Visitors Insurance ϥϳέ΋΍ίϟ΍ϰϠϋϥϳϣ΄Ηϟ΍

Policy Schedule ϥϳϣ΄Ηϟ΍ΔϘϳΛϭϝϭΩΟ

͂̀͡͵̯̠̺͙ͱ̴̹̘̘̓́ͣ͡௬̺͵̠̹͂௛̡
Name of the Company ϥϳϣ΄Ηϟ΍Δϛέηϡγ΍
Solidarity Saudi Takaful Company
Policy No: 1230705442020 ΔϘϳΛϭϟ΍ϡϗέ
Policyholder Details ΔϘϳΛϭϟ΍ϝϣΎΣΕΎϧΎϳΑ
Policyholder Name: LAYLA ELREFAEY ΔϘϳΛϭϟ΍ϝϣΎΣ

Nationality: EGY ΔϳγϧΟϟ΍

Purpose of visit ΔϳϠ΋ΎϋΓέΎϳί ΓέΎϳίϟ΍ϥϣνέϐϟ΍
Reference Number: E265509719 ϊΟέϣϟ΍ϡϗέ
Postal Address: ΓΩΟέϣΎγϟ΍ϰΣ ϱΩϳέΑϟ΍ϥ΍ϭϧόϟ΍

Telephone No in homecountry: ΔϣΎϗϹ΍ΩϠΑϲϓϑΗΎϬϟ΍ϡϗέ

Fax No in homecountry: ΔϣΎϗϹ΍ΩϠΑϲϓαϛΎϔϟ΍ϡϗέ
Telephone No in Destination: ΩϭλϘϣϟ΍ΩϠΑϟ΍ϲϓϑΗΎϬϟ΍ϡϗέ
Fax No in Destination: ΩϭλϘϣϟ΍ΩϠΑϟ΍ϲϓαϛΎϔϟ΍ϡϗέ
Mobile Number: 0548001553 ϝ΍ϭΟϟ΍ϑΗΎϬϟ΍ϡϗέ
Type of Insurance ϥϳϣ΄Ηϟ΍ωϭϧ
Insurance for the visitors fo the kingdom of Saudi Arabia ͂̀͡͵̯̠̺͙͂௬̗௛̯̺͙̹͂Ͼ̻̻Ͼ̺ͳ௬̸̻̺͙̓͡ͳ̀௛͙ͅ௜̺͙̓Ͼ̮ͳ௬̻̔௪̺͙
Product: Visit Visa ΞΗϧϣϟ΍
Provider's Network: C ϥϳΩϭίϣϟ΍ΔϛΑη

Policy / Insurance Period ϥϳϣ΄Ηϟ΍ΓΩϣΔϘϳΛϭϟ΍ΓΩϣ

From 08-04-2020 ϥϣ
To 07-07-2020 ϰϟ·
Both dates included ͳ௬̞̀ͣ̓௪̺͙͇̹ͱ̡̻̀
This policy is issued once and upon expiry a new policy shall be ͳ͕ͩ௛௪̡̀͆͵̸͛̀͂̚͡͡௬̙͵̢͙͙ͣ͡Ͳ௪̸̭̼͙̀̓̾̓ͅͱ̴̜̓́͵̜͙͛͡͵͛௛̸̢̻̺̘ͣ͂͡௬̙͵̺͙ʹ̽͢
issued and does not need to be valid for one complete year) ͂Ͼ̻̹̼̠̘̻̓͂̓̾͡ͳ͵̹̘

Premium / Contribution Amount 225.00 - SAR ργϘϟ΍ϙ΍έΗηϻ΍Δϣϳϗ

Excess ϝϣΣΗϟ΍ώϠΑϣ

Medical emegencies ΔϳΑρϟ΍Ήέ΍ϭρϠϟ

Customer care centre 920003533 | +966 (0)11 2994 555 ˯ϼϣόϟ΍ΔϣΩΧίϛέϣ
Email cc@sstc.com.sa ϲϧϭέΗϛϟϻ΍ΩϳέΑϟ΍
Any claims payment made for covered losses under this policy ̸͂௬̙͵̺͙ʹ͚̽̚͢͵̻̗̲̻̺͙͛̓ͩ௛̸̠̞̺̗̓̓͂ͅϾ̯௪̸̻̺͙̜͂௪̴̠̻̺͙̗̺̻̺͙̜̘̯̓̓ͩ̓̾͜͜͡Ͳ௪̳̺̗̻̀̓ͷ͕
will be in Saudi Riyals (SAR). ͷ͡͵̯̠̺͙ͱ̓̀௛̺̗̓ͳ͵̹̘ͮ͵̠

