ABDUL REHMAN MASOOD - Ins

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Malath Cooperative Insurance Co.

‫ﺷﺮﻛﺔ ﻣﻼﺫ ﻟﻠﺘﺄﻣﻴﻦ ﺍﻟﺘﻌﺎﻭﻧﻲ‬

Electronic Receipt ‫ﺳﻨﺪ ﻗﺒﺾ ﺇﻟﻜﺘﺮﻭﻧﻲ‬


Mandatory Insurance on Visitors to the ‫ﻭﺛﻴﻘﺔ ﺍﻟﺘﺄﻣﻴﻦ ﺍﻟﻄﺒﻲ ﺍﻹﻟﺰﺍﻣﻲ ﻋﻠﻰ ﺍﻟﺰﺍﺋﺮﻳﻦ ﻭﺍﻟﻘﺎﺩﻣﻴﻦ ﻟﻠﻤﻤﻠﻜﺔ‬
kingdom of Saudi Arabia ‫ﺍﻟﻌﺮﺑﻴﺔ ﺍﻟﺴﻌﻮﺩﻳﺔ‬

Print Date 08-04-2024 ‫ﺗﺎﺭﻳﺦ ﺍﻟﻄﺒﺎﻋﺔ‬


Policy Number 22583570 ‫ﺭﻗﻢ ﺍﻟﻮﺛﻴﻘﺔ‬

Policy Holder Details ‫ﺑﻴﺎﻧﺎﺕ ﺣﺎﻣﻞ ﺍﻟﻮﺛﻴﻘﺔ‬


Policy Holder Name ABDUL REHMAN MASOOD ‫ﺇﺳﻢ ﺣﺎﻣﻞ ﺍﻟﻮﺛﻴﻘﺔ‬
Nationality Pakistan ‫ﺍﻟﺠﻨﺴﻴﺔ‬
E-Number E766948678 ‫ﺍﻟﺮﻗﻢ ﺍﻹﻟﻜﺘﺮﻭﻧﻲ‬
Visa Number ‫ﺭﻗﻢ ﺍﻟﺘﺄﺷﻴﺮﺓ‬
Visa Validity ‫ ﻳﻮﻡ‬365 ‫ﺻﻼﺣﻴﺔ ﺍﻟﺘﺄﺷﻴﺮﺓ‬
Policy Start Date ‫ﺗﺎﺭﻳﺦ ﺑﺪﺍﻳﺔ ﺍﻟﻮﺛﻴﻘﺔ‬
Policy Expiry Date ‫ﺗﺎﺭﻳﺦ ﻧﻬﺎﻳﺔ ﺍﻟﻮﺛﻴﻘﺔ‬
Insurance Duration ‫ ﻳﻮﻡ‬365 ‫ﻣﺪﺓ ﺍﻟﺘﺄﻣﻴﻦ‬
Visa Type Multi ‫ﻧﻮﻉ ﺍﻟﺘﺄﺷﻴﺮﺓ‬
Visit Type Hayya ‫ﻧﻮﻉ ﺍﻟﺰﻳﺎﺭﺓ‬
Price ‫ ﺩﻭﻻﺭ‬5 ‫ﺍﻟﺴﻌﺮ‬
Mobile Number 92168370 ‫ﺭﻗﻢ ﺍﻟﺠﻮﺍﻝ‬
E-mail ALSHAAAISHA592@GMAIL.COM ‫ﺍﻟﺒﺮﻳﺪ ﺍﻹﻟﻜﺘﺮﻭﻧﻲ‬
Address JEDDAH ‫ﺍﻟﻌﻨﻮﺍﻥ‬

Insured List ‫ﻗﺎﺋﻤﺔ ﺍﻟﻤﺆﻣﻦ ﻟﻬﻢ‬


‫ﺍﻟﻌﻼﻗﺔ‬ ‫ﻧﻮﻉ ﺍﻟﻤﺴﺘﻔﻴﺪ‬ ‫ﺍﻟﺠﻨﺲ‬ ‫ﺍﻟﺤﺎﻟﺔ ﺍﻹﺟﺘﻤﺎﻋﻴﺔ‬ ‫ﺍﻟﺠﻨﺴﻴﺔ‬ ‫ﺍﻹﺳﻢ‬
1 Main Male Married Pakistan ABDUL REHMAN MASOOD

