NEOM – 03 OXAGON

Contract No. 1100001344/026

Contract Name: Port Operated Upgraded Facilities

Lifting Plan Procedure

Contract: WO#1100001344/026 Contact No: 0592440461

Lift plan QY100K-1 Prefab Method Statement Ref 1100001344/026 -BZL-HSE- DC Will update

Date of Lifting Operation: 27/08/2023-28/12/2023 Location Oxagon - ASB - Ports

Lift Plan Prepared By Arif ullah khan Title Appointed Person

Date: 27/12/2023 Signed:

Lift Team
Appointed Person Arifullah khan Crane Supervisor
Please refer to briefing sheet for Crane Operator, Slinger / Signaller, Lift Supervisor and Crane Co-ordinator.

Type of Lifts Basic Intermediate x Complex Contract

Description of Lifts, if multiple lifts/ positions are involved state sequencing

Unloading and installation of prefab cabins for temporary ports buildings as per schedule of lifts contained within

Site Access & Route (See Sketch)

Details of Crane Owner / Hire Company
Company Name: ‫ﻣؤﺳﺳﺔ اﺑراھﯾم ﻣﺣﻣد ﺟﻌﻔري ﻟﻠﻣﻘﺎوﻻت اﻟﻌﺎﻣﺔ‬
Makkha Al mukarma Hi Al Rasefa
Address:
Contact Name: Ammir Telephone: 0500292965
Details of Crane
Capacity and Type: Max Boom Length Counterweight Details:
XXMG QY25 K 34.8m 19.2t plus full vehicle body
CRANE/ counterweight
25 Tons
Outrigger Spread: Point Load: Max Working Radius:

7.56x7.6m (fully extended) 18t 16m

Size of Outrigger mats required: Fly Jib:

2 x 3m 30mm thick steel plates N/A

CRANE ACCESSORIES REQUIRED
Chains Wire Ropes Shackles x Tag Lines x Webbing Slings x

Lifting Beams x Other (specify)

LOAD DETAILS
Maximum weight of load (s) : Maximum Size of Load: Designed Lifting Yes No
Point’s x
11.06t Varies, see schedule of lifts See schedule of lifts
Maximum Lift Height: Others eg. Centre of Gravity:

Offset CoG. Rigging to be adjusted accordingly. If in doubt

10m check with AP.

Working Environment, Site Conditions and Proximity Hazards

Identify location for setting up and operating crane / Identify access and space for crane / lifting appliance /
lifting appliance. transport etc.
See site drawing Transport/haulage access for offloading activities to be
designated by site team in works area. Crane to be
positioned as per layout drawing
Identify suitable lay down area for materials. Overhead / Underground services

Foreman/Supervisor and operator to identify before lift Utilities running beneath tarmac surface.
commences. Trailers to be positioned in front/rear of
crane
Ground Conditions Crane / Mat required

Compacted sand FDT tested to 95% compaction 2m x 3m 3cm thick spreader plates to be utilised
/Tarmac road beneath outriggers
Roads / Traffic Obstructions (e.g., structures, excavations, trees etc.)
As per BOC traffic management plan Lighting poles, fencing, steel structure and excavations
adjacent to crane setup area
Adjacent Activities Requirements for road closures, possessions, site
clearance etc.
Ongoing excavations, backfilling and utility works As per site requirements to be agreed at daily
activity briefing

Requirements for signage, barriers, fencing, lighting etc Other / additional control measures (please list) :

Exclusion zones around all lifting activities, to be Crane and lifting accessory 3rd party thorough
coordinated with all stakeholders and 3rd parties. Task examination inspection records to be provided by Bin
lighting to be provided as necessary during night hours Omairah and records kept onsite.

Third Party Considerations,

Keep noise to a minimum. Always work to the WMS. Any variation to this LP shall result in work being stopped
and reassessed to ensure continued safe operation. Crane Supervisor to ensure everyone is adequately briefed
before work commences; when lifting in the proximity of adjacent assets; loads may be picked up/ laid down
as close as is reasonably practicable without oversailing site/hoarding boundaries

Hazard Control
See Documents: Lifting management plan See same document: 07-1435-1100001344-Bz-
HSE-PLN-000006

Radios will be used by all cranes alongside pre-

agreed hand signals.

