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Insurance Certificate ‫ﺷﻬﺎﺩﺓ ﺍﻟﺘﺄﻣﻴﻦ‬

Involuntary Loss of Employment ‫ﺿﺪ ﺍﻟﺘﻌﻄﻞ ﻋﻦ ﺍﻟﻌﻤﻞ‬
Insurance Certificate Number C/02/2024/007391910 C/02/2024/007391910 ‫ﺭﻗﻢ ﺷﻬﺎﺩﺓ ﺍﻟﺘﺄﻣﻴﻦ‬
Coverage Period ‫ﻣﺪﺓ ﺍﻟﺘﻐﻄﻴﺔ‬
Inception Date 29-03-2024 29-03-2024 ‫ﺗﺎﺭﻳﺦ ﺍﻟﺴﺮﻳﺎﻥ‬
Expiry Date 24 months as of inception ‫ ﺷﻬﺮﺍً ﺑﻌﺪ ﺗﺎﺭﻳﺦ ﺑﺪﺍﻳﺔ ﺍﻟﺘﺄﻣﻴﻦ‬24 ‫ﺗﺎﺭﻳﺦ ﺍﻻﻧﺘﻬﺎﺀ‬
date
Details of the Insured Employee/ Worker ‫ﺑﻴﺎﻧﺎﺕ ﺍﻟﻤُﺆﻣَﻦ ﻟﻪ‬
Name of the Insured Worker AFSAL AHAMMED ‫ﺍﻓﻀﻞ ﺍﺣﻤﺪ ﻛﺎﻟﻴﺘﺎﺩﺍﺗﻴﻞ ﺑﺎﻓﺎ ﻏﻔﻮﺭ‬ ‫ﺍﺳﻢ ﺍﻟﻌﺎﻣﻞ ﺍﻟﻤُﺆﻣَﻦ ﻟﻪ‬
KALLITHADATHIL BAVA ‫ﻛﺎﻟﻴﺘﺎﺩﺍﺗﻴﻞ‬
GAFOOR
KALLITHADATHIL
Emirates ID /UID No. 238015221 238015221 ‫ ﺍﻟﺮﻗﻢ ﺍﻟﻤﻮﺣﺪ‬/ ‫ﺭﻗﻢ ﺍﻟﻬﻮﻳﺔ‬
Category Category A ‫ﺍﻟﻔﺌﺔ ﺃ‬ ‫ﻟﻔﺌﺔ‬
Premium (AED) 120.00 120.00 (‫ﺍﻟﻘﺴﻂ ﺍﻟﺘﺄﻣﻴﻨﻲ )ﺑﺎﻟﺪﺭﻫﻢ‬
Premium Paid upon purchase 120.00 120.00 ‫ﺩﻭﺭﻳﺔ ﺍﻟﺴﺪﺍﺩ ﻋﻨﺪ ﺍﻟﺸﺮﺍﺀ‬
Establishment Details ‫ﺑﻴﺎﻧﺎﺕ ﻣﻨﺸﺄﺓ ﺍﻟﻌﻤﻞ‬
at the date of issuing the Certificate of Insurance ‫ﻋﻨﺪ ﺇﺻﺪﺍﺭ ﺷﻬﺎﺩﺓ ﺍﻟﺘﺄﻣﻴﻦ‬
Establishment Name NOBLE TECH FUEL ‫ﻧﻮﺑﻞ ﺗﻴﻚ ﻟﺘﺠﺎﺭﻩ ﺍﻟﻮﻗﻮﺩ ﺫ ﻡ ﻡ‬ ‫ﺍﺳﻢ ﺻﺎﺣﺐ ﺍﻟﻌﻤﻞ‬
TRADING L L C
Establishment No. 928609 928609 ‫ﺭﻗﻢ ﺍﻟﻤﻨﺸﺄﺓ‬
Insurance Coverage ‫ﺍﻟﺘﻐﻄﻴﺔ ﺍﻟﺘﺄﻣﻴﻨﻴﺔ‬
60% of Basic Salary/Wage calculated based on the ‫ 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 ‫ ﻭﻻ ﺗﺰﻳﺪ ﻋﻦ‬،‫( ﻋﺸﺮﺓ ﺁﻻﻑ ﺩﺭﻫﻢ ﺍﻣﺎﺭﺍﺗﻲ ﻟﻠﻔﺌﺔ ﺍﻷﻭﻟﻰ‬10,000) ‫ﻻ ﺗﺰﻳﺪ ﻋﻦ‬
categories respectively as specified in the Policy Schedule. .‫( ﻋﺸﺮﻳﻦ ﺃﻟﻒ ﺩﺭﻫﻢ ﺍﻣﺎﺭﺍﺗﻲ ﻟﻠﻔﺌﺔ ﺍﻟﺜﺎﻧﻴﺔ ﻛﻤﺎ ﻫﻮ ﻣﺒﻴﻦ ﻓﻲ ﺟﺪﻭﻝ ﺍﻟﻮﺛﻴﻘﺔ‬20,000)

