Information Form ‫وﺛﯾﻘــــﺔ ﺗـﻌـــــــــﺎرف‬

Applicant Details ‫ﺑﯾﺎﻧﺎت اﻟﺷﺧص‬

Full name ‫اﻻﺳم ﺑﺎﻟﻛﺎﻣل‬
Photograph ‫اﻟﺻـــــــــــــــورة‬
Nickname ‫اﺳم اﻟﺷﮭرة‬ Surname ‫اﺳم اﻟﻌﺎﺋﻠﺔ‬
(5X5) cm
Previous Nationality ‫اﻟﺟﻧﺳﯾﺔ اﻟﺳﺎﺑﻘﺔ‬ Nationality ‫اﻟﺟﻧﺳﯾﺔ اﻟﺣﺎﻟﯾﺔ‬

Place of Birth ‫ﻣﻛﺎن اﻟﻣﯾﻼد‬ Religion/Doctrine ‫ﻟﻣذھب‬/‫اﻟدﯾﺎﻧﺔ‬

Date of Entry ‫ﺗﺎرﯾﺦ اﻟدﺧول‬ Date of Birth ‫ﺗﺎرﯾﺦ اﻟﻣﯾﻼد‬

Port of Entry ‫ﻣرﻛز اﻟدﺧول‬ Sponsor’s Name ‫اﻟﻛﻔﯾل ﻋﻧد اﻟد ﺧول‬

Office Tel. ‫ھﺎﺗف اﻟﻌﻣل‬ Current Sponsor ‫اﻟﻛﻔﯾل اﻟﺣﺎﻟﻲ‬

Occupation Work Location ‫ﻣﻛﺎن اﻟﻌﻣل‬

Bank Salary ‫اﻟراﺗب‬

Place of Issue ‫ﻣﻛﺎن اﻹﺻد ار‬ Passport No. ‫رﻗم اﻟﺟواز‬

Expiry Date ‫ﺗﺎرﯾﺦ اﻻﻧﺗﮭﺎء‬ Date of Issue ‫ﺗﺎرﯾﺦ اﻹﺻدار‬

Place of Issue ‫ﻣﻛﺎن اﻹﺻد ار‬ Residence No. ‫رﻗم اﻹﻗﺎﻣﺔ‬

Expiry Date ‫ﺗﺎرﯾﺦ اﻻﻧﺗﮭﺎء‬ Date of Issue ‫ﺗﺎرﯾﺦ اﻹﺻدار‬

Expiry Date ‫ﺗﺎرﯾﺦ اﻻﻧﺗﮭﺎء‬ I.D Number ‫رﻗم اﻟﮭوﯾﺔ‬

Education ‫اﻟﻣؤھل اﻟدراﺳﻲ‬

College/University ‫اﻟﺟﺎﻣﻌﺔ‬/‫اﻟﻣدرﺳﺔ‬ Graduation ‫ﺗﺎرﯾﺦ اﻟﺗﺧرج‬

Place of Issue ‫ﻣﻛﺎن اﻹﺻد ار‬ Residence No. ‫رﻗم اﻹﻗﺎﻣﺔ‬

Country ‫اﻟدوﻟﺔ‬ Languages ‫اﻟﻠﻐﺎت‬

Spouse Name ‫اﻟزوﺟﺔ‬/‫اﺳم ﻟزوج‬ Marital Status ‫اﻟﺣﺎﻟﺔ اﻻﺟﺗﻣﺎﻋﯾﺔ‬