This lift plan will run alongside a specific method Binzafrah CO. crane supervisor/Rigger I will be
statement and risk assessment for the works included. always supervising crane setup and movements.

Operator to announce proposed movements and

obtain acknowledgement from others.
Crane team briefing explaining the load paths to all
involved personnel.

Lift Plan Prepared By: Arifullah khan Signed:

 Suitably qualified and experienced lead rigger/ lift
supervisor to perform all crane safety checks with
crane operator prior to lift.

Site and Crane Layout Plan

Include crane position, lay-down / rigging area, position of delivery vehicles, landing points, banksman positions,
ground and overhead hazards and exclusion zones. If required use elevation drawings.

Lift Plan Prepared By: Arifullah khan Signed:

Site Layout B02

A
A

C2 C1

A = Pick Up Area/Trailer
B = Designated Laydown
C = 2no Crane setup areas East/West

= Slew Path

= Exclusion Zone

It is the slingers responsibility to ensure the path of the load is clear of personnel and obstructions before the lift
commences. All operatives to be aware of crane movements. Hook block is central to the load at all times

Lift Plan Prepared By: Arifullah khan Signed:

Site Layout B1

C
A

B B

A = Pick Up Area/Trailer
B = Designated Laydown
C = Crane setup area

= Slew Path

= Exclusion Zone

It is the slingers responsibility to ensure the path of the load is clear of personnel and obstructions before the lift
commences. All operatives to be aware of crane movements. Hook block is central to the load at all times

Lift Plan Prepared By: Arifullah Khan Signed:

Site Layout

B B

A
C

A = Pick Up Area/Trailer
B = Designated Laydown
C = Crane setup area

= Slew Path

= Exclusion Zone

It is the slingers responsibility to ensure the path of the load is clear of personnel and obstructions before the lift
commences. All operatives to be aware of crane movements. Hook block is central to the load at all times

Lift Plan Prepared By: Arifullah Khan Signed:

Site Layout B03

A A

C1 C2
B

A = Pick Up Area/Trailer
B = Designated Laydown
C = 2no. Crane setup areas East/West

= Slew Path

= Exclusion Zone

It is the slingers responsibility to ensure the path of the load is clear of personnel and obstructions before the lift
commences. All operatives to be aware of crane movements. Hook block is central to the load at all times

Lift Plan Prepared By: Arifullah khan Signed:

 OPERATING DUTY HIGHLIGHTED IN GREEN

Always work within the confines of the duty chart provided.

Schedule of Lifts

Lift Plan Prepared By: Arifullah Khan Signed:

 Schedule of lifts to be carried out during the lifting operation.

1. 24no. Prefabricated Cabins

Weight of heaviest load: 9,000kg

Max permissible windspeed: 10.5m/s

4no. Lifting points chocked on bottom frame. Offset CoG to be predetermined in trial lift and rigging adjusted
accordingly. Load to be level at all times.

Lifting Accessories to be used:

Hook block = 800kg

6m, 10t Lifting beam = 1,100kg
4 no. 17.5t shackles on beam = 50kg
4 no. 12t shackles = 40kg
4 no. 10t, 8m flat slings = 40kg
2 no. 10t, 6m flat slings = 30kg

Total 11,060kg

Max crane utilisation @ 16m radius = 78%

Lift Plan Prepared By: Arifullah Khan Signed:

 NEOM – 03 OXAGON
Contract No. 1100001344/026
Contract Name: Port Operated Upgraded Facilities

Lifting Plan Procedure

Lift Plan Briefing Sheet Lift Plan: Prefabricated Units (Portacabins)

All operatives involved within the lifting activity addressed within this lift plan are briefed and listed below.
Lift Plan Briefed By AP / Crane Supervisor: Signed:
Location: Oxagon Community Date / Time of Briefing:

No Name Qualification Job Title Signature Employer Contract / Site Line Manager
1

10
11

12

Skill Site Appointed Lifting Personnel

Appointed Person Arifullah khan

Crane Supervisor/Rigger L1

Slinger Signaller/Rigger L3

Lift Plan Prepared By: Arif ullah Khan Signed:

