﺍﻟﻤﺆﻣﻦ ﻟﻪ ﺃﻻ ﻳﺴﺘﻌﻤﻞ ﺍﻟﻤﺮﻛﺒﺔ ﺇﻻ ﻟﻠﻐﺮﺽ ﺍﻟﻤﺮﺧﺺ ﻟﻬﺎ‬
specified in the licence. If the vehicle is used for any other purpose that what is ‫ﺍﻟﻤﺮﻛﺒﺔ ﻓﻲ ﻏﻴﺮ ﺍﻟﻐﺮﺽ ﺍﻟﻤﺮﺧﺼﺔ ﻟﻪ ﻓﻼ ﻳﺸﻤﻞ ﺍﻟﺘﺄﻣﻴﻦ ﺍﻟﺤﻮﺍﺩﺙ ﺍﻟﻨﺎﺗﺠﺔ ﻋﻦ ﻫﺬﺍ‬
specified in the licence, the insurance shall not cover accidents resulting from ‫ﺍﻻﺳﺘﻌﻤﺎﻟﻲ‬.
such use.

Pol.No:103/0501/2025/P/004581 Page 4 of 6
Limits of the Insurer’s Liability:- : ‫ﺣﺪﻭﺩ ﻣﺴﺆﻭﻟﻴﺔ ﺍﻟﻤﺆﻣﻦ‬
1- (a) The maximum liability limit of the Insurer for repair cost in 3) ‫)ﺍﻟﺤﺪ ﺍﻷﻗﺼﻰ ﻟﻤﺴﺆﻭﻟﻴﺔ ﺍﻟﻤﺆﻣﻦ ﻋﻦ ﺗﻜﺎﻟﻴﻒ ﺍﻹﺻﻼﺡ ﻭﻓﻘﺎ ﻟﻠﺒﻨﺪ‬ (‫)ﺃ‬ -1
accordance with clause 3 of Chapter 2 is RO 150/- (Rials Omani ‫ ﺭﻳﺎﻻ ﻋﻤﺎﻧﻴﺎ ) ﻣﺎﺋﺔ ﻭﺧﻤﺴﻮﻥ ﺭﻳﺎﻻ ﻋﻤﺎﻧﻴﺎ‬150/- ‫)ﻣﻦ ﺍﻟﻔﺼﻞ ﺍﺍﻟﺜﺎﻧﻲ‬.
One Hundred Fifty)
(b) The maximum amount authorized for protecting and transporting ‫( ﻣﻦ‬5) ‫ﻟﺤﺪ ﺍﻷﻗﺼﻰ ﻟﺘﻜﺎﻟﻴﻒ ﺍﻟﺤﺮﺍﺳﺔ ﻭﺍﻟﻨﻘﻞ ﺍﻟﻤﺼﺮﺡ ﺑﻬﺎ ﻭﻓﻘﺎ ﻟﻠﺒﻨﺪ‬ (‫)ﺑـ‬
as per Clause 5 of Chapter 2 is RO 100/- (Rials Omani One ‫ ﻣﺎ ﻟﻢ ﻳﺘﻔﻖ ﻋﻠﻰ‬.(‫ ﺭﻳﺎﻝ ﻋﻤﺎﻧﻲ )ﻣﺎﺋﺔ ﺭﻳﺎﻝ ﻋﻤﺎﻧﻲ‬100/- ‫ﺍﻟﻔﺼﻞ ﺍﻟﺜﺎﻧﻲ‬
Hundred), unless agreed on higher amount in the additional ‫ ﻣﺒﻠﻎ ﺃﻛﺒﺮ ﺿﻤﻦ ﺍﻟﻤﺰﺍﻳﺎ ﺍﻻﺿﺎﻓﻴﺔ‬.
benefits.