Place of Birth ‫ﻣﻛن اﻟﻣﯾﻼد‬ Nationality ‫اﻟﺟﻧﺳﯾﺔ‬

Occupation ‫اﻟﻣﮭﻧﺔ‬ Employer ‫ﻣﻛﺎن اﻟﻌﻣل‬ DOB ‫ﺗﺎرﯾﺦ اﻟﻣﯾﻼد‬

Children Names ‫أﺳﻣﺎء اﻷﺑﻧﺎء‬

5 1

6 2

7 3

8 4

Parent Details ‫ﺑﯾﺎﻧﺎت اﻟواﻟدﯾن‬

Nationality ‫اﻟﺟﻧﺳﯾﺔ‬ Father’s Name ‫اﺳم اﻷب‬

Date of Birth ‫ﺗﺎرﯾﺦ اﻟﻣﯾﻼد‬ Place of Birth ‫ﻣﻛﺎن اﻟﻣﯾﻼد‬

Occupation ‫اﻟﻣﮭﻧﺔ‬ Employer ‫ﻣﻛﺎن اﻟﻌﻣل‬

Nationality ‫اﻟﺟﻧﺳﯾﺔ‬ Mother’s Name ‫اﺳم اﻷ م‬

Date of Birth ‫ﺗﺎرﯾﺦ اﻟﻣﯾﻼد‬ Place of Birth ‫ﻣﻛﺎن اﻟﻣﯾﻼد‬

Occupation ‫اﻟﻣﮭﻧﺔ‬ Employer ‫ﻣﻛﺎن اﻟﻌﻣل‬

.‫ﻛﺗﺎﺑﺔ اﻟوﺛﯾ ﻘﺔ ﺑﺧط اﻟﯾد ﺑﺎﻟﻧﺳﺑﺔ اﻟ ﻌرب أ و ﻣن أﺻ ل ﻋرﺑﻲ أﻣﺎ ﺑﺎﻟﻧﺳﺑ ﺔ ﻟﻸﺟﺎﻧب طﺑﺎﻋﺔ اﻟ وﺛﯾ ﻘﺔ ﺑﺎﻟﻠ ﻐﺔ اﻹﻧ ﺟﻠﯾزﯾﺔ‬
The document shouldn’t be hand written in Arabic for Arabs nationals & English typing for other nationalities.
 ‫‪Relatives‬‬ ‫اﻷﻗــــــــــﺎرب‬
‫‪Employer‬‬ ‫ﺟﮭﺔ اﻟﻌﻣ ل‬ ‫‪Nationality‬‬ ‫اﻟﺟﻧﺳــﯾﺔ‬ ‫‪Name‬‬ ‫اﻻﺳــم‬ ‫‪#‬‬

‫‪1‬‬

‫‪2‬‬

‫‪3‬‬

‫‪Friends‬‬ ‫اﻷﺻدﻗــــــــﺎء‬
‫‪Employer‬‬ ‫ﺟﮭﺔ اﻟﻌﻣ ل‬ ‫‪Nationality‬‬ ‫اﻟﺟﻧﺳــﯾﺔ‬ ‫‪Name‬‬ ‫اﻻﺳــم‬ ‫‪#‬‬

‫‪1‬‬

‫‪2‬‬

‫‪3‬‬

‫‪Residence Address‬‬ ‫ﻋﻧـــــوان اﻟﺳﻛـــــــــن‬

‫‪Street‬‬ ‫اﻟــﺷــــــــــــــــــــــــــﺎرع‬ ‫‪Location‬‬ ‫اﻟﻣـﻧــطــﻘـــــــــــﺔ‬

