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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

Unit Number

Street Name

District

City

Postal Code

Country *

Home Country Address

Home Country *

House *

Street *

City *

Postal Code *

Contact info

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

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.

I have read and disagreed on the tax compliance declaration

Financial info

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

Type of operation

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 documents

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

| PROTECTION & SAVINGS | KYC

Personal Information

Contact info

Financial info

Type of operation

Attach documents

| PROTECTION & SAVINGS |
KYC