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Personal Information

ID Type

ID Number

Expiry Date *

Marital Status *

First Name

Father Name

Grand Father Name

Family Name

Date of Birth (Hijri)

Date of Birth (Gregorian)

Age

Gender

First Name in english *

Middle Name in english

Last Name in english *

Who pays the subscription? *

Payee Info

ID Type *

ID Number

Marital Status *

First Name

Father Name

Grand Father Name

Family Name

Date of Birth (Gregorian)

Age

Gender *

First Name in english *

Middle Name in english

Last Name in english *

How are you related ? *

Policy Number

National Address

Building Number

Additional Number

Street Name

District

City

Postal Code

Country *

Home Country Address

Home Country *

House *

Street *

City *

Postal Code *

Country of Birth *

Nationality *

Contact Information

Phone Number - Home

Phone Number - Work

Mobile Number *

Email *

Are you a person from the United States of America?

Please fill in the Foreign Account Tax Compliance Act (FATCA) Self-Certification Certificate Form

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Are you a tax resident in any country or countries outside the Kingdom of Saudi Arabia?

I assert that Saudi Arabia is a toolkit for experimental purposes

Please fill out the Common Reporting Standard (CRS) self-certification form.

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I have read and disagreed on the tax compliance declaration

Financial Information

SAR

Do you have an additional source of income?

Please select the source of income

Free business Rent Savings Owner of a private establishment / business Investment products Legacy

What is the expected annual volume of the Policy transactions (for the protection and savings account)

Type of operation

Do you expect to deposit additional amount in your account for protection and savings?

Times per year *

Amount per year *

Type of operation

Do you expect to increase the contribution amount?

Times per year *

Amount per year *

Type of operation

Do you expect to make a partial withdrawal from your Net Asset Value account?

Times per year *

Amount per year *

What is the purpose of your subscription?

Do you have other insurance documents with insurance companies in the Kingdom?

I am the ultimate beneficiary of this policy and I am not issuing this policy on behalf of other person.

Attach copy of the applicant ID *

Attach files

Attached IBAN document

Attach files

Attach copy of the annual income and additional income sources

Attach files

Attach copy of the Individual to be covered ID *

Attach files

Foreign Account Tax Compliance Act (FATCA) Self-Certification Certificate Form *

Attach files

Common Reporting Standard (CRS) self-certification form *

Attach files

I confirm that the above statements are true and complete.
I declare that I am not legally prohibited from dealing with you, and that all information and data that I have provided are correct.
I undertake to update my personal information with Al Jazeera Takaful at the specified times or if the company requests it.
I authorize Aljazira Takaful to collect from and/or disclose to any potential third parties approved by the Central Bank of Saudi Arabia, so that the company, at its discretion, may create and/or review and/or manage my insurance policy.
I agree that Al Jazeera will send any marketing materials related to new features, offers and insurance products, and if I want to cancel this service at any time, I must contact the Customer Service Center in Al Jazeera Takaful to cancel it
I acknowledge my statement about the real beneficiary of the Al Jazeera Takaful program .

I declare that I am a resident who is required to pay taxes in any country or countries outside the Kingdom of Saudi Arabia.
(tax declaration)

I declare that I am not a resident who is required to pay taxes in any country or countries outside the Kingdom of Saudi Arabia

Personal Data Protection Consent Form

This consent form outlines how AJT collects, uses, and processes my personal data, including sensitive personal information, in compliance with the Personal Protection Law (PDPL) of Saudi Arabia. A parent or guardian should complete the consent for any member that is under the age of 13. By signing this Consent Form, I am providing explicit consent for Aljazira Takaful company to process my personal and sensitive personal information along with minor data as provided by me (if applicable), as described herein. I understand that If I do not provide my explicit consent for the processing of personal as outlined below, Aljazira Takaful will not be able to handle my data or process any claims that may be owed to me.

1.Scope of Consent

I understand and acknowledge that by signing this consent form, I authorize Aljazira Takaful and its contracted agents (including from third parties like physicians, nursing and hospital staff, other medical institutions, care homes, statutory health insurance funds, professional associations, and public authorities, etc.) to:

• To provide me with insurance services, including underwriting, claims processing, anti-money laundering, and fraud-preventing activities.

• To manage my insurance policy and account.

• To communicate with me about their services and other offerings along with marketing messages.

• To comply with legal and regulatory requirements.

