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Registration Form

Mohamed Khaled

Regional Manager

The pioneer of protection & saving solutions in the Kingdom

Prospective Policyholder Details:

Full Commercial Name

Business Industry

Email Address

Commercial Registration No.

Authorized Signatory Person

Contact Person

Mobile No

Website

Do you have other associated companies and / or subsidiaries you want to be covered by this Policy?

Yes

No

If yes :

Full Commercial Name :

Business Industry :

Commercial Registration No:

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