Mandatory Insurance for Domestic Workers
(Claim Submission Form - Domestic Worker)
عربي
EN
Insured Details (Domestic Worker)
Domestic Worker Name
Insurance Policy Number
Residence or Visa Number
Mobile Number
Bank Name
Bank Account IBAN
SA then 22 digits — total 24
Nationality
Email
Passport Number
Passport Expiry Date
Monthly Salary
Occupation
Birth Date
Date of Entry to KSA
Gender
Select Gender
Male
Female
Details of the Insured (Employer)
Employer Name
Identity Number
Mobile Number
Nationality
Please specify the claim reason
Reason for Claim
Select Reason for Claim
Employer’s failure to pay due salaries for more than 4 months due to permanent or partial disability
Employer’s Death
Total/permanent/partial permanent disability & chronic critical illnesses of the worker
Emergency and Compelling Circumstances
Essential Attachments
1- Musaned unified contract (Required)
Attach
2- Passport copy (no./name/border no./entry stamp) (Required)
Attach
3- Sponsor ID copy (Required)
Attach
4- Worker residence (Optional)
Attach
5- Receipts of previously paid salaries (Required)
Attach
6- IBAN certificate (Required)
Attach
Declaration & Undertaking
I/we declare that the above information is accurate and undertake to notify you of any changes, and accept the applicable policy terms.
Submit