 NEOM – 03 OXAGON
Contract No. 1100001344/026
Contract Name: Port Operated Upgraded Facilities

Lifting Plan Procedure

Documents &Third Party Certificates (TPC)

Lift Plan Prepared By: Arifullah Khan Signed:
 ‫ﺷﻬﺎﺩﺓ ﻛﻔﺎﻟﺔ ﺗﺄﻣﻴﻦ ﺍﻟﺴﻴﺎﺭﺍﺕ‬
‫‪Shari’a opinion reference‬‬ ‫‪:‬‬ ‫ﺭﻣﺰ ﺍﻟﻤﻨﺘﺞ‬
‫‪EAD-1036-03-03-03-19‬‬ ‫‪A-ETHD-1-B-15-039‬‬

‫‪110978 /‬‬ ‫ﺍﻟﺮﻗﻢ ﺍﻟﺘﺴﻠﺴﻠﻲ ‪1 :‬‬ ‫ﺍﻟﻔﺮﻉ ‪ :‬ﺍﻟﻤﺮﻛﺰ ﺍﻟﺮﺋﻴﺴﻲ‬ ‫‪Third Party Liability -‬‬ ‫ﺍﻟﺘﻐﻄﻴﺔ ‪:‬‬

‫ﺭﻗﻢ ﺍﻟﻬﻮﻳﺔ ‪7014635341 :‬‬ ‫ﻣﺆﺳﺴﺔ ﺍﺑﺮﺍﻫﻴﻢ ﻣﺤﻤﺪ ﺟﻌﻔﺮﻱ ﻟﻠﻤﻘﺎﻭﻻﺕ ﺍﻟﻌﺎﻣﺔ‬ ‫‪:‬‬ ‫ﺍﺳﻢ ﺍﻟﻤﺎﻟﻚ‬
‫ﺍﻟﻤﺮﺟﻊ‬ ‫ﺳﻨﺔ ﺍﻟﺼﻨﻊ‬ ‫ﺭﻗﻢ ﺍﻟﻬﻴﻜﻞ‬ ‫ﺭﻗﻢ ﺍﻟﻠﻮﺣﺔ‬ ‫ﻧﻮﻉ ﺍﻟﺴﻴﺎﺭﺓ‬
‫‪236111410‬‬ ‫‪2014‬‬ ‫‪LXGCPA289EA003551‬‬ ‫‪2880 TDA‬‬ ‫‪XUHO CRANE‬‬
‫ﺍ ﺩ ﻁ ‪2880‬‬

‫‪:‬‬ ‫ﺗﺸﻬﺪ ﺷﺮﻛﺔ ﺍﻻﺗﺤﺎﺩ ﺍﻟﺘﺠﺎﺭﻱ ﻟﻠﺘﺄﻣﻴﻦ ﺍﻟﺘﻌﺎﻭﻧﻲ ﺑﺄﻥ ﺍﻟﺴﻴﺎﺭﺓ ﺍﻟﻤﺒﻴﻨﺔ ﺃﻋﻼﻩ ﻣﺆﻣﻦ ﻋﻠﻴﻬﺎ ﺣﺴﺐ ﻭﺛﻴﻘﺔ ﺍﻟﺘﺎﻣﻴﻦ ﺭﻗﻢ‬
‫ﻧﻬﺎﻳﺔ ﺍﻟﺘﺄﻣﻴﻦ‬ ‫ﺑﺪﺍﻳﺔ ﺍﻟﺘﺄﻣﻴﻦ‬ ‫ﺭﻗﻢ ﺍﻟﻮﺛﻴﻘﺔ‬
‫ﺍﻟﻴﻮﻡ ‪:‬‬
‫ﺍﻟﺠﻤﻌﺔ‬ ‫ﺍﻟﺨﻤﻴﺲ‬ ‫ﺍﻟﻴﻮﻡ ‪:‬‬ ‫‪1/82/1/29/6/23/110978‬‬
‫‪11/10/2024‬‬ ‫‪:‬‬ ‫ﺍﻟﺘﺎﺭﻳﺦ‬ ‫‪12/10/2023‬‬ ‫‪:‬‬ ‫ﺍﻟﺘﺎﺭﻳﺦ‬
‫‪21:49‬‬ ‫‪:‬‬ ‫ﺍﻟﻮﻗﺖ‬ ‫‪21:49‬‬ ‫‪:‬‬ ‫ﺍﻟﻮﻗﺖ‬