Product Code: A-MLTH-2-I-17-037


Malath Cooperative Insurance Co. ‫ﺷﺮﻛﺔ ﻣﻼﺫ ﻟﻠﺘﺄﻣﻴﻦ ﺍﻟﺘﻌﺎﻭﻧﻲ‬

Notes ‫ﺗﻌﻠﻴﻤﺎﺕ ﻫﺎﻣﺔ‬

This invoice is issued upon payment. ‫ﻫﺬﺍ ﺍﻟﺴﻨﺪ ﺑﻤﺜﺎﺑﺔ ﺷﻬﺎﺩﺓ ﺇﺳﺘﻼﻡ ﺍﻟﻤﺒﻠﻎ ﻭ ﻻ ﻳﻌﻨﻲ ﺑﺪﺀ ﺳﺮﻳﺎﻥ ﺍﻟﺘﻐﻄﻴﺔ ﺍﻟﺘﺄﻣﻴﻨﻴﺔ‬

Insurance policy will be activated on the expected date that ‫ﺳﻴﺘﻢ ﺗﻔﻌﻴﻞ ﻭﺛﻴﻘﺔ ﺍﻟﺘﺄﻣﻴﻦ ﺣﺴﺐ ﺍﻟﺘﺎﺭﻳﺦ ﺍﻟﻤﺘﻮﻗﻊ ﻟﻠﺪﺧﻮﻝ ﺇﻟﻰ ﺍﻟﻤﻤﻠﻜﺔ ﺍﻟﻌﺮﺑﻴﺔ‬
was registered in MOFA’s Visa Issuance System (Enjaz). ( ‫ﺍﻟﺴﻌﻮﺩﻳﺔ ﺍﻟﻤﺪﺧﻞ ﻓﻲ ﻧﻈﺎﻡ ﻭﺯﺍﺭﺓ ﺍﻟﺨﺎﺭﺟﻴﺔ ﻹﺻﺪﺍﺭ ﺍﻟﺘﺄﺷﻴﺮﺍﺕ )ﺇﻧﺠﺎﺯ‬

Upon policy activation, an electronic copy of the insurance ‫ﻋﻨﺪ ﺗﻔﻌﻴﻞ ﺍﻟﻮﺛﻴﻘﺔ ﺳﻮﻑ ﻳﺘﻢ ﺇﺭﺳﺎﻝ ﻧﺴﺨﺔ ﺇﻟﻜﺘﺮﻭﻧﻴﺔ ﻣﻦ ﺟﺪﻭﻝ ﻭﺛﻴﻘﺔ ﺍﻟﺘﺄﻣﻴﻦ‬
policy schedule and electronic medical card will be sent to ‫ﺑﺎﻹﺿﺎﻓﺔ ﺇﻟﻰ ﺑﻄﺎﻗﺔ ﺍﻟﺘﺄﻣﻴﻦ ﺍﻹﻟﻜﺘﺮﻭﻧﻲ‬
your e-mail registered at Enjaz.

Policy cannot be canceled without canceling Visit Visa ‫ﻻﻳﻤﻜﻦ ﺇﻟﻐﺎﺀ ﻭﺛﻴﻘﺔ ﺍﻟﺘﺄﻣﻴﻦ ﺑﺪﻭﻥ ﺇﻟﻐﺎﺀ ﺗﺄﺷﻴﺮﺓ ﺍﻟﺰﻳﺎﺭﺓ‬
from the Saudi Embassy or Consulate office.