Solidarity Saudi Takaful Company ϝϓΎϛΗϠϟΔϳΩϭόγϟ΍ϲΗέΩϳϟϭγΔϛέη

Head Office ʹPhone +966 11 299 4555 Fax +966 11 299 4556 966112994556αϛΎϓ966112994555ϑΗΎϫ
PO Box 85770 ʹRiyadh 11612 Kingdom of Saudi Arabia ΔϳΩϭόγϟ΍ΔϳΑέόϟ΍ΔϛϠϣϣϟ΍11612νΎϳέϟ΍±85770Ώι
cc@sstc.com.sa cc@sstc.com.sa
 Benefit Limits - ΩϭΩΣϟ΍ ̵̯̼̻̺͙͂
Diagnosis and treatment of emergency cases Up to SAR 100,000 ̺͙̜̺͙͇̮͂ͣ̓ͩ͆̓͜͞ͅ͵̼̯̻͂̀̓
Hospitalization Up to SAR 100,000 ̵̡̓௪̴̠̻̺͙́Ͳ̀͵̼௪̺͙
Emergency dental treatment (*) Up to SR 500  ̺͙͂ͣ̓ͩͅͳ̼̠͙͇̮̓͋͞
Treatment of emergency pregnancy and delivery cases Up to SAR 5,000 ̺͙͂ͣ̓ͩ͛͆͡ͅ͵̺͙͵ͱ̻̜̺͙̜͇̮͆̓͜͞
The treatment of premature babies (**) Up to SAR 100,000  ͳ̀௛̠௪̗̻̺͙ͱ̵͙͇̮̓ͩ͋͞
Emergency Medical Evacuation inside and outside the Kingdom Up to SAR 100,000 ̹͂Ͼ̻̻̺͙̞ͣ̓͞͵ͱ̞͙̺͙̗̺͙͓͇̞ͣ̓ͩ́ͩ͘͡΀͙
Emergency Kidney Dialysis Up to SAR 100,000 ̺͙ͣ̓ͩ͘ͷ͵Ͼ̹̺͙ͱ௬̠̲̺͙
Repatriation of mortal remains to the home country Up to SAR 10,000 ́Ͼ̢͙͋ʹ͡Ͼ̴̗̺̓͗́͵௪̴̻̺͙̮̓ͣ͛̓͗͜͡
Cost of travel and accompanying of one direct family member Up to SAR 5,000 ̜͙͡͵௛̡̗̻̓͛௛̠͕͵̸̴̭̮͙͂௛̻͵௛̵̠
Treatment to injuries resulting from road traffic accidents Up to SAR 100,000 ͂௬̺͍͙̗̹̓͜௛̻̺͙͙͝͡͵̜ͳ̢̮̘̼̺͙̗͂̓̓̓̚͜΀͙͇̮͞
Geographical limits ͂௬̴͙௛̲̺͙̚͡͵̜̺͙͡
the insurance coverage will be effective when the insured ΔϳΩϭόγϟ΍ΔϳΑέόϟ΍ΔϛϠϣϣϟ΍ΩϭΩΣϪϟϥϣ΅ϣϟ΍ϝϭΧΩΩϧϋϲϧϳϣ΄Ηϟ΍˯Ύρϐϟ΍ϱέγϳ
enters the borders of the Kingdom of Saudi Arabia