‫ﺗﻌﺘﺒﺮ ﻫﺬﻩ ﺍﻟﺸﻬﺎﺩﺓ ﺍﻟﺼﺎﺩﺭﺓ ﺑﻤﺜﺎﺑﺔ ﻛﻔﺎﻟﺔ ﻏﺮﻡ ﻭﺃﺩﺍﺀ ﻟﻠﺤﻖ ﺍﻟﺨﺎﺹ ﺑﺎﻟﻄﺮﻑ ﺍﻟﺜﺎﻟﺚ ﻭﺫﻟﻚ ﻓﻴﻤﺎ ﻳﺘﻌﻠﻖ ﺑﺎﻟﻤﺴﺌﻮﻟﻴﺎﺕ ﺍﻟﻤﺒﻴﻨﺔ ﺃﺩﻧﺎﻩ ﻭﺍﻟﺘﻲ ﺗﻨﺘﺞ‬
‫ﻋﻦ ﺣﺎﺩﺙ ﺃﻭ ﺣﻮﺍﺩﺙ ﺗﺴﺒﺒﺖ ﻓﻴﻬﺎ ﺍﻟﻤﺮﻛﺒﺔ ﺍﻟﻤﺆﻣﻨﺔ ﻋﻠﻴﻬﺎ‪ ،‬ﺷﺮﻳﻄﺔ ﺗﻄﺒﻴﻖ ﺷﺮﻭﻁ ﻭﺃﺣﻜﺎﻡ ﺍﻟﻮﺛﻴﻘﺔ ﻋﻠﻰ ﺃﻥ ﻻ ﻳﺘﺠﺎﻭﺯ ﻣﺠﻤﻮﻉ ﺍﻟﺘﻌﻮﻳﻀﺎﺕ‬
‫ﺍﻟﺤﺪ ﺍﻷﻗﺼﻰ ﺍﻟﻤﻮﺿﺢ ﺍﺩﻧﺎﻩ‪:‬‬
‫ﺍﻟﺤﺪ ﺍﻵﻗﺼﻰ ﻟﻤﺴﺆﻭﻟﻴﻪ ﺍﻟﺸﺮﻛﺔ ﻓﻲ ﺍﻟﻮﺍﻗﻌﺔ ﺍﻟﻮﺍﺣﺪﺓ‬ ‫ﻓﺈﻥ‬ ‫ﺍﻟﻮﺛﻴﻘﺔ‬ ‫ﻫﺬﻩ‬ ‫ﻷﺣﻜﺎﻡ‬ ‫ﻭﻓﻘﺎ‬ ‫ﺛﺎﻟﺚ‬ ‫ﻟﻄﺮﻑ‬ ‫ﺍﻟﺘﻌﻮﻳﺾ‬ ‫ﻋﻠﻴﻪ‬ ‫ﻓﻲ ﺣﺎﻝ ﻭﻗﻮﻉ ﺣﺎﺩﺙ ﻳﺘﺮﺗﺐ‬
‫ﻭ ﺍﻷﺿﺮﺍﺭ ﺍﻟﻤﺎﺩﻳﺔ ﻭﺍﻟﻤﺼﺎﺭﻳﻒ ﻣﻌﺎ ﻟﻦ ﻭﺧﻼﻝ ﻓﺘﺮﺓ ﺳﺮﻳﺎﻥ ﺍﻟﻮﺛﻴﻘﺔ ﺑﺎﻟﻨﺴﺒﺔ ﻟﻸﺿﺮﺍﺭ ﺍﻟﺠﺴﺪﻳﺔ ﺗﺘﺠﺎﻭﺯ ﻣﺒﻠﻐﺎ ﺍﺟﻤﺎﻟﻴﺎ ﻗﺪﺭﻩ ‪ 10,000,000‬ﺭﻳﺎﻝ‬
‫)ﻋﺸﺮﺓ ﻣﻼﻳﻴﻦ ﺭﻳﺎﻝ ﺳﻌﻮﺩﻯ ( ﻛﺤﺪ ﺍﻗﺼﻰ ﻟﻤﺴﺌﻮﻟﻴﺔ ﺍﻟﺸﺮﻛﺔ‬
‫ﺍﻟﺤﺎﻻﺕ ﺍﻟﺘﻰ ﺗﻠﺘﺰﻡ ﺍﻟﺸﺮﻛﺔ ﺑﺘﻌﻮﻳﺾ ﺍﻟﻄﺮﻑ ﺍﻟﺜﺎﻟﺚ ﻋﻨﻬﺎ ﻣﻊ ﺍﺣﺘﻔﺎﻇﻬﺎ ﺑﺤﻖ ﺍﻟﺮﺟﻮﻉ ﻋﻠﻰ ﺍﻟﻤﺆﻣﻥ ﻟﻪ ﺃﻭ ﺍﻟﺴﺎﺋﻖ ﺃﻭ ﺍﻟﻤﺴﺌﻮﻝ ﻋﻦ ﺍﻟﺤﺎﺩﺙ‪:‬‬
