. Haga dyad Heda 5 the jane ‘ls peal pit Bhat: Royal Embasoy of Saudi Ceabica Canbowa | Consutar Section Barcode: rast! First Name: Middle Name: Surname: sda pat Mother’s name: 3ilpel Date of Birth: _ Place of Birtl Previous Nationalit Present Nation: Place of Issue: Passport No: ‘Date of Expiry: Date of Issue Sex: Marital Status: Femate O mae Q #0 « O Married [)_ single [ Religio ~ ‘Occupation: 244) | Qualification: SB Home Address and Telephone and Mobile No: OAT Alyy pal yy Spall Gl ge ‘E-mail Address: rp SDN Sa Business Address and Telephone No: Toa yy sel) 16 Ge ‘Purpose of Travel: Tb ge GT ve as Baty be e employment C] residence swdent J vn maj O Faas bos yet Se bap gas piptome [] special Personal [J Bseon [J reeny [] os ae tus eldes Bag vranst tourism LC] commerce L] Businessmen] Govermen O seis tue bas Sine ba work Vise C]—romity visit LC) temporary Work visit CL] ‘Method of Payment: Bank Check: [] Money Order: [J] ‘Name and Address of Company oF Individual you are meeting in the Kingdon Ta FOE, ‘Travel Information: qe Sage Date of arrival in Saudi Arabia: Via Airlin Flight No: ‘Destination: Port of Entry: Duration of Stay in the Kingdom: Name of traveling companion: Relationship to you of traveling compani +" Application must be filed out its entirety *** I, the undersigned hereby certify that: © Tagre to have my fingerprints taken and my etna scanned onlin By gheailinay Sige GUISE & © Allthe information provided is corct. will abide by the Li olay tance ein seta Bob a ‘Laws of the kingdom during the period of my residence Seegepng tl aa sty) sgh sel Name: Signature: Date: For official use only: pel Dent “BH Guilfoyle Street Varralumla ACT 2600 > Telephone{ 61262507000) « Fax( 41262807000) www saudiombassy org.au