‫‪910451838479‬‬

‫ﻃﻠﺐ ﺗﻘﺮﻳﺮ ﻣﻘﻴﻢ‬

‫‪Passport Number‬‬ ‫‪AB9567223‬‬ ‫ﺭﻗﻢ ﺍﻟﺠﻮﺍﺯ‬ ‫ﺍﻻﺳﻢ ﺑﺎﻟﻌﺮﺑﻴﺔ‬

‫‪Passport Issuance Place‬‬ ‫‪304‬‬ ‫ﻣﻜﺎﻥ ﺇﺻﺪﺍﺭ ﺍﻟﺠﻮﺍﺯ‬ ‫ﻣﺤﻤﺪ ﺣﺴﻴﻦ‬
‫‪Passport Issuance Date‬‬ ‫‪1436/02/10‬‬ ‫ﺗﺎﺭﻳﺦ ﺇﺻﺪﺍﺭ ﺍﻟﺠﻮﺍﺯ‬ ‫‪Name in English‬‬
‫‪Passport Expiry Date‬‬ ‫‪1446/05/28‬‬ ‫ﺗﺎﺭﻳﺦ ﺍﻧﺘﻬﺎﺀ ﺍﻟﺠﻮﺍﺯ‬ ‫‪MUHAMMAD RAFIQUE FAZAL HUSSAIN‬‬
‫‪Passport Status‬‬ ‫ﺍﺳﺘﺒﺪﺍﻝ‬ ‫ﺣﺎﻟﺔ ﺍﻟﺠﻮﺍﺯ‬
‫‪Iqama Number‬‬ ‫‪2341732234‬‬ ‫ﺭﻗﻢ ﺍﻹﻗﺎﻣﺔ‬
‫‪Visa Expiry Date‬‬ ‫‪-‬‬ ‫ﺗﺎﺭﻳﺦ ﺍﻧﺘﻬﺎﺀ ﺍﻟﺘﺄﺷﻴﺮﺓ‬
‫‪Iqama Version‬‬ ‫‪5‬‬ ‫ﻧﺴﺨﺔ ﺍﻹﻗﺎﻣﺔ‬
‫‪Visa Issuance Place‬‬ ‫‪-‬‬ ‫ﻣﻜﺎﻥ ﺇﺻﺪﺍﺭ ﺍﻟﺘﺄﺷﻴﺮﺓ‬
‫‪Iqama Expiry Date‬‬ ‫‪1442/07/28‬‬ ‫ﺗﺎﺭﻳﺦ ﺍﻧﺘﻬﺎﺀ ﺍﻹﻗﺎﻣﺔ‬
‫‪Date of Last Exit‬‬ ‫‪26/02/2020‬‬ ‫ﺗﺎﺭﻳﺦ ﺁﺧﺮ ﺧﺮﻭﺝ‬
‫‪Iqama Issuance Date‬‬ ‫‪1434/05/19‬‬ ‫ﺗﺎﺭﻳﺦ ﺇﺻﺪﺍﺭ ﺍﻹﻗﺎﻣﺔ‬
‫‪Health Insurance Information‬‬
‫‪Occupation‬‬ ‫ﺳﺎﺋﻖ ﺷﺎﺣﻨﺔ‬ ‫ﺍﻟﻤﻬﻨﺔ‬
‫‪Health Insurance‬‬ ‫‪1441/10/19‬‬ ‫ﺗﺎﺭﻳﺦ ﺍﻧﺘﻬﺎﺀ‬
‫‪Marital Status‬‬ ‫ﺃﻋﺰﺏ‬ ‫ﺍﻟﺤﺎﻟﺔ ﺍﻻﺟﺘﻤﺎﻋﻴﺔ‬
‫‪Expiry Date‬‬ ‫ﺍﻟﺘﺄﻣﻴﻦ ﺍﻟﺼﺤﻲ‬
‫‪Nationality‬‬ ‫ﺑﺎﻛﺴﺘﺎﻥ‬ ‫ﺍﻟﺠﻨﺴﻴﺔ‬
‫‪Vehicles Information‬‬
‫‪Blood Type‬‬ ‫‪-‬‬ ‫ﻓﺼﻴﻠﺔ ﺍﻟﺪﻡ‬
‫‪Number of Vehicles‬‬ ‫‪0‬‬ ‫ﻋﺪﺩ ﺍﻟﻤﺮﻛﺒﺎﺕ‬
‫‪Traffic Violations Number‬‬ ‫‪0‬‬ ‫ﻋﺪﺩ ﺍﻟﻤﺨﺎﻟﻔﺎﺕ ﺍﻟﻤﺮﻭﺭﻳﺔ‬ ‫‪Place of Birth‬‬ ‫ﺑﺎﻛﺴﺘﺎﻥ‬ ‫ﻣﻜﺎﻥ ﺍﻟﻤﻴﻼﺩ‬
‫‪Number of Licenses‬‬ ‫‪1‬‬ ‫ﻋﺪﺩ ﺭﺧﺺ ﺍﻟﻘﻴﺎﺩﺓ‬ ‫‪Date of Birth‬‬ ‫‪14/04/1968‬‬ ‫ﺗﺎﺭﻳﺦ ﺍﻟﻤﻴﻼﺩ‬