To refund policy fees, please contact us on the provided ‫ ﻳﺮﺟﻰ ﻣﺮﺍﺟﻌﺔ ﺷﺮﻛﺔ ﺍﻟﺘﺄﻣﻴﻦ ﻋﺒﺮ ﻭﺳﺎﺋﻞ‬، ‫ﻹﺳﺘﻌﺎﺩﺓ ﺭﺳﻮﻡ ﺍﻟﺘﺄﻣﻴﻦ‬
contact information. ‫ﺍﻹﺗﺼﺎﻝ ﺍﻟﻤﺘﺎﺣﺔ‬

In case Visitor has entered Saudi Arabia before ‫ﻓﻲ ﺣﺎﻟﺔ ﺩﺧﻮﻝ ﺍﻟﺰﺍﺋﺮ ﺇﻟﻰ ﺍﻟﻤﻤﻠﻜﺔ ﺍﻟﻌﺮﺑﻴﺔ ﺍﻟﺴﻌﻮﺩﻳﺔ ﻗﺒﻞ ﺍﻟﺘﺎﺭﻳﺦ ﺍﻟﻤﺘﻮﻗﻊ‬
the expected date, please contact us to activate ‫ ﺍﻟﺮﺟﺎﺀ ﺍﻹﺗﺼﺎﻝ ﺑﺨﺪﻣﺔ ﺍﻟﻌﻤﻼﺀ ﻓﻲ ﺍﻟﺸﺮﻛﺔ ﻟﺘﻔﻌﻴﻞ ﻭﺛﻴﻘﺔ ﺍﻟﺘﺄﻣﻴﻦ‬، ‫ﻟﻠﺪﺧﻮﻝ‬
the insurance policy.

In case Visa was issued after the expected date, ‫ﻓﻲ ﺣﺎﻟﺔ ﺇﺻﺪﺍﺭ ﺗﺄﺷﻴﺮﺓ ﺍﻟﺪﺧﻮﻝ ﺑﻌﺪ ﺍﻟﺘﺎﺭﻳﺦ ﺍﻟﻤﺘﻮﻗﻊ ﻟﻠﺪﺧﻮﻝ ﺇﻟﻰ ﺍﻟﻤﻤﻠﻜﺔ‬
insurance policy will be activated on the same date ‫ﺍﻟﻌﺮﺑﻴﺔ ﺍﻟﺴﻌﻮﺩﻳﺔ ﻓﺴﻴﺘﻢ ﺗﻔﻌﻴﻞ ﻭﺛﻴﻘﺔ ﺍﻟﺘﺄﻣﻴﻦ ﻣﻦ ﺗﺎﺭﻳﺦ ﺇﺻﺪﺍﺭ ﺍﻟﺘﺄﺷﻴﺮﺓ‬
the Visa was issued.
Malath Cooperative Insurance Co. ‫ﺷﺮﻛﺔ ﻣﻼﺫ ﻟﻠﺘﺄﻣﻴﻦ ﺍﻟﺘﻌﺎﻭﻧﻲ‬

Type of Insurance ‫ﻧﻮﻉ ﺍﻟﺘﺄﻣﻴﻦ‬


Mandatory Insurance for the visitors for the kingdom ‫ﺍﻟﺘﺄﻣﻴﻦ ﺍﻹﻟﺰﺍﻣﻲ ﻋﻠﻰ ﺍﻟﺰﺍﺋﺮﻳﻦ ﺍﻟﻘﺎﺩﻣﻴﻦ ﻟﻠﻤﻤﻠﻜﺔ ﺍﻟﻌﺮﺑﻴﺔ ﺍﻟﺴﻌﻮﺩﻳﺔ‬
of Saudi Arabia
The benefits and limit of coverage under
this policy: :‫ﻣﻨﺎﻓﻊ ﻭﺣﺪﻭﺩ ﺍﻟﺘﻐﻄﻴﺔ ﺑﻤﻮﺟﺐ ﺍﻟﻮﺛﻴﻘﺔ‬
The maximum benefits limit for each person 100,000 SR 100,000 ‫ ﺃﻟﻒ‬100 ‫ﺣﺪ ﺍﻟﻤﻨﻔﻌﺔ ﺍﻷﻗﺼﻰ ﻟﻜﻞ ﺷﺨﺺ ﻋﻦ ﻣﺪﺓ ﺍﻟﻮﺛﻴﻘﺔ ﻭﻳﺸﻤﻞ‬
for the duration of the policy and that includes ‫ﺭﻳﺎﻝ ﺳﻌﻮﺩﻱ‬ ‫ﺭﻳﺎﻝ ﺳﻌﻮﺩﻱ‬
lower limits specified in this policy ‫ﺫﻟﻚ ﺍﻟﺤﺪﻭﺩ ﺍﻟﺪﻧﻴﺎ ﺍﻟﻮﺍﺭﺩﺓ ﻓﻲ ﻫﺬﻩ ﺍﻟﻮﺛﻴﻘﺔ‬
The expenses of examination and Up to the policy ‫ﺑﺤﺪ ﺍﻟﻤﻨﻔﻌﺔ‬ ‫ﻧﻔﻘﺎﺕ ﻣﻌﺎﻳﻨﺔ ﻭﻋﻼﺝ ﺍﻟﺤﺎﻻﺕ ﺍﻟﻄﺎﺭﺋﺔ‬
treatment of emergency cases limit ‫ﺍﻷﻗﺼﻰ ﻟﻬﺬﻩ ﺍﻟﻮﺛﻴﻘﺔ‬