(c) The maximum amount for protecting and transporting costs as per ‫ﻫـ( ﻣﻦ‬/1/‫ﺍﻟﺤﺪ ﺍﻷﻗﺼﻰ ﻟﺘﻜﺎﻟﻴﻒ ﺍﻟﺤﺮﺍﺳﺔ ﻭﺍﻟﻨﻘﻞ ﻭﻓﻘﺎ ﻟﻠﻔﻘﺮ )ﺃﻭﻻ‬ (‫)ﺟـ‬
Clause 1 - e of Chapter 3 is the protecting and transportation cost ‫ﺍﻟﻔﺼﻞ ﺍﻟﺜﺎﻧﻲ ﻫﻲ ﺗﻜﻠﻔﺔ ﺍﻟﺤﺮﺍﺳﺔ ﻭﺍﻟﻨﻘﻞ ﺍﻟﻤﺘﻌﺎﺭﻑ ﻋﻠﻴﻬﺎ ﺑﺎﻟﺴﻮﻕ‬.
recognised in the market.
2- The maximum liability limit of the Insurer under item (a) of Clause 1 of ‫ﻟﺤﺪ ﺍﻷﻗﺼﻰ ﻟﻤﺴﺆﻭﻟﻴﺔ ﺍﻟﻤﺆﻣﻦ ﺑﺎﻟﻨﺴﺒﺔ ﻟﻠﻔﻘﺮﺓ )ﺃ( ﻣﻦ ﺍﻟﺒﻨﺪ ﺃﻭﻻ ﻣﻦ ﺍﻟﻔﺼﻞ‬ -2
Chapter 3 for any claim or all claims arising from one accident is the amount ‫ﺍﻟﺜﺎﻟﺚ ﻋﻦ ﺃﻱ ﻣﻄﺎﻟﺒﺔ ﺃﻭ ﺟﻤﻠﺔ ﻣﻄﺎﻟﺒﺎﺕ ﻧﺸﺄﺕ ﻋﻦ ﺣﺎﺩﺙ ﻭﺍﺣﺪ ﻫﻮ ﻗﻴﻤﺔ ﻣﺎ ﻳﺤﻜﻢ ﺑﻪ‬
of compensation decided by the court ‫ﻗﻀﺎﺋﻴﺎ ﻣﻦ ﺗﻌﻮﻳﺾ‬.
3- The maximum liability limit of the Insurer under item (b) of Clause 1 of ‫ﻟﺤﺪ ﺍﻷﻗﺼﻰ ﻟﻤﺴﺆﻭﻟﻴﺔ ﺍﻟﻤﺆﻣﻦ ﺑﺎﻟﻨﺴﺒﺔ ﻟﻠﻔﻘﺮﺓ )ﺏ( ﻣﻦ ﺍﻟﺒﻨﺪ ﺃﻭﻻَ ﻣﻦ ﺍﻟﻔﺼﻞ‬ -3
Chapter 3 for any claim or all claims arising from one accident is RO ‫ ﺭﻳﺎﻝ ﻋﻤﺎﻧﻲ‬150000/- ‫ﺍﻟﺜﺎﻟﺚ ﻋﻦ ﺃﻱ ﻣﻄﺎﻟﺒﺔ ﺃﻭ ﺟﻤﻠﺔ ﻣﻄﺎﻟﺒﺎﺕ ﻧﺸﺄﺕ ﻋﻦ ﺣﺎﺩﺙ ﻭﺍﺣﺪ‬
150,000/- (Rials Omani One Hundred Fifty Thousand) unless otherwise (‫ﻣﺎﺋﺔ ﻭﺧﻤﺴﻮﻥ ﺃﻟﻒ ﺭﻳﺎﻝ ﻋﻤﺎﻧﻲ( ﻣﺎ ﻟﻢ ﻳﺘﻔﻖ ﻋﻠﻰ ﻣﺒﻠﻎ ﺃﻛﺒﺮ‬.
agreed by both parties in writing on a higher amount.