‫ﺃﻭﻻ‪ :‬ﻟﻠﺸﺮﻛﺔ ﺣﻖ ﺍﻟﺮﺟﻮﻉ ﻋﻠﻰ ﺍﻟﻤﺆﻣﻥ ﻟﻪ ﺃﻭ ﺍﻟﺴﺎﺋﻖ ﻻﺳﺘﺮﺩﺍﺩ ﻣﺎ ﻗﺪﻡ ﻟﻠﻄﺮﻑ ﻟﺜﺎﻟﺚ ﻣﻦ ﺗﻌﻮﻳﻀﺎﺕ ﻓﻰ ﺃﻱ ﻣﻦ ﺍﻟﺤﺎﻻﺕ ﺍﻵﺗﻴﺔ‬
‫‪.‬‬ ‫‪ -1‬ﺍﻟﺴﻴﺮ ﺑﺎﻟﻤﺮﻛﺒﺔ ﻋﻜﺲ ﺍﺗﺠﺎﻩ ﺍﻟﺴﻴﺮ‬
‫‪ -2‬ﺗﺠﺎﻭﺯ ﺍﻹﺷﺎﺭﺓ ﺍﻟﺤﻤﺮﺍﺀ‬
‫‪ -3‬ﺃﻱ ﻣﺴﺆﻭﻟﻴﺔ ﺃﻭ ﻣﺼﺎﺭﻳﻒ ﺗﻨﺸﺄ ﺃﻭ ﺗﺘﺮﺗﺐ ﻋﻨﺪﻣﺎ ﺗﻜﻮﻥ ﺍﻟﻤﺮﻛﺒﻪ‬
‫ﺃ‪ -‬ﻣﺴﺘﻌﻤﻠﺔ ﻋﻠﻰ ﻭﺟﻪ ﻳﺨﺎﻟﻒ ﻗﻴﺪ ﺍﻻﺳﺘﻌﻤﺎﻝ ﺍﻟﻤﺒﻴﻦ ﻓﻲ ﺟﺪﻭﻝ ﺍﻟﻮﺛﻴﻘﺔ‬
‫ﺏ‪ -‬ﺗﺤﻤﻞ ﻋﺪﺩﺍ ﻣﻦ ﺍﻟﺮﻛﺎﺏ ﻳﺘﺠﺎﻭﺯ ﺍﻟﺴﻌﺔ ﺍﻟﻤﺼﺮﺡ ﺑﻬﺎ ﻟﻠﻤﺮﻛﺒﺔ‪ ،‬ﻭﺛﺒﺖ ﺃﻥ ﺣﺼﻮﻝ ﺍﻟﺤﺎﺩﺙ ﻛﺎﻥ ﺑﺴﺒﺐ ﻫﺬﺍ ﺍﻟﺘﺠﺎﻭﺯ‬
‫ﺝ‪ -‬ﺇﺫﺍ ﺛﺒﺖ ﺃﻥ ﻗﻴﺎﺩﺓ ﺍﻟﻤﺮﻛﺒﺔ ﺗﻤﺖ ﺩﻭﻥ ﺍﻟﺤﺼﻮﻝ ﻋﻠﻰ ﺭﺧﺼﺔ ﻗﻴﺎﺩﺓ ﻟﻨﻮﻉ ﺍﻟﻤﺮﻛﺒﺔ ﻃﺒﻘﺎ ﻟﻸﻧﻈﻤﺔ ﻭﺍﻟﻠﻮﺍﺋﺢ ﺫﺍﺕ ﺍﻟﻌﻼﻗﺔ‪ ،‬ﺃﻭ ﺃﻥ ﺗﻜﻮﻥ ﺍﻟﺮﺧﺼﺔ‬
‫ﻗﺪ ﺻﺪﺭ ﺃﻣﺮ ﺑﺴﺤﺒﻬﺎ ﻣﻦ ﺍﻟﺠﻬﺎﺕ ﺍﻟﻤﺨﺘﺼﺔ‪ ،‬ﺃﻭ ﻛﺎﻧﺖ ﻣﻨﺘﻬﻴﺔ ﻭﻗﺖ ﺍﻟﺤﺎﺩﺙ ﻣﺎﻟﻢ ﺗﺠﺪﺩ ﺍﻟﺮﺧﺼﺔ ﺍﻟﻤﻨﺘﻬﻴﺔ ﺧﻼﻝ ) ‪ ( 50‬ﻳﻮﻡ ﻋﻤﻞ ﻣﻦ ﺗﺎﺭﻳﺦ ﺍﻟﺤﺎﺩﺙ‬

