المجموعة المتحدة للتأمين التعاوني ( أسيج )

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ACIG City Motor Insurance

Data Form

Type of Repair:

Deductible Amount :

Vehicle Manufacture Year:

            I / We declare that the information given in this proposal and all attachment to it are true and correct and includes all required information according to the relevant insurance terms, regulations and Fundamentals.
            I / We hereby authorized the Allied Cooperative Insurance Group (ACIG) to review all information including my/our credit record from other insurance companies and/or The Saudi Credit Bureau (SIMAH) and /or Najm for insurance services and any other party and in accordance with the rules of collection and exchange of insurance information for vehicles issued by SAMA and other related regulations and instructions ; I agree to grant Allied Cooperative Insurance Group (ACIG) the right to inquire from Najm Insurance Services Company for the insurance claims data for the vehicles to which I was a party, and I agree to grant Najm Insurance Services Company the right Collect and exchange insurance claims data for the vehicles to which you were a party, prior or future, with insurance, reinsurance companies or self-employed.
            I/ We agree that this proposal, together with any other information supplied by us shall form the basis of the insurance contract between us and Allied Cooperative Insurance Group (ACIG). Hence, we are bound by the information provided and its veracity.

I accept the above terms