4- The maximum liability limit of the Insurer under the first para of clause ‫ﻟﺤﺪ ﺍﻷﻗﺼﻰ ﻟﻤﺴﺆﻭﻟﻴﺔ ﺍﻟﻤﺆﻣﻦ ﺑﺎﻟﻨﺴﺒﺔ ﻟﻠﻔﻘﺮﺓ ﺍﻷﻭﻟﻰ ﻣﻦ ﺍﻟﺒﻨﺪ ﺛﺎﻧﻴﺎ ﻣﻦ‬ -4
Second of Chapter 3 is RO 10,000/- (Rials Omani Ten Thousand) for the ‫( )ﻋﺸﺮﺓ ﺃﻻﻑ ﺭﻳﺎﻝ ﻋﻤﺎﻧﻲ( ﻋﻦ ﺍﻟﺴﻨﺔ ﺍﻟﺘﺄﻣﻴﻨﻴﺔ ﺃﻳﺎ ﻛﺎﻥ‬10000) ‫ﺍﻟﻔﺼﻞ ﺍﻟﺜﺎﻟﺚ ﻫﻮ‬
insurance year regardless of the number of accidents, unless agreed on a ‫ﺗﻜﺮﺍﺭ ﺍﻟﺤﻮﺍﺩﺙ ﻣﺎ ﻟﻢ ﻳﺘﻔﻖ ﻋﻠﻰ ﻣﺒﻠﻎ ﺍﻛﺒﺮ ﺿﻤﻦ ﺍﻟﻤﺰﺍﻳﺎ ﺍﻻﺿﺎﻓﻴﺔ‬.
higher amount in the additional bnefits
5- The maximum liability limit of the Insurer for first aid expense stated in ‫ ﻟﺤﺪ ﺍﻷﻗﺼﻰ ﻟﻤﺴﺆﻭﻟﻴﺔ ﺍﻟﻤﺆﻣﻦ ﺑﺎﻟﻨﺴﺒﺔ ﻟﻤﺼﺎﺭﻳﻒ ﺍﻹﺳﻌﺎﻓﺎﺕ ﺍﻷﻭﻟﻴﺔ ﺍﻟﻮﺍﺭﺩﺓ‬- 5
Chapter 3 for any claim or all claims arising from one accident is RO 400/- ‫ ﺭﻳﺎﻝ‬400/- ‫ﺑﺎﻟﻔﺼﻞ ﺍﻟﺜﺎﻟﺚ ﻋﻦ ﺃﻱ ﻣﻄﺎﻟﺒﺔ ﺃﻭ ﺟﻤﻠﺔ ﻣﻄﺎﻟﺒﺎﺕ ﻧﺸﺄﺕ ﻋﻦ ﺣﺎﺩﺙ ﻭﺍﺣﺪ‬
(Rials Omani Four Hundred). ‫)ﻋﻤﺎﻧﻲ )ﺃﺭﺑﻌﻤﺎﺋﺔ ﺭﻳﺎﻝ ﻋﻤﺎﻧﻲ‬
Rules for settlement of Medical Expenses:- ‫ﻗـﻮﺍﻋـﺪ ﺳــﺪﺍﺩ ﻣـﺼـﺎﺭﻳـﻒ ﺍﻟـﻌـﻼﺝ‬
The Insurer is bound to pay to hospitals and medical institutions the expenses ‫ﻳﻠﺘﺰﻡ ﺍﻟﻤﺆﻣﻦ ﺑﺴﺪﺍﺩ ﻣﺼﺎﺭﻳﻒ ﻋﻼﺝ ﺍﻹﺻﺎﺑﺎﺕ ﺍﻟﺒﺪﻧﻴﺔ ﺍﻟﺘﻲ ﺗﻘﻊ ﻟﻠﻐﻴﺮ ﺃﻭ ﻟﻠﻤﺆﻣﻦ ﻟﻪ ﻭﻣﻦ‬
incurred for the treatment of bodily injuries of third party or the Insured and anyone ‫ﻓﻲ ﺣﻜﻤﻪ ﻭﺃﻓﺮﺍﺩ ﺃﺳﺮﺗﻴﻬﻤﺎ ﻟﻠﻤﺴﺘﺸﻔﻴﺎﺕ ﻭﺍﻟﺠﻬﺎﺕ ﺍﻟﻄﺒﻴﺔ ﻭﻓﻘﺎ ﻟﻠﻘﻮﺍﻋﺪ ﺍﻷﺗﻴـﺔ‬:-