Hospitalization expenses : :‫ﻧﻔﻘﺎﺕ ﺍﻟﺘﻨﻮﻳﻢ ﺑﺎﻟﻤﺴﺘﺸﻔﻰ‬

Excess percentage (contribution in payment) No ‫ﻻ ﻳﻮﺟﺪ‬ ( ‫ﻧﺴﺒﺔ ﺍﻟﺘﺤﻤﻞ )ﺍﻟﻤﺸﺎﺭﻛﺔ ﻓﻲ ﺍﻟﺪﻓﻊ‬

Hospitalization Up to the policy ‫ﺑﺤﺪ ﺍﻟﻤﻨﻔﻌﺔ‬ ‫ﺍﻟﺘﻨﻮﻳﻢ ﺑﺎﻟﻤﺴﺘﺸﻔﻰ‬


limit ‫ﺍﻷﻗﺼﻰ ﻟﻬﺬﻩ ﺍﻟﻮﺛﻴﻘﺔ‬
Accommodation and daily subsistence limit for
the patient which include bed wage, nursing ‫ﺣﺪ ﺍﻹﻗﺎﻣﺔ ﻭﺍﻹﻋﺎﺷﺔ ﺍﻟﻴﻮﻣﻲ ﻟﻠﻤﺮﻳﺾ ﻭﺗﺸﻤﻞ ﺃﺟﺮﺓ‬
services, visitations, medical supervision and Shared Room and ‫ﻏﺮﻓﺔ ﻣﺸﺘﺮﻛﺔ ﺑﺤﺪ ﺃﻗﺼﻰ‬ ‫ﺍﻟﺴﺮﻳﺮ ﻭﺧﺪﻣﺎﺕ ﺍﻟﺘﻤﺮﻳﺾ ﻭﺍﻟﺰﻳﺎﺭﺍﺕ ﻭﺍﻹﺷﺮﺍﻑ‬
life support services , but it does not include up to a limit of SR 600
600 / day ‫ﻳﻮﻡ‬ / ‫ﺳﻌﻮﺩﻱ‬ ‫ﺭﻳﺎﻝ‬ ‫ﺍﻟﻄﺒﻲ ﻭﺧﺪﻣﺎﺕ ﺍﻹﻋﺎﺷﺔ ﻭﻻ ﻳﺘﻀﻤﻦ ﺫﻟﻚ ﺗﻜﻠﻔﺔ ﺍﻷﺩﻭﻳﺔ‬
the cost of medicines and medical supplies, ‫ﻭﺍﻟﻤﺴﺘﻠﺰﻣﺎﺕ ﺍﻟﻄﺒﻴﺔ ﺍﻟﺘﻲ ﺗﺼﺮﻑ ﺑﺄﻣﺮ ﺍﻟﻄﺒﻴﺐ‬
as prescribed by the physician.
Shared Room and ‫ﻏﺮﻓﺔ ﻣﺸﺘﺮﻛﺔ ﺑﺤﺪ ﺃﻗﺼﻰ‬
Accommodation limit for patient's escort up to a limit of SR 150 ‫ﺣﺪ ﺍﻹﻗﺎﻣﺔ ﻭﺍﻹﻋﺎﺷﺔ ﺍﻟﻴﻮﻣﻲ ﻟﻠﻤﺮﺍﻓﻖ‬