‫ﺛﺎﻧﻴﺍ‪ :‬ﺇﺫﺍ ﻛﺎﻧﺖ ﺍﻟﻤﺮﻛﺒﺔ ﻣﺴﺮﻭﻗﺔ ﺃﻭ ﻣﺄﺧﻮﺫﺓ ﻏﺼﺒﺍ ﻓﺈﻥ ﻟﻠﺸﺮﻛﺔ ﺣﻖ ﺍﻟﺮﺟﻮﻉ ﻋﻠﻰ ﺍﻟﻤﺘﺴﺒﺐ ﻓﻲ ﺍﻟﺤﺎﺩﺙ‪ ،‬ﻭﻟﻬﺎ ﺍﻟﺮﺟﻮﻉ ﻋﻠﻰ ﺍﻟﻤﺆﻣﻦ ﻟﻪ‬
‫ﻓﻲ ﺣﺎﻝ ﻟﻢ ﻳﺨﻄﺮ ﺍﻟﺠﻬﺎﺕ ﺍﻟﻤﺨﺘﺼﺔ ﺩﻭﻥ ﻋﺬﺭ ﻣﻘﺒﻮﻝ‬

‫ﺛﺎﻟﺜﺎ‪ :‬ﻋﻠﻰ ﺍﻟﺸﺮﻛﺔ ﺇﺧﻄﺎﺭ ﺍﻟﻤﺆﻣﻦ ﻟﻪ ﺃﻭ ﺍﻟﺴﺎﺋﻖ ﺧﻼﻝ ﻋﺸﺮﻳﻦ ﻳﻮﻡ ﻋﻤﻞ ﻣﻦ ﺗﺎﺭﻳﺦ ﺗﻘﺪﻳﻢ ﺍﻟﻤﻄﺎﻟﺒﺔ ﺍﻟﺘﻲ ﺗﻨﻄﺒﻖ ﻋﻠﻴﻬﺎ ﺇﺣﺪﻯ ﺣﺎﻻﺕ ﺍﻟﺮﺟﻮﻉ‬
‫ﻛﻤﺎ ﻋﻠﻰ ﺍﻟﺸﺮﻛﺔ ﻣﻤﺎﺭﺳﺔ ﺣﻖ ﺍﻟﺮﺟﻮﻉ ﺧﻼﻝ ﻣﺪﺓ ﺃﻗﺼﺎﻫﺎ ﺳﻨﺔ ﻣﻦ ﺗﺎﺭﻳﺦ ﺗﺴﻮﻳﺔ ﺍﻟﻤﻄﺎﻟﺒﺔ‬