in his position and their family members according to the following rules:-
a) The hospital or medical institution shall prepare a detailed report on the ‫ﻳﻌﺪُ ﺍﻟﻤﺴﺘﺸﻔﻰ ﺃﻭ ﺍﻟﺠﻬﺔ ﺍﻟﻄﺒﻴﺔ ﺗﻘﺮﻳﺮﺍ ﺗﻔﺼﻴﻠﻴﺎ ﻳﺒﻠﻌﻼﺝ ﺍﻟﺬﻱ ﺗﻢ‬ ‫)ﺃ‬
treatment and the actual cost of the same, along with the necessary ‫ ﻭﺍﻟﺘﻜﻠﻔﺔ ﺍﻟﺤﻘﻴﻘﻴﺔ ﻣﺪﻋﻤﺎ ﺑﺎﻟﻤﺴﺘﻨﺪﺍﺕ ﺍﻟﻼﺯﻣـﺔ‬،‫ﺑﺎﻟﻔﻌﻞ‬.
supporting documents.
b) Claims for medical expenses shall be based only on the amount approved by ‫ﻳﻌﺘﺪ ﻋﻨﺪ ﺍﻟﻤﻄﺎﻟﺒﺔ ﺑﻤﺼﺎﺭﻳﻒ ﺍﻟﻌﻼﺝ ﺑﺎﻟﻘﻴﻤﺔ ﺍﻟﺘﻲ ﺗﻌﺘﻤﺪﻫﺎ ﻭﺯﺍﺭﺓ ﺍﻟﺼﺤﺔ‬. ‫) ﺑـ‬
the Ministry of Health
c) The Insurer, after reviewing the reports received, shall pay the required ‫ﻋﻠﻰ ﺍﻟﻤﺆﻣﻦ ﺑﻌﺪ ﺍﻹﻃﻼﻉ ﻋﻠﻰ ﺃﻭﺭﺍﻕ ﺍﻟﺘﻘﺮﻳﺮ ﺗﻮﺭﻳﺪ ﺍﻟﻤﺒﻠﻎ ﺍﻟﻤﻄﻠﻮﺏ ﺇﻟﻰ‬ ‫)ﺟـ‬
amount to the hospital or medical institution which carried out the treatment. ‫ﺍﻟﻤﺴﺘﺸﻔﻰ ﺃﻭ ﺍﻟﺠﻬﺔ ﺍﻟﻄﺒﻴﺔ ﺍﻟﺘﻲ ﺗﻮﻟﺖ ﻋﻼﺝ ﺍﻟﻤﺼﺎﺏ‬.
d) In case the treatment abroad, an evidence from Ministry of Health shall be ‫ﻓﻲ ﺣﺎﻟﺔ ﻣﺎ ﺇﺫﺍ ﺗﻢ ﺍﻟﻌﻼﺝ ﺧﺎﺭﺝ ﺍﻟﺴﻠﻄﻨﺔ ﻭﺟﺐ ﺗﻘﺪﻳﻢ ﻣﺎ ﻳﺜﺒﺖ ﻣﻦ ﻭﺯﺍﺭﺓ ﺍﻟﺼﺤﺔ‬ ‫)ﺩ‬
provided that the treatment is not available in the Sultanate ‫ﺑﺘﻌﺬﺭ ﺍﻟﻌﻼﺝ ﺩﺍﺧﻞ ﺍﻟﺴﻠﻄﻨﺔ‬.
VAT CLAUSE

