6/29/2021 Orient Insurance
Review Details
Policy Details
Quotation No MED/2021/178697 Product DMed
Policy No P/40/1305/2021/3609 Issue Date 29/06/2021 17:01:02
Policy From date 29/06/2021 17:08:35 Policy To Date 28/06/2022 23:59:00
Insured Details
Insured Name ABDUL HAADI AHMED Gender MALE
ALI
Mobile No 971503551923 Marital Status Single
Sponsor Relationship Children (Other than Passport No AP6493572
Married Females)
EmiratesID No 111-1111-1111111-1 EmiratesID Expiry 29/06/2021
Date
UID No 221361079 Nationality Pakistan
Country Of Origin Pakistan Country Of Residence UAE
Emirates Of Dubai Sub-region ABU HAIL
Residence
Residence Visa Place Dubai Do you hold Dubai Yes
Visa?
Chronic Conditions No Critical Cases No
Pregnancy Yes/No No Height(in Cm) / Weight 155 / 55
(in Kg)
Member Type Member ID
Uploaded to TPA Y/N No Medical Card Number
Sponsor Details
Sponsor Name AHMED ALI MUHAMMAD Sponsor Number(UID) 784198586577839
RIAZ
https://www.orientonline.ae/PORTALS/Transaction/MedicalMedView.aspx?enc=PkRBVUX%2bmdM7vtxlwyDkZIHBJ56QMsiK4zVasMHwIjh%2fqP… 1/3
6/29/2021 Orient Insurance
Sponsor Details
Sponsor Type Resident No. of persons holding 0
a visa under this
employer/sponsor
No. of Lower band 0 No. of other 0
salary employees employees
Work Email Id [email protected] Landline No 065696400
Premium
AED 788.65
File Uploads for Insured
Passport
EmiratesID
Visa
Passport Size Photo
File Uploads for Sponsor
Sponsor Passport
https://www.orientonline.ae/PORTALS/Transaction/MedicalMedView.aspx?enc=PkRBVUX%2bmdM7vtxlwyDkZIHBJ56QMsiK4zVasMHwIjh%2fqP… 2/3
6/29/2021 Orient Insurance
Sponsor EmiratesID
Sponsor Visa
Sponsor Passport Size Photo
Payment Mode
CREDIT CARD
Tax Invoice in the name
Tax Invoice Name
Insured TRN No
Insured TRN No
Declarations
I confirm that all the information provided and documents uploaded in this form are as provided /
submitted by the client and reviewed by me.
I understand that checking this box constitutes a legal signature confirming that I agree to the
above terms and conditions of Orient Insurance.Any non-disclosure / misrepresentation * or
concealment of material facts will make this policy void with immediate effect without any entitlement
for refund. In the event, this medical application form has been completed by someone else; I take full
responsibility of the information provided, and agree that a true declaration has been given.
Policy will be subject to audit post policy issuance.
In order to avoid suspended/non continuity of the service, please make sure that :
a) All information is complete
b) Correct documents are uploaded
c) All information is properly and correctly disclosed.
Notification email will be sent to the client and respective sales channel with documents needed or
correction requested.
in case we did not receive the requirements within 14 days; policy will be cancelled without refund
* For first scheme membership
https://www.orientonline.ae/PORTALS/Transaction/MedicalMedView.aspx?enc=PkRBVUX%2bmdM7vtxlwyDkZIHBJ56QMsiK4zVasMHwIjh%2fqP… 3/3