‫ﺭﺍﺑﻌﺎ‪ :‬ﻻ ﻳﺠﻮﺯ ﻟﻠﻄﺮﻑ ﺍﻟﺜﺎﻟﺚ ﻓﻲ ﺣﺎﻝ ﻛﺎﻥ ﺷﺨﺺ ﺍﻋﺘﺒﺎﺭﻱ ﻣﻄﺎﻟﺒﺔ ﺍﻟﺸﺮﻛﺔ ﻋﻦ ﺗﻜﺎﻟﻴﻒ ﻋﻼﺝ ﺍﻷﺿﺮﺍﺭ ﺍﻟﺠﺴﺪﻳﺔ ﺍﻟﺘﻲ ﺗﺤﻤﻠﻬﺎ ﻓﻲ‬
‫ﺣﺎﻝ ﺍﻧﻄﺒﻘﺖ ﺇﺣﺪﻯ ﺣﺎﻻﺕ ﺍﻟﺮﺟﻮﻉ ﻋﻠﻰ ﺫﺍﺕ ﺍﻟﻤﻄﺎﻟﺒﺔ‬

‫ﻻ ﻳﻌﺘﺪ ﺑﺄﻯ ﺷﻄﺐ ﺃﻭ ﺗﻌﺪﻳﻞ ﻋﻠﻰ ﻫﺬﻩ ﺍﻟﺸﻬﺎﺩﺓ ﺍﻻ ﺑﺨﻄﺎﺏ ﺧﻄﻰ ﻣﻌﺘﻤﺪ ﻣﻦ ﺷﺮﻛﺔ ﺍﻟﺘﺄﻣﻴﻦ ‪.‬‬
‫ﺗﺨﻀﻊ ﻫﺬﻩ ﺍﻟﺸﻬﺎﺩﺓ ﻷﺣﻜﺎﻡ ﻭﺷﺮﻭﻁ ﻭﺍﺳﺘﺜﻨﺎﺀﺍﺕ ﻭﺛﻴﻘﺔ ﺍﻟﺘﺄﻣﻴﻦ ﺍﻟﻤﺬﻛﻮﺭﺓ ﺃﻋﻼﻩ‪ ،‬ﻛﻤﺎ ﺗﻌﺘﺒﺮ ﺟﺰﺀ ﻻ ﻳﺘﺠﺰﺃ ﻣﻦ ﻭﺛﻴﻘﺔ ﺍﻟﺘﺄﻣﻴﻦ ﺍﻻﺻﻠﻴﻪ‬
‫ﻻ ﺗﻘﺒﻞ ﺍﻻ ﺍﻟﺸﻬﺎﺩﺓ ﺍﻷﺻﻠﻴﺔ ‪.‬‬

‫ﺷﺮﻛﺔ ﺍﻻﺗﺤﺎﺩ ﻟﻠﺘﺄﻣﻴﻦ ﺍﻟﺘﻌﺎﻭﻧﻲ‬ ‫ﻟﻼﺳﺘﻔﺴﺎﺭ ﻭﺍﻟﺘﺒﻠﻴﻎ ﻋﻦ ﺍﻟﺤﻮﺍﺩﺙ‬

‫‪21:49‬‬ ‫‪11/10/2023‬‬ ‫ﻭ ﻭﻗﺖ ﺍﻟﺤﺎﻟﺔ ‪:‬‬ ‫ﺗﺎﺭﻳﺦ‬

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‫‪920000560‬‬ ‫‪:‬‬ ‫ﻧﺠﻢ ﺍﻟﺤﻮﺍﺩﺙ‬
‫‪8003040110 :‬‬ ‫ﺍﻟﺮﻗﻢ ﺍﻟﻤﺠﺎﻧﻲ‬
Lift Plan Prepared By: Arifullah khan Signed:
Lift Plan Prepared By: Arifullah Khan Signed:
Lift Plan Prepared By: Arifullah Khan Signed:
Lift Plan Prepared By: Arifullah Khan Signed:
Lift Plan Prepared By: Arifullah Khan Signed:
CamScanner