All premiums, fees, charges [under the policy/in this quotation] are shown exclusive of any value added tax, or any other similar taxes, charges or duties applicable at the time of
the proposal or which may become applicable as a result of provision of insurance services (“Applicable Tax”) at any point in time. The Applicable Tax shall be added to the
Premiums/fees/charges in accordance with the applicable laws and regulations of the Sultanate of Oman and shall be solely payable by the Policyholder/Insured.

Article 1: The Premiums, Fees and/or Charges stated in this [Insurance] Policy are shown exclusive of any value added tax, goods and service tax or sales tax, or any other similar
taxes, charges or duties to the extent any such tax is applicable or will become applicable as a result of provision of the services under this Policy (hereinafter – “Applicable Tax”).

Article 2: Any payment due as a result of the application of the Applicable Tax to the Premiums, Fees and/or Charges stated in this Policy shall be solely the responsibility of the
Insured.

Article 3: In the event the Insurer is obligated to remit to the relevant tax authority any Applicable Tax in connection with the services provided hereunder, the Insurer shall charge
such Applicable Tax on the Premiums, Fees and/or Charges stated in this Policy at the prevailing rate and in accordance with the applicable laws and regulations, and the Insured
shall pay such Applicable Tax to the Insurer in accordance with the Insurer’s invoice.

It is a condition precedent to the Insurer's liability under this Policy that the Insured pay the full amount of the Applicable Tax due in respect of the Premiums, Fees and/or Charges
stated in this Policy/advised by a separate notice.

Without prejudice to the foregoing, the failure of the Insured to pay the full amount of the Applicable Tax shall be considered as a material breach of the terms and conditions of
this Policy and the Insurer retains its rights to invoke any legal remedies available for such breach, including but not limited to immediate termination of this Policy.

The Insurer shall not be liable for any penalties or interest that may arise due to the Insured’s non-compliance with the relevant statutory requirements on Applicable Taxes.

Article 4: The pay ability of the Applicable Tax element of the amounts claimed under this Policy, if any, will depend on the tax registration status of the Insured/claimant and /or
whether the appropriate and relevant invoice is raised in the name of the Insurer or not.
. ‫ ﻛﻤﺎ ﺃﻭﻛﺪ ﺑﺄﻥ ﺍﻟﻤﻌﻠﻮﻣﺎﺕ ﺍﻟﺘﻲ ﻗﺪﻣﺘﻬﺎ ﺇﻟﻰ ﺍﻟﺸﺮﻛﺔ ﺍﻟﻤﺆﻣﻨﺔ ﺻﺤﻴﺤﺔ‬،‫ﻟﻘﺪ ﺇﻃﻠﻌﺖ ﻋﻠﻰ ﻣﺤﺘﻮﻳﺎﺕ ﻭﺟﺪﻭﻝ ﻭﺛﻴﻘﺔ ﺍﻟﺘﺄﻣﻴﻦ ﻭﺃﺗﻔﻖ ﺗﻤﺎﻣﺎ ﻣﻊ ﻣﺎ ﻭﺭﺩ ﺑﻬﺎ ﻣﻦ ﺷﺮﻭﻁ ﻭﺇﻟﺘﺰﺍﻣﺎﺕ‬
I acknowledge having read the contents and schedules of the insurance policy and agree entirely with its terms and conditions. I also confirm that the information provided to the
Insurer are true.

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‫ﺍﻟﻤﺆﻣﻦ ﻟﻪ‬ ‫ﺍﻟﺘﺎﺭﻳﺦ‬ ‫ﻉ‬.‫ﻉ‬.‫ﻡ‬.‫ﺷﺮﻛﺔ ﻇﻔﺎﺭ ﻟﻠﺘﺄﻣﻴﻦ ﺵ‬
Signature of Insured Date Dhofar Insurance Company SAOG

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