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Insurance Certificate ‫ﺷﻬﺎﺩﺓ ﺍﻟﺘﺄﻣﻴﻦ‬

Involuntary Loss of Employment ‫ﺿﺪ ﺍﻟﺘﻌﻄﻞ ﻋﻦ ﺍﻟﻌﻤﻞ‬
Insurance Certificate Number C/01/2023/003439448 C/01/2023/003439448 ‫ﺭﻗﻢ ﺷﻬﺎﺩﺓ ﺍﻟﺘﺄﻣﻴﻦ‬
Coverage Period ‫ﻣﺪﺓ ﺍﻟﺘﻐﻄﻴﺔ‬
Inception Date 31-05-2023 31-05-2023 ‫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 NAZMUL HOSSEN ‫ﻧﺎﺯﻣﻮﻝ ﺣﺴﻴﻦ ﺳﻮﺭﻭﻑ ﻣﺤﻤﺪ ﻣﺤﻴﺐ‬ ‫ﺍﺳﻢ ﺍﻟﻌﺎﻣﻞ ﺍﻟﻤُﺆﻣَﻦ ﻟﻪ‬
SOUROV MD MOHIBUR ‫ﺍﻟﺮﺣﻤﻦ‬
RAHMAN
Emirates ID No./UID number 784200293400600 784200293400600 ‫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 MANBAA AL KHOORI ‫ﻣﻨﺒﻊ ﺍﻟﺨﻮﺭ ﻟﺨﺪﻣﺎﺕ ﺍﻟﺘﻮﺻﻴﻞ ﺍﻟﻄﻠﺒﺎﺕ‬ ‫ﺍﺳﻢ ﺻﺎﺣﺐ ﺍﻟﻌﻤﻞ‬
DELIVERY SERVICES
Establishment No. 1166232 1166232 ‫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 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
 Dubai Insurance Company Psc, Head Office, Al Rigga Road, PO Box 3027, Dubai, UAE
TRN: 100032059600003

TAX INVOICE ‫ﻓﺎﺗﻮﺭﺓ ﺿﺮﻳﺒﻴّﺔ‬

Tax Invoice Number 0003439448 ‫ﺭﻗﻢ ﺍﻟﻔﺎﺗﻮﺭﺓ ﺍﻟﻀﺮﻳﺒﻴّﺔ‬

Date(same as payment date) 31-05-2023 ‫ﺗﺎﺭﻳﺦ ﺍﻟﻔﺎﺗﻮﺭﺓ‬
The Insured Worker’s Name NAZMUL HOSSEN SOUROV MD ‫ﺍﺳﻢ ﺍﻟﻌﺎﻣﻞ ﺍﻟﻤﺆﻣﻦ ﻋﻠﻴﻪ‬
MOHIBUR RAHMAN
Emirates ID or UID number 784200293400600 ‫ﺭﻗﻢ ﺍﻟﻬﻮﻳﺔ ﺍﻹﻣﺎﺭﺍﺗﻴّﺔ‬
Certificate of Insurance No. C/01/2023/003439448 ‫ﺭﻗﻢ ﺷﻬﺎﺩﺓ ﺍﻟﺘﺄﻣﻴﻦ‬
Coverage Period 31-05-2023 to 30-05-2024 ‫ﻓﺘﺮﺓ ﺍﻟﺘﻐﻄﻴﺔ‬
Payment Plan (monthly/quarterly/yearly) Full/Annual ‫ﺩﻭﺭﻳّﺔ ﺍﻟﺴﺪﺍﺩ‬

Due Date of last installment 31-05-2023 ّ‫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 PR0003773661 ‫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