‫‪Hajj Information‬‬
‫‪Iqama Issuance Place‬‬ ‫ﺟﻮﺍﺯﺍﺕ ﺍﻟﺪﻣﺎﻡ‬ ‫ﻣﻜﺎﻥ ﺇﺻﺪﺍﺭ ﺍﻹﻗﺎﻣﺔ‬

‫‪Hajj Eligibility‬‬ ‫✘‬ ‫‪Yes‬‬ ‫‪No‬‬ ‫ال‬ ‫ﻧﻌﻢ‬ ‫✘‬ ‫ﺃﺣﻘﻴﺔ ﺍﻟﺤﺞ‬ ‫‪Gender‬‬ ‫✘‬ ‫‪Male‬‬ ‫‪Female‬‬ ‫ﺃﻧﺜﻰ‬ ‫ﺫﻛﺮ‬ ‫✘‬ ‫ﺍﻟﺠﻨﺲ‬

‫‪Last Year of Hajj‬‬ ‫‪-‬‬ ‫ﺃﺧﺮ ﺳﻨﺔ ﺣﺞ‬ ‫‪Inside Kingdom‬‬ ‫✘‬ ‫‪Yes‬‬ ‫‪No‬‬ ‫ال‬ ‫ﻧﻌﻢ‬ ‫✘‬ ‫ﺩﺍﺧﻞ ﺍﻟﻤﻤﻠﻜﺔ‬
‫‪Religion‬‬ ‫ﺍﻻﺳﻼﻡ‬ ‫ﺍﻟﺪﻳﺎﻧﺔ‬
‫‪Sponsor Information‬‬

‫‪Sponsor ID Number‬‬ ‫‪7006756600‬‬ ‫ﺭﻗﻢ ﻫﻮﻳﺔ ﺍﻟﻜﻔﻴﻞ‬ ‫?‪Is there a finger print‬‬ ‫✘‬ ‫‪Yes‬‬ ‫ال ‪No‬‬ ‫ﻧﻌﻢ‬ ‫✘‬ ‫ﻫﻞ ﺗﻮﺟﺪ ﺑﺼﻤﺔ؟‬

‫‪Sponsor Name‬‬ ‫ﺍﺳﻢ ﺍﻟﻜﻔﻴﻞ‬ ‫‪No. of Sponsorship Transfers‬‬ ‫‪2‬‬ ‫ﻋﺪﺩ ﻣﺮﺍﺕ ﻧﻘﻞ ﺍﻟﻜﻔﺎﻟﺔ‬

‫ﻣﺆﺳﺴﺔ ﺍﻟﻄﻮﺏ ﺍﻟﻤﻄﻮﺭ ﻟﻠﻤﻘﺎﻭﻻﺕ ﺍﻟﻌﺎﻣﺔ‬

‫ﻣﺪﺓ ﺻﻼﺣﻴﺔ ﺍﻟﺴﺠﻞ ‪ 30‬ﻳﻮﻣﺎً ﺍﻋﺘﺒﺎﺭﺍً ﻣﻦ ﺗﺎﺭﻳﺦ ﺍﻹﺻﺪﺍﺭ ‪ 16/03/2020‬ﻡ‬

‫ﻳﻤﻜﻦ ﺍﻟﺘﺤﻘﻖ ﻣﻦ ﺻﺤﺔ ﺍﻟﺴﺠﻞ ﻣﻦ ﺧﻼﻝ ﺧﺪﻣﺔ ﺍﻻﺳﺘﻌﻼﻡ ﻋﺒﺮ ﺃﺑﺸﺮ ﻭﺫﻟﻚ ﺑﺎﺳﺘﺨﺪﺍﻡ ﺍﻟﺮﻗﻢ ﺍﻟﻤﺮﺟﻌﻲ‬
‫ﻋﻠﻰ ﺍﻟﺮﺍﺑﻂ )‪ ،(www.absher.sa‬ﺍﻟﺒﻴﺎﻧﺎﺕ ﺍﻟﻤﻌﺮﻭﺿﺔ ﺗﺸﻤﻞ ﺍﻟﺒﻴﺎﻧﺎﺕ ﺍﻟﻤﺴﺠﻠﺔ ﺃﺛﻨﺎﺀ ﻋﻤﻠﻴﺔ ﺍﻹﺻﺪﺍﺭ‬
‫ﻭﺍﻟﻄﺒﺎﻋﺔ‪ ،‬ﻋﻠﻤﺎً ﺃﻧﻪ ﺳﻴﺘﻢ ﻋﺮﺽ ﺍﻟﺒﻴﺎﻧﺎﺕ ﺍﻟﻤﺴﺠﻠﺔ ﺑﺎﻟﻨﻈﺎﻡ ﻋﻨﺪ ﺍﻻﺳﺘﻔﺴﺎﺭ‪