‫‪Building No.‬‬ ‫رﻗم اﻟﻣﻧزل‪/‬اﻟﺑﻧﺎﯾﺔ‬ ‫‪Landlord‬‬ ‫اﺳـم اﻟﻣــــــﺎﻟك‬

‫‪Flat No.‬‬ ‫رﻗــــم اﻟﺷﻘــــــــــــﺔ‬ ‫‪Floor‬‬ ‫اﻟطــــــــــــــــﺎﺑــــق‬

‫‪Mobile No.‬‬ ‫اﻟﮭﺎﺗف اﻟﻣﺗﺣـــــرك )‪(1‬‬ ‫‪Landline‬‬ ‫اﻟﮭﺎﺗف اﻟﺛﺎﺑت‬

‫‪Mobile No.‬‬ ‫اﻟﮭﺎﺗف اﻟﻣﺗﺣـــــرك )‪(2‬‬ ‫‪E-mail‬‬ ‫اﻟﺑرﯾد اﻻﻟﻛﺗروﻧﻲ‬

‫‪P.O Box‬‬ ‫ﺻﻧــدوق اﻟـﺑرﯾـــــــد‬ ‫‪Instagram‬‬ ‫اﻧﺳﺗﻐرام‬

‫‪Facebook‬‬ ‫ﻓﯾﺳﺑوك‬ ‫‪Twitter‬‬ ‫ﺗوﯾﺗر‬

‫‪Previous Occupation in UAE‬‬ ‫اﻷﻋﻣﺎل اﻟﺗﻲ ﻣﺎرﺳﺗﮭﺎ داﺧل اﻟدوﻟﺔ‬

‫‪3‬‬ ‫‪1‬‬

‫‪4‬‬ ‫‪2‬‬

‫‪Countries you worked with‬‬ ‫اﻟدوﻟﺔ اﻟﺗﻲ ﺳﺑـق ﻟك اﻟﻌﻣل ﺑﮭــــﺎ‬

‫‪4‬‬ ‫‪1‬‬

‫‪5‬‬ ‫‪2‬‬

‫‪6‬‬ ‫‪3‬‬

‫‪Vehicle Information‬‬ ‫ﺑﯾـــــﺎﻧــــــﺎت اﻟﻣـرﻛـﺑــــــــﺔ‬

‫‪Place of‬‬ ‫ﺟﮭﺔ اﻟﺗرﺧﯾص‬ ‫‪Car Model‬‬
‫ﻧوع اﻟﻣرﻛﺑﺔ‬
‫‪Regis.‬‬
‫‪Plate Color/‬‬ ‫ﻟون اﻟﻠوﺣﺔ‪/‬اﻟﻔﺋﺔ‬ ‫‪Plate No.‬‬ ‫رﻗم اﻟﻠوﺣﺔ‬
‫‪Place of Issue‬‬ ‫ﻣﻛﺎن اﻹﺻد ار‬ ‫‪License No.‬‬ ‫رﻗم رﺧﺻﺔ ﻟﻘﯾﺎدة‬
‫‪Expiry Date‬‬ ‫ﺗﺎرﯾﺦ اﻻﻧﺗﮭﺎء‬ ‫‪Date of Issue‬‬ ‫ﺗﺎرﯾﺦ اﻹﺻدار‬

‫‪Have you served in the Military Services:‬‬ ‫‪Yes‬‬ ‫‪NO‬‬ ‫ﻻ‬ ‫ﻧﻌ م‬ ‫ھل ﺳﺑ ق ﻟك اﻟﻌﻣل ﻓﻲ اﻟﻣﺟﺎل اﻟﻌ ﺳﻛري‪:‬‬
‫‪Level of Service‬‬ ‫ﻧوع اﻟﺧدﻣﺔ‬ ‫‪Country‬‬ ‫اﺳم اﻟدوﻟﺔ‬
‫‪Date of Service‬‬ ‫ﻣدة اﻟﺧدﻣﺔ‬ ‫‪Rank‬‬ ‫اﻟـرﺗﺑــــــــــــــﺔ‬

‫‪I, Undersigned certify that all statement are correct complete.‬‬ ‫أﺗﻌﮭد اﻧﺎ اﻟﻣوﻗﻊ أدﻧﺎه ﺑﺄن اﻟﺑﯾﺎﻧﺎت ﺑﮭ ذه اﻟوﺛﯾﻘﺔ ﺻﺣﯾﺣﺔ وﻛﺎﻣﻠﺔ‪.‬‬

‫‪Date‬‬ ‫اﻟﺗﺎرﯾﺦ‬ ‫‪Signature‬‬ ‫اﻟﺗوﻗﯾﻊ‬ ‫‪Name‬‬ ‫اﻻﺳم‬

‫§ ﻓﻲ ﺣﺎﻟﺔ ﻣﺧﺎﻟﻔﺔ دﺧول اﻟﻣﻧﺷﺎة ﺳﯾﺗم ﺳﺣب اﻟﺗ ﺻرﯾ ﺢ ﻟﻣدة ﺗﺗراو ح ﻣن أﺳﺑوع وﻟﻐﺎﯾﺔ ﺷﮭر ﺣﺳب ﻧوع اﻟﻣﺧﺎﻟﻔﺔ وﻓﻲ ﺣﺎل اﻟﺗﻛرار ﺳﯾﺗم ﺣرﻣﺎن اﻟﺷﺧص ﻣن اﻟﺗ ﺻرﯾ ﺢ‪.‬‬
‫§‬ ‫‪In the evet of violation of entering the facility, a permit will be withdrawn for a period ranging from a week to a month depending on the type of‬‬
‫‪violation. In event of repetition, the permit will be denied.‬‬