150 / day ‫ ﻳﻮﻡ‬/ ‫ﺭﻳﺎﻝ ﺳﻌﻮﺩﻱ‬
Treatment of emergency maternity and Up to SR 5,000 ‫ﺑﺤﺪ ﺃﻗﺼﻰ‬
5,000 ‫ﺭﻳﺎﻝ ﺳﻌﻮﺩﻱ‬ ‫ﻧﻔﻘﺎﺕ ﺍﻟﺤﻤﻞ ﻭﺍﻟﻮﻻﺩﺓ ﺍﻟﻄﺎﺭﺋﺔ‬
delivery cases
for the duration of ‫ﺧﻼﻝ ﻣﺪﺓ ﺍﻟﻮﺛﻴﻘﺔ‬
the policy
Cost of travel and accompanying of one Up to SR 5,000 ‫ﺑﺤﺪ ﺃﻗﺼﻰ‬ ‫ﺗﻜﺎﻟﻴﻒ ﺳﻔﺮ ﻭﻣﺮﺍﻓﻘﺔ ﻋﻀﻮ ﺃﺳﺮﺓ ﻣﺒﺎﺷﺮ ﻭﺍﺣﺪ‬
direct family member 5,000 ‫ﺭﻳﺎﻝ ﺳﻌﻮﺩﻱ‬
for the duration of ‫ﺧﻼﻝ ﻣﺪﺓ ﺍﻟﻮﺛﻴﻘﺔ‬
the policy
Up to SR 500 500 ‫ﺑﺤﺪ ﺃﻗﺼﻰ‬
Emergency dental treatment for the duration of ‫ﺭﻳﺎﻝ ﺳﻌﻮﺩﻱ‬ ‫ﺗﻜﺎﻟﻴﻒ ﻋﻼﺝ ﺍﻷﺳﻨﺎﻥ ﺍﻟﻄﺎﺭﺋﺔ‬
the policy ‫ﺧﻼﻝ ﻣﺪﺓ ﺍﻟﻮﺛﻴﻘﺔ‬
The expenses of the birth and treatment Up to the policy ‫ﺑﺤﺪ ﺍﻟﻤﻨﻔﻌﺔ‬
of premature babies limit ‫ﺍﻷﻗﺼﻰ ﻟﻬﺬﻩ ﺍﻟﻮﺛﻴﻘﺔ‬ ‫ﺗﻜﺎﻟﻴﻒ ﻭﻻﺩﺓ ﻭﻋﻼﺝ ﺍﻷﻃﻔﺎﻝ ﺍﻟﻤﺒﺘﺴﺮﻳﻦ‬
Treatment to injuries resulting from road Up to the policy ‫ﺑﺤﺪ ﺍﻟﻤﻨﻔﻌﺔ‬ ‫ﺍﻹﺻﺎﺑﺎﺕ ﺍﻟﻨﺎﺗﺠﺔ ﻋﻦ ﺣﻮﺍﺩﺙ ﺍﻟﺴﻴﺮ‬
traffic accidents limit ‫ﺍﻷﻗﺼﻰ ﻟﻬﺬﻩ ﺍﻟﻮﺛﻴﻘﺔ‬

The expenses of emergency kidney Dialysis Up to the policy ‫ﺑﺤﺪ ﺍﻟﻤﻨﻔﻌﺔ‬ ‫ﺗﻜﺎﻟﻴﻒ ﺍﻟﻐﺴﻴﻞ ﺍﻟﻜﻠﻮﻱ ﻟﻠﺤﺎﻻﺕ ﺍﻟﻄﺎﺭﺋﺔ‬
limit ‫ﺍﻷﻗﺼﻰ ﻟﻬﺬﻩ ﺍﻟﻮﺛﻴﻘﺔ‬
Emergency Medical Evacuation inside Up to the policy ‫ﺑﺤﺪ ﺍﻟﻤﻨﻔﻌﺔ‬ ‫ﺍﻹﺧﻼﺀ ﺍﻟﻄﺒﻲ ﺩﺍﺧﻞ ﻭﺧﺎﺭﺝ ﺍﻟﻤﻤﻠﻜﺔ‬
and outside the Kingdom limit ‫ﺍﻷﻗﺼﻰ ﻟﻬﺬﻩ ﺍﻟﻮﺛﻴﻘﺔ‬
Up to SR 10,000 ‫ﺑﺤﺪ ﺃﻗﺼﻰ‬
Repatriation of mortal remains to the 10,000 ‫ﺭﻳﺎﻝ ﺳﻌﻮﺩﻱ‬
country of origin for the duration of ‫ﺧﻼﻝ ﻣﺪﺓ ﺍﻟﻮﺛﻴﻘﺔ‬ ‫ﺇﻋﺎﺩﺓ ﺭﻓﺎﺕ ﺍﻟﻤﺘﻮﻓﻰ ﺇﻟﻰ ﻣﻮﻃﻨﻪ ﺍﻷﺻﻠﻲ‬
the policy
Malath Cooperative Insurance Co. ‫ﺷﺮﻛﺔ ﻣﻼﺫ ﻟﻠﺘﺄﻣﻴﻦ ﺍﻟﺘﻌﺎﻭﻧﻲ‬

Scope of coverage Kingdom of Saudi ‫ﺍﻟﻤﻤﻠﻜﺔ ﺍﻟﻌﺮﺑﻴﺔ ﺍﻟﺴﻌﻮﺩﻳﺔ‬ ‫ﻧﻄﺎﻕ ﺍﻟﺘﻐﻄﻴﺔ‬


Arabia

This policy is issued once and upon expiry a new policy shall be ‫ﻫﺬﻩ ﺍﻟﻮﺛﻴﻘﺔ ﺗﺼﺪﺭ ﻟﻤﺮﺓ ﻭﺍﺣﺪﺓ ﻭ ﻓﻲ ﺣﺎﻝ ﺍﻧﻘﻀﺎﺋﻬﺎ ﻳﺘﻢ ﺍﺻﺪﺍﺭ ﻭﺛﻴﻘﺔ ﺟﺪﻳﺪﺓ‬
issued and does not need to be valid for one complete year. ‫ﻭ ﻻ ﻳﺸﺘﺮﻁ ﺃﻥ ﺗﻜﻮﻥ ﻣﺪﺗﻬﺎ ﺳﻨﺔ ﻛﺎﻣﻠﺔ‬
All applicants for a visa to visit the kingdom-or extend it- or to ‫ﺍﻟﻤﺆﻫﻠﻮﻥ ﻟﻠﺘﺄﻣﻴﻦ ﺟﻤﻴﻊ ﺍﻟﻤﺘﻘﺪﻣﻴﻦ ﻟﻠﺤﺼﻮﻝ ﻋﻠﻰ ﺗﺄﺷﻴﺮﺓ ﺩﺧﻮﻝ ﺇﻟﻰ ﺍﻟﻤﻤﻠﻜﺔ‬
transit. ‫ ﺃﻭ ﺑﻐﺮﺽ ﺍﻟﻤﺮﻭﺭ‬- ‫ ﺃﻭ ﺗﻤﺪﻳﺪﻫﺎ‬- ‫ﺑﻐﺮﺽ ﺍﻟﺰﻳﺎﺭﺓ‬

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Telephone +966114168222 ‫ﻫﺎﺗﻒ‬
Fax +966114168333 ‫ﻓﺎﻛﺲ‬
E-mail info@malath.com.sa ‫ﺍﻟﺒﺮﻳﺪ ﺍﻹﻟﻜﺘﺮﻭﻧﻲ‬
Website www.malath.com.sa ‫ﺍﻟﻤﻮﻗﻊ ﺍﻹﻟﻜﺘﺮﻭﻧﻲ‬

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Telephone 011/2021300 ‫ﻫﺎﺗﻒ‬
Fax 011/4870071 ‫ﻓﺎﻛﺲ‬
E-mail HIDPS@cchi.gov.sa ‫ﺍﻟﺒﺮﻳﺪ ﺍﻹﻟﻜﺘﺮﻭﻧﻲ‬
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