Proposal Form/Policy Schedule

Drive Easy - Unified Motor Vehicle Insurance

Policy Schedule Basics
Policy Number 0102010100871808 Policy Issuance Date 20 July 2017
Insurance Period 20 July 2017 00:00:00 - 19 August 2018 23:59:59
Intermediary Name PEARL INSURANCE BROKERS COMPANY L.L.C.

Insured Details
Insured Name Mr. Seppilai Amanulla Mohamed Ismail
Date of Birth 23 April 1977 Country of Issuance of 1st Driving License INDIA
Emirates ID 784-1977-9462608-1 Licensed Driving experience Driving License held more than 12 months
Mobile Number 050 2787466 Driving License Number 1080644
Home Number - Driving License Expiration Date 15 August 2026
Office Number - Profession Accountant
PO Box 31127 Employer -
Address DUBAI Head Office -
Emirate DUBAI Email Address meeran@pibco.ae

Vehicle Details
Model Year 2013 Place of Registration Dubai
Make & Model NISSAN SUNNY Plate Category Private
Body Type Sedan Vehicle Ownership Individual
Seating Capacity 5 Vehicle Specification GCC
Color Silver Vehicle modified? No
Cylinders / Tonnage 4 Country of Manufacturer -
Plate Number 61409 Purpose of Use -
Chassis Number MDHBN7AD5DG031682 Registration Type -
Engine Number HR15754345B Motor Vehicle Classification -
Sum Insured AED 29,700 /- Financed by Not Applicable

Cover Type, Deductible & Premium

Cover Type Third Party Liability & Loss and Damage Basic Deductible AED 200/-
Cover Plan Gold Ancillary Deductible* Not Applicable
Repair Condition Any Garage of Company Choice Premium AED 1,600/-

Scope of Cover Section Covers Limit

Third Party Liability 1.0 Third Party Bodily Injury Limit set by UAE Courts
1.0 Third Party Property Damage Limit Up to AED 3,500,000/-
1.0 Ambulance Cover AED 6,770/-
1.0 Loss of Use Allowance (maximum up to 10 days) Up to AED 300/- per day
Loss and Damage 2.0 Loss and Damage of Vehicle Up to AED 29,700/-
Riders (Additional Covers) 3.1 Personal Accident Benefit - Passengers Up to AED 200,000/-
3.1 Personal Accident Benefit - Driver Up to AED 200,000/-
3.2 Emergency Medical Expenses Up to AED 5,000/-
3.3 Personal Injury AED 30,000/-
3.4 Geographical Scope (Orange Card can be provided upon request) ** United Arab Emirates , Oman & Qatar
3.5 Natural Disaster, Strike, Riot & Civil Commotion Up to AED 29,700/-
3.6 Personal Belongings Up to AED 5,000/-
3.7 Windscreen Damage (No Deductible) Up to AED 3,000/-
3.8 Replacement of Locks Up to AED 1,000/-
3.9 Valet Parking Theft Up to AED 29,700/-
3.10 Road Side Assistance (Free Toll 8000 973 0048) Gold Plan
3.11 Courtesy Car Cash Benefit Not Covered
3.12 Track Day Not Covered
3.13 Auto Gap Insurance covers Not Covered

** Double the basic deductible applicable

*** Double the basic deductible or 10% of the claim amount applicable, whichever is higher
Disclaimer
In the event that any untrue or inaccurate or mismatching or incomplete or un-updated information has formed the basis of underwriting and issuance of this Insurance Policy, then Oman Insurance Company at its
sole discretion shall retain the full right to reject any claim(s) submitted under such issued policy and/or treat the policy or any section of it as voidable. Should any issue arise out of the above, please refer to the
Terms & Conditions that form part of this insurance policy and shall prevail in case of dispute. Terms & Conditions is available online and should be thoroughly reviewed to understand the full scope of the available
covers
*Ancillary deductible if stated, is applicable in addition to basic deductible. If the vehicle driver's age at the time of accident is less than 25 then, higher of 10% of claim amount or the ancillary deductible as stated
above is applicable
Conditions as per standard Motor Policy approved by the Insurance Authority

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Issued By: Wasim on 18 Jul 2017 9:50

‫ ﻟﺪﻯ ﻫﻴﺌﺔ ﺍﻟﺘﺄﻣﻴﻦ ﺑﺘﺎﺭﻳﺦ‬٩ ‫ ﺭﻗﻢ ﺍﻟﻘﻴﺪ‬،٤١٩٥٢ .‫ ﺕ‬.‫ ﺭﻗﻢ ﺱ‬،‫ ﺩﺭﻫﻢ ﺇﻣﺎﺭﺍﺗﻲ‬٤٦١,٨٧٢,١٢٥ ‫ ﺭﺃﺱ ﺍﻟﻤﺎﻝ ﺍﻟﻤﺪﻓﻮﻉ‬،(‫ﻉ‬.‫ﻡ‬.‫ﺷﺮﻛﺔ ﻋُﻤﺎﻥ ﻟﻠﺘﺄﻣﻴﻦ )ﺵ‬
١٩٨٤/١٢/٢٤
www.tameen.ae,+٩٧١ ٤ ٢٣٣ ٧٧٧٥ :‫ ﻓﺎﻛﺲ‬،+٩٧١ ٤ ٢٣٣ ٧٧٧٧ :‫ ﻫﺎﺗﻒ‬.‫ ﺍﻹﻣﺎﺭﺍﺕ ﺍﻟﻌﺮﺑﻴﺔ ﺍﻟﻤﺘﺤﺪﺓ‬،‫ ﺩﺑﻲ‬،٥٢٠٩ ‫ﺏ‬.‫ ﺹ‬:‫ﺍﻟﻤﺮﻛﺰ ﺍﻟﺮﺋﻴﺴﻲ‬
Oman Insurance Company (P.S.C.), Paid up Capital 461,872,125, C.R. No. 41952, Insurance Authority No. 9 dated 24/12/1984
Head Office: P.O. Box 5209, Dubai, United Arab Emirates. Tel.: +971 4 233 7777, Fax: +971 4 233 7775, www.tameen.ae