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Policy Holder Details

Policy Details

Recent Professional Experience 1


Is the proposer under contract with or in the employment of any individual, firm, or corporation? If yes, please give details.

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Has a previous insurance

Has the proposer previously been insured?
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Has previous application been declined/required rate increase/not renewed by an insurer?

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Have any claims or suits for malpractice been made against proposer or any of his partners, assistants, or technicians during the past five years?

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Is the proposer or any of his partners, assistants or technicians aware of any circumstances or incidents which may result in a claim?

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Summary and Payment

Product Summary

  • ProductProduct Name
  • ID NumberID Number
  • NameName
  • Policy Start Date12/12/2020
  • Profession12/12/2020
  • Policy Duration12/12/2020
  • Policy Expiry Date12/12/2020
  • Liability LimitText

  • Insurance Premium1000 SAR
  • Extended Reporting Period Fees1000 SAR
  • Policy Issuance Fees1000 SAR
  • Promotion Disc.1000 SAR
  • Value-added Tax (15%)1000 SAR
  • Total Insurance Premium1000 SAR
  • Total Amount1000 SAR

Payment Details

Select Payment Method
Debit/Credit Card.

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