Saudi Arabian Cooperative Insurance Company

Policy Issuance Form for the Kingdom of Saudi Arabia


Please Note: Saudi Arabian Cooperative Insurance Company must have a contact for distribution of the policy. If the local company does not have a copy on file, they could face penalties.

Policy Number / Subgroup Numbers*
Group Name*
Group Sponsor Number* (Number starts with 1 or 7 and is 10 digits long)
Local KSA Group Name* (should match commercial registration)


Authorized Contact for Policy
Contact / Authorized Person First Name*
Contact / Authorized Person Last Name*
Position / Designation
*

Postal Address must be a P.O. Box and include City
P.O. Box*
*
KSA

Courier for Policy/Invoice Documents

First Name*
Last Name*
*
Office / Unit and Floor Number*
Building Name*
Street Name*
*
*
*
* (Please use '00000' if you do not have a postal code)
Country Code*

  * Required