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Insurance Certificate ﺷﻬﺎﺩﺓ ﺍﻟﺘﺄﻣﻴﻦ
Involuntary Loss of Employment ﺿﺪ ﺍﻟﺘﻌﻄﻞ ﻋﻦ ﺍﻟﻌﻤﻞ
Insurance Certificate Number C/01/2023/005260939 C/01/2023/005260939 ﺭﻗﻢ ﺷﻬﺎﺩﺓ ﺍﻟﺘﺄﻣﻴﻦ
Coverage Period ﻣﺪﺓ ﺍﻟﺘﻐﻄﻴﺔ
Inception Date 08-08-2023 08-08-2023 ﺗﺎﺭﻳﺦ ﺍﻟﺴﺮﻳﺎﻥ
Expiry Date 12 months as of inception ﺷﻬﺮﺍً ﺑﻌﺪ ﺗﺎﺭﻳﺦ ﺑﺪﺍﻳﺔ ﺍﻟﺘﺄﻣﻴﻦ12 ﺗﺎﺭﻳﺦ ﺍﻻﻧﺘﻬﺎﺀ
date
Details of the Insured Employee/ Worker ﺑﻴﺎﻧﺎﺕ ﺍﻟﻤُﺆﻣَﻦ ﻟﻪ
Name of the Insured Worker SIDDEEK KARIMBALAPU ﺻﺪﻳﻖ ﻛﺎﺭﻳﻤﺒﺎﻻﺑﻮ ﺟﻤﻌﻪ ﻣﺴﺠﺪ ﺍﺑﺮﺍﻫﻴﻢ ﺍﺳﻢ ﺍﻟﻌﺎﻣﻞ ﺍﻟﻤُﺆﻣَﻦ ﻟﻪ
JUMA MASJID IBRAHIM
Emirates ID No./UID number 784197951576327 784197951576327 ﺍﻟﺮﻗﻢ ﺍﻟﻤﻮﺣﺪ
Category Category A ﺍﻟﻔﺌﺔ ﺃ ﻟﻔﺌﺔ
Premium (AED) 60.00 60.00 (ﺍﻟﻘﺴﻂ ﺍﻟﺘﺄﻣﻴﻨﻲ )ﺑﺎﻟﺪﺭﻫﻢ
Premium Paid upon purchase 60.00 60.00 ﺩﻭﺭﻳﺔ ﺍﻟﺴﺪﺍﺩ ﻋﻨﺪ ﺍﻟﺸﺮﺍﺀ
Establishment Details ﺑﻴﺎﻧﺎﺕ ﻣﻨﺸﺄﺓ ﺍﻟﻌﻤﻞ
at the date of issuing the Certificate of Insurance ﻋﻨﺪ ﺇﺻﺪﺍﺭ ﺷﻬﺎﺩﺓ ﺍﻟﺘﺄﻣﻴﻦ
Establishment Name ARNOLD PROJECT ﺷﺮﻛﺔ ﺃﺭﻧﻮﻟﺪ ﻟﺨﺪﻣﺎﺕ ﺇﺩﺍﺭﺓ ﺍﻟﻤﺸﺎﺭﻳﻊ ﺍﺳﻢ ﺻﺎﺣﺐ ﺍﻟﻌﻤﻞ
MANAGEMENT SERVICES
CO.
Establishment No. 1258605 1258605 ﺭﻗﻢ ﺍﻟﻤﻨﺸﺄﺓ
Insurance Coverage ﺍﻟﺘﻐﻄﻴﺔ ﺍﻟﺘﺄﻣﻴﻨﻴﺔ
60% of Basic Salary/Wage Wage calculated based on ﺍﻟﺮﺍﺗﺐ ﺍﻷﺳﺎﺳﻲ/ ﻣﻦ ﺍﻷﺟﺮ%60 ﻳﻜﻮﻥ ﺍﻟﺘﻌﻮﻳﺾ ﻋﻠﻰ ﺃﺳﺎﺱ ﺷﻬﺮﻱ ﺑﻨﺴﺒﺔ
average Basic Salary/Wage of the last 6 months prior to ( ﺃﺷﻬﺮ ﺍﻟﺴﺎﺑﻘﺔ ﻟﻠﺘﻌﻄﻞ ﻋﻦ ﺍﻟﻌﻤﻞ6 )ﺗﺤﺴﺐ ﻋﻠﻰ ﺃﺳﺎﺱ ﻣﺘﻮﺳﻂ ﺍﻷﺟﺮ ﺍﻷﺳﺎﺳﻲ ﺁﺧﺮ
Unemployment for a maximum of three (3) months per ،( ﺛﻼﺛﺔ ﺃﺷﻬﺮ ﺑﺤﺪ ﺃﻗﺼﻰ ﻟﻜﻞ ﻣﻄﺎﻟﺒﺔ ﻣﻦ ﺗﺎﺭﻳﺦ ﺍﻟﺘﻌﻄﻞ ﻋﻦ ﺍﻟﻌﻤﻞ3) ﻭﻟﻤﺪﺓ
Claim from the date of Unemployment, not exceeding: :ﻋﻠﻰ ﺃﻻ ﺗﺰﻳﺪ ﻋﻦ
Maximum Monthly Limit :ﺍﻟﺤﺪ ﺍﻷﻗﺼﻰ ﻟﻠﺘﻐﻄﻴﺔ ﺍﻟﺘﺄﻣﻴﻨﻴﺔ ﺍﻟﺸﻬﺮﻳﺔ
AED 10,000 and AED 20,000 for the first and second (20,000) ﻭﻻ ﺗﺰﻳﺪ ﻋﻦ،( ﻋﺸﺮﺓ ﺁﻻﻑ ﺩﺭﻫﻢ ﺍﻣﺎﺭﺗﻲ ﻟﻠﻔﺌﺔ ﺍﻷﻭﻟﻰ10,000)
categories respectively as specified in the Policy .ﻋﺸﺮﻳﻦ ﺃﻟﻒ ﺩﺭﻫﻢ ﺍﻣﺎﺭﺗﻲ ﻟﻠﻔﺌﺔ ﺍﻟﺜﺎﻧﻴﺔ ﻛﻤﺎ ﻫﻮ ﻣﺒﻴﻦ ﻓﻲ ﺟﺪﻭﻝ ﺍﻟﻮﺛﻴﻘﺔ
Maximum Claim Limit/Maximum Aggregate Limit
The maximum compensation for any one Claim is three ﺍﻟﺤﺪ ﺍﻷﻗﺼﻰ ﻟﻠﺘﻐﻄﻴﺔ/ﺍﻟﺤﺪ ﺍﻷﻗﺼﻰ ﻟﻠﺘﻐﻄﻴﺔ ﺍﻟﺘﺄﻣﻴﻨﻴَّﺔ ﻋﻦ ﻛﻞ ﻣﻄﺎﻟﺒﺔ
(3) consecutive months. :ﺍﻟﺘﺄﻣﻴﻨﻴَّﺔ ﺍﻹﺟﻤﺎﻟﻴﺔ
The aggregate Claim shall not exceed the equivalent of .( ﺛﻼﺛﺔ ﺃﺷﻬﺮ ﻋﻦ ﻛﻞ ﻣﻄﺎﻟﺒﺔ3) :ﺍﻟﻤﺪﺓ ﺍﻟﻘﺼﻮﻯ ﻟﻠﺘﻌﻮﻳﺾ
12 monthly benefits over the entire service period of ( ﺍﺛﻨﻲ ﻋﺸﺮ ﺷﻬﺮﺍً ﺧﻼﻝ ﻛﺎﻣﻞ ﻣﺪﺓ ﺧﺪﻣﺔ12) ﻋﻠﻰ ﺃﻻ ﺗﺰﻳﺪ ﻣﺪﺓ ﺍﻟﺘﻌﻮﻳﺾ ﻋﻦ
Insured in the Country. .ﺍﻟﻤُﺆﻣﻦ ﻋﻠﻴﻪ ﻓﻲ ﺳﻮﻕ ﺍﻟﻌﻤﻞ ﻓﻲ ﺍﻟﺪﻭﻟﺔ
This Insurance Certificate is subject to the terms and ﻳﻤﻜﻦ ﺍﻻﻃﻼﻉ ﻋﻠﻰ ﻭﺛﻴﻘﺔ ﺍﻟﺘﺄﻣﻴﻦ ﻋﺒﺮ. ﺗﺨﻀﻊ ﻫﺬﻩ ﺍﻟﺸﻬﺎﺩﺓ ﻟﺸﺮﻭﻁ ﻭﺍﺣﻜﺎﻡ ﻭﺛﻴﻘﺔ ﺍﻟﺘﺄﻣﻴﻦ
conditions of the Insurance Policy. The insurance policy can be : (؛ ﺃﻭ ﻣﻦ ﺧﻼﻝ ﻣﺴﺢ ﺍﻟﺮﻣﺰ ﺍﻟﺘﺎﻟﻲ[Link] ) ﺭﺍﺑﻂ ﺍﻟﻤﻮﻗﻊ ﺍﻻﻟﻜﺘﺮﻭﻧﻲ
viewed via the website link ([Link]), or scan the QR:
This certificate was issued by Dubai Insurance Company ﺑﺼﻔﺘﻬﺎ ﻋﻀﻮ، ﻉ.ﻡ.ﺻﺪﺭﺕ ﻫﺬﻩ ﺍﻟﺸﻬﺎﺩﺓ ﻋﻦ ﺷﺮﻛﺔ ﺩﺑﻲ ﻟﻠﺘﺄﻣﻴﻦ ﺵ
PJSC, in its capacity as a member and manager of the ﻭﻣﺪﻳﺮ ﺍﻟﻤﺠﻤﻊ ﺍﻟﺘﺄﻣﻴﻨﻲ ﻭﺑﺎﻟﻨﻴﺎﺑﺔ ﻋﻦ ﺃﻋﻀﺎﺀ ﺍﻟﻤﺠﻤﻊ ﺍﻟﺘﺄﻣﻴﻨﻲ
Insurance Pool and on behalf of the members of the
Insurance Pool
Dubai Insurance Company Psc, Head Office, Al Rigga Road, PO Box 3027, Dubai, UAE
TRN: 100032059600003
TAX INVOICE ﻓﺎﺗﻮﺭﺓ ﺿﺮﻳﺒﻴّﺔ
Tax Invoice Number 0005261023 ﺭﻗﻢ ﺍﻟﻔﺎﺗﻮﺭﺓ ﺍﻟﻀﺮﻳﺒﻴّﺔ
Date(same as payment date) 08-08-2023 ﺗﺎﺭﻳﺦ ﺍﻟﻔﺎﺗﻮﺭﺓ
The Insured Worker’s Name SIDDEEK KARIMBALAPU JUMA ﺍﺳﻢ ﺍﻟﻌﺎﻣﻞ ﺍﻟﻤﺆﻣﻦ ﻋﻠﻴﻪ
MASJID IBRAHIM
Emirates ID or UID number 784197951576327 ﺭﻗﻢ ﺍﻟﻬﻮﻳﺔ ﺍﻹﻣﺎﺭﺍﺗﻴّﺔ
Certificate of Insurance No. C/01/2023/005260939 ﺭﻗﻢ ﺷﻬﺎﺩﺓ ﺍﻟﺘﺄﻣﻴﻦ
Coverage Period 08-08-2023 to 07-08-2024 ﻓﺘﺮﺓ ﺍﻟﺘﻐﻄﻴﺔ
Payment Plan (monthly/quarterly/yearly) Full/Annual ﺩﻭﺭﻳّﺔ ﺍﻟﺴﺪﺍﺩ
Due Date of last installment 08-08-2023 ّﺗﺎﺭﻳﺦ ﺍﺳﺘﺤﻘﺎﻕ ﺍﻟﺪﻓﻌﺔ ﺍﻷﺧﻴﺮﺓ ﻣﻦ ﺍﻟﻘﺴﻂ ﺍﻟﺘﺄﻣﻴﻨﻲ
Premium in AED 60.00 (ﺍﻟﻘﺴﻂ ﺍﻟﺘﺄﻣﻴﻨﻲّ )ﺑﺎﻟﺪﺭﻫﻢ
VAT 5% on premium 3.00 (%5)ّﺿﺮﻳﺒﺔ ﺍﻟﻘﻴﻤﺔ ﺍﻟﻤﻀﺎﻓﺔ ﻋﻠﻰ ﺍﻟﻘﺴﻂ ﺍﻟﺘﺄﻣﻴﻨﻲ
Total consideration payable 63.00 ﺇﺟﻤﺎﻟﻲ ﺍﻟﻤﺒﻠﻎ ﻣﺴﺘﺤﻖ ﺍﻟﺴﺪﺍﺩ
Payment Reference Number PR0006104819 ﺭﻗﻢ ﻣﻌﺎﻣﻠﺔ ﺍﻟﺴﺪﺍﺩ
Payment made through Worker ﺁﻟﻴﺔ ﺍﻟﺴﺪﺍﺩ
First installment received with VAT (AED) 63.00 ﻣﺘﻀﻤﻨﺔ- ﺍﻟﺪﻓﻌﺔ ﺍﻷﻭﻟﻰ ﻣﻦ ﺍﻟﻘﺴﻂ ﺍﻟﺘﺄﻣﻴﻨﻲّ ﺍﻟﻤﺴﺘﺤﻘﺔ
(ﺿﺮﻳﺒﺔ ﺍﻟﻘﻴﻤﺔ ﺍﻟﻤﻀﺎﻓﺔ )ﺑﺎﻟﺪﺭﻫﻢ
Balance to be received in agreed 0.00 (ﺑﺎﻗﻲ ﺩﻓﻌﺎﺕ ﺍﻟﻘﺴﻂ ﺍﻟﺘﺄﻣﻴﻨﻲّ ﺍﻟﻤﺴﺘﺤﻘﺔ )ﺑﺎﻟﺪﺭﻫﻢ
instalments (AED)
This is a system generated document ﺗﺼﺪﺭ ﻫﺬﻩ ﺍﻟﻔﺎﺗﻮﺭﺓ ﻣﻦ ﺧﻼﻝ ﻧﻈﺎﻡ ﺇﻟﻜﺘﺮﻭﻧﻲّ ﻭﻻ
does not need any signature or stamp ﺣﺎﺟﺔ ﻟﺨﺘﻤﻬﺎ ﺃﻭ ﺗﻮﻗﻴﻌﻬﺎ
