Mandatory Insurance for Domestic Workers
(Claim Submission Form - Employer)
عربي
EN
Insured Details (Employer)
Insured Name
Insurance Policy Number
Identity Number
Mobile Number
10 digits, starts with 0
Bank Name
Bank Account IBAN
SA then 22 digits — total 24
Nationality (Employer)
Email
Details of the Insured (Domestic Worker)
Domestic Worker Name
Residence Number
Passport Number
Date of Entry to KSA
Last Working Day
Nationality (Domestic Worker)
Please specify the type and status of the claim
Claim Reason
Select Claim Reason
Domestic Worker Refusal to Work
Domestic Worker Absconding
Permanent or Partial Disability or Critical Illness
Emergency and Compelling Circumstances
Death Case
Essential Required Documents
1- Musaned unified contract (Required)
Attach
2- Passport (no./name/border no./entry stamp) (Required)
Attach
3- Sponsor ID (Required)
Attach
4- Receipts of previously paid salaries (Required)
Attach
5- IBAN certificate (Required)
Attach
6- Worker residence (Optional)
Attach
Declaration & Undertaking
I/we declare that the above information is accurate and will notify you of any changes. If information is inaccurate, the company may seek recourse. Buruj may request additional documents.
Submit