Insurance eligibility criteria ϥϳϣ΄ΗϠϟϥϭϠϫ΅ϣϟ΍

Includes all individuals arriving in the Kingdom of Saudi Γέϳη΄ΗΏΟϭϣΑˬϡϫέγ΃Ω΍έϓ΃ϭΔϳΩϭόγϟ΍ΔϳΑέόϟ΍ΔϛϠϣϣϠϟϥϳϣΩΎϘϟ΍ϊϳϣΟϝϣηϳ
Arabia and their family members, under a legitimate visit ϥϳέϣΗόϣϟ΍ϭΝΎΟΣϟ΍˯ΎϧΛΗγΎΑΔϳϣΎυϧΓέΎϳί
visa (except for pilgrims - Hajj and Umrah)
Special Conditions: ΔλΎΧρϭέη
The company¶s prior approval is required for medical expense ϥϣοΔϘϳΛϭϟ΍ϕΎυϧϲϓΔϳΑρϑϳέΎλϣϱ΃ΔϳρϐΗϟΔϛέηϟ΍ϥϣΔϘΑγϣϟ΍ΔϘϓ΍ϭϣϟ΍ϰϠϋϝϭλΣϟ΍ΏΟϳ
to be covered under the policy at the selected provider ΓΩΩΣϣϟ΍ϥϳΩϭίϣϟ΍ΔϛΑη
network
Compensation will be paid after the company approval of those ΝΫϭϣϧϝΎϣϛΗγ΍ΩόΑ˱Ύϳϧϳϣ΄ΗΓΎρϐϣΕΎϘϔϧϟ΍ϥϭϛϰϠϋΔϛέηϟ΍ΔϘϓ΍ϭϣΩόΑνϳϭόΗϟ΍ΩϳΩγΗϡΗϳϑϭγ
expenses that are covered after completing the insurance Ε΍ΩϧΗγϣϱ΃ϰϟ·ΔϓΎοϹΎΑΔϠλϔϣϟ΍ΔϳϠλϷ΍έϳΗ΍ϭϔϟ΍ϪόϣϖϓέϣϭΔϛέηϠϟϪϣϳϠγΗϭϥϳϣ΄Ηϟ΍ΏϠρ
application form and submitting it to the company along with the έϔγϟ΍Ε΍ΩϧΗγϣϭϥ΍έϳρϟ΍έϛ΍ΫΗϭΔϳΑρϟ΍ΕΎϣϭϠόϣϟ΍Ε΍ΩϧΗγϣϝΛϣΔϠλΕ΍ΫϯέΧ΃
original detailed bills in additional to any other related documents
such as medical information documents, flight tickets and travelling Δ΋έΎρΔϟΎΣϟϥϛϳϡϟΎϣϰρϐϣέϳϏΔϳΟέΎΧϟ΍Ε΍ΩΎϳόϟ΍ϭΩΣ΍ϭϟ΍ϡϭϳϟ΍ίϛ΍έϣϲϓΝϼόϟ΍
documents
ϲΗϟ΍ϭϪϳϠϋΔΑΗέΗϣϟ΍Ξ΋ΎΗϧϟ΍ϭϲϧΩΑίΟϋϭ΃ϱΩγΟϑόοϭ΃ΔΑΎλ·ϭ΃νέϣϱ΃ϲρϐϳϻϥϳϣ΄Ηϟ΍
ˬΝέΎΧϠϟΔϠΣέϝϛϝΑϗΎϬο΍έϋ΃έϬυΗϭ΃ΙΩΣΗ
Treatment in day care and outpatient clinics shall not be covered
unless it is for emergency ϭΏϠρϟ΍ΓέΎϣΗγ·ϲϓϙϟΫϥϋ΢ϳέλΗϟ΍ϡΗ΍Ϋ·ϻ·ΓΩϻϭϟ΍ϭϝϣΣϟ΍ΕϻΎΣϲρϐϳϻΞΗϧϣϟ΍΍Ϋϫ
ρϘϓΉέ΍ϭρϟ΍ΕϻΎΣϰϠϋΔϳρϐΗϟ΍έλΗϘΗγ
There will be no cover for any illness or injury or physical ϲϓΝέΩϣϥϳϣ΄ΗϟΎΑϝϭϣηϣιΧηϱ΃ϭΔϘϳΛϭϟ΍ϝϣΎΣΩϬόΗϳΝϼόϟ΍νέϐϟΓέΎϳίϟ΍ϡΩόΑΩϬόΗϟ΍
weakness or physical disabilities, and the consequences and ϭ΃ϪϳΩϟϡϭϠόϣΝϼϋϱ΃ΔϳρϐΗϟΔϘϳΛϭϟ΍ϩΫϫϡ΍ΩΧΗγ΍ϡΩόΑΔϘϳΛϭϟ΍ϩΫϬΑϪϟϥϣ΅ϣϟ΍ιΎΧηϷ΍ϝϭΩΟ
symptoms that occur or appear before each trip ΔϳρϐΗϟ΍ΞϣΎϧέΑϥϣοϥϣΝϼόϟ΍΍ΫϫϰϠϋϝϭλΣϟ΍ϑΩϬΑΔϛϠϣϣϟ΍ΓέΎϳίϭΎϘΑγϣιΧηϣ
This product does not cover pregnancy and delivery cases unless
declared on the porposal from and cover will be limited to
emergency only.

The policyholder and any other person that is listed on the policy
schedule and included in the insurance undertake not to use this
policy to cover any previously known treatment or diagnostic nor
visit the kingdom in order to obtain this treatment within this
coverage.

Signed on behalf of the company Δϛέηϟ΍ϥϋΔΑΎϳϧΎϬόϗϭ

Attorney: ϊϳϗϭΗϟΎΑϝϭΧϣϟ΍

Company Seal Δϛέηϟ΍ϡΗΧ

Solidarity Saudi Takaful Company ϝϓΎϛΗϠϟΔϳΩϭόγϟ΍ϲΗέΩϳϟϭγΔϛέη

Head Office ʹPhone +966 11 299 4555 Fax +966 11 299 4556 966112994556αϛΎϓ966112994555ϑΗΎϫ
PO Box 85770 ʹRiyadh 11612 Kingdom of Saudi Arabia ΔϳΩϭόγϟ΍ΔϳΑέόϟ΍ΔϛϠϣϣϟ΍11612νΎϳέϟ΍±85770Ώι
cc@sstc.com.sa cc@sstc.com.sa