• To conduct risk assessments and prevent fraud.

• To conduct marketing, scientific research, statistical activities, and analysis to improve their services and products.

• To provide me with customer service, communication, and feedback services.

The personal and health information Aljazira Takaful collects, and processes may include, but is not limited to:

• Personal identity information, including Name, Sex, Nationality, Citizenship, Job Title, Mobile Number, Email Address, Signature, occupation, Telephone number, date of Birth, Place of birth, Marital status, Family status, National Address (including historic address, contact address, and permanent address), Company/employer details, Job position, and any relationship with politically exposed person.

• Sensitive Personal Information (such as National/Iqama ID number, health data, genetic data, intellectual, religious, and political beliefs, and criminal records. Personal biometrics information, such as Signature, Handwriting, Fingerprint, Voice, Face Recognition Information, etc.)

• Demographic information (such as age, gender, nationality, and occupation)

• Usage data (such as information about how you use our website or services)

• Financial/Credit Information (bank account details, payment information)

• Health Information (medical records, health condition, treatment history, medical history, related to health conditions or diseases, family details (including spouse, children), etc)

• Other Information relevant to insurance services

• Any other personal data that is voluntarily provided

2. Confidentiality and Security

Al-Jazira Takaful Taawuni Company is a Saudi joint stock company Regulated and supervised by Insurance Authority, with a capital of 660,000,000 Saudi riyals offers various insurance programs and solutions that are Sharia Compliant. Commercial registration number ********** / **********, aims to contribute to achieving the vision of the Kingdom of Saudi Arabia 2030.

3. Sensitive Health Information

I acknowledge that I am providing sensitive health information to Aljazira Takaful for insurance-related purposes. This includes information about medical conditions, treatments, and health history.

4. Data Retention

Aljazira Takaful will retain my personal and health information for as long as required to fulfill the purposes specified in Section 1 and as mandated by applicable laws and regulations.

5. Rights

Right Of Access / Right to Request Access I can access the personal and health information Aljazira Takaful holds about me

Right to Request Correction I can request correction and updating of inaccuracies in my personal and health information.

Right to Request Destruction I can request the deletion of my personal and health information under specific circumstances.

Right to Object I can object to the processing of my personal and health information in certain situations.

6. Withdrawal of Consent

I have the right to withdraw my consent at any time by contacting Aljazira Takaful's Data Privacy Officer. However, I acknowledge that withdrawing consent may affect Aljazira Takaful's ability to provide me with insurance services, also Consent withdrawal shall not affect the Processing of Personal Data that is based on other legal bases.

7. Children’s Data

I understand that if I am the legal guardian/parent providing consent for children's information, Aljazira Takaful has no intention of collecting any minors’ personal information unless it is agreed by me, and it is necessary for the products or services offered to the minor. In the case that Aljazira Takaful collect personal data of a child under the age of 13 through its website or application, the data would be used for the purpose of directly responding to the request, without using their data for any other purposes. It will be used or disclosed to the extent allowed by law and regulation or expressly consented to by parents or legal guardians or necessary for the protection of the minors’ interests. The child’s data will not be processed without notifying the guardian/parent of the request except for the following:

• If there is a legal justification for Aljazira Takaful to process the data specified by law, regulation, or for security reasons.

• When the sole purpose of collecting the contact details of the child is to respond directly to a specific request from the child, and not for any other purpose.

8. Contact Information

I understand that if I have any questions, or concerns, or wish to exercise my rights, I can contact Aljazira Takaful's Data Privacy Officer:

Hira Street, Al Salamah, Jeddah, U-Zone Building

Al Salama, 4516-23324, Kingdom of Saudi Arabia

P.O. Box: 5215 Jeddah 21422

********** | +966 12 6688877

info@ajt.com.sa

Sunday- Thursday : 09:00 AM to 5:00 PM

Personal Information

Contact info

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Financial info

Type of operation

Attach documents

| PROTECTION & SAVINGS | KYC

Personal Information

Contact info

DOWNLOAD

DOWNLOAD

Financial info

Type of operation

Attach documents

Personal Data Protection Consent Form

1.Scope of Consent

2. Confidentiality and Security

3. Sensitive Health Information

4. Data Retention

5. Rights

6. Withdrawal of Consent

7. Children’s Data

8. Contact Information

| PROTECTION & SAVINGS |
KYC