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) 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
the 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 ﺍﻟﺘﺎﻟﻲ‬www.ILOE.ae ) ‫ﺭﺍﺑﻂ ﺍﻟﻤﻮﻗﻊ ﺍﻻﻟﻜﺘﺮﻭﻧﻲ‬
viewed via the website link (www.ILOE.ae), 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
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For inquires: 600 599 555 600 599 555:‫ﻟﻠﺘﻮﺍﺻﻞ ﻭﺍﻻﺳﺘﻔﺴﺎﺭ‬

Dubai Insurance Company Psc, Head Office, Al Rigga Road, PO Box 3027, Dubai, UAE
TRN: 100032059600003

TAX INVOICE ‫ﻓﺎﺗﻮﺭﺓ ﺿﺮﻳﺒﻴّﺔ‬

Tax Invoice Number 0008244850 ‫ﺭﻗﻢ ﺍﻟﻔﺎﺗﻮﺭﺓ ﺍﻟﻀﺮﻳﺒﻴّﺔ‬

Date(same as payment date) 29-03-2024 ‫ﺗﺎﺭﻳﺦ ﺍﻟﻔﺎﺗﻮﺭﺓ‬
The Insured Worker’s Name AFSAL AHAMMED KALLITHADATHIL ‫ﺍﺳﻢ ﺍﻟﻌﺎﻣﻞ ﺍﻟﻤﺆﻣﻦ ﻋﻠﻴﻪ‬
BAVA GAFOOR KALLITHADATHIL
Emirates ID or UID number 238015221 ‫ﺭﻗﻢ ﺍﻟﻬﻮﻳﺔ ﺍﻹﻣﺎﺭﺍﺗﻴّﺔ‬
Certificate of Insurance No. C/02/2024/007391910 ‫ﺭﻗﻢ ﺷﻬﺎﺩﺓ ﺍﻟﺘﺄﻣﻴﻦ‬
Coverage Period 29-03-2024 to 28-03-2026 ‫ﻓﺘﺮﺓ ﺍﻟﺘﻐﻄﻴﺔ‬
Payment Plan (monthly/quarterly/yearly) Full/Annual ‫ﺩﻭﺭﻳّﺔ ﺍﻟﺴﺪﺍﺩ‬

Due Date of last installment 29-03-2024 ّ‫ﺗﺎﺭﻳﺦ ﺍﺳﺘﺤﻘﺎﻕ ﺍﻟﺪﻓﻌﺔ ﺍﻷﺧﻴﺮﺓ ﻣﻦ ﺍﻟﻘﺴﻂ ﺍﻟﺘﺄﻣﻴﻨﻲ‬

Premium in AED 120.00 (‫ﺍﻟﻘﺴﻂ ﺍﻟﺘﺄﻣﻴﻨﻲّ )ﺑﺎﻟﺪﺭﻫﻢ‬

VAT 5% on premium 6.00 (%5)ّ‫ﺿﺮﻳﺒﺔ ﺍﻟﻘﻴﻤﺔ ﺍﻟﻤﻀﺎﻓﺔ ﻋﻠﻰ ﺍﻟﻘﺴﻂ ﺍﻟﺘﺄﻣﻴﻨﻲ‬

Total consideration payable 126.00 ‫ﺇﺟﻤﺎﻟﻲ ﺍﻟﻤﺒﻠﻎ ﻣﺴﺘﺤﻖ ﺍﻟﺴﺪﺍﺩ‬

Payment Reference Number PR0010784259 ‫ﺭﻗﻢ ﻣﻌﺎﻣﻠﺔ ﺍﻟﺴﺪﺍﺩ‬
Payment made through Worker ‫ﺁﻟﻴﺔ ﺍﻟﺴﺪﺍﺩ‬

First installment received with VAT (AED) 126.00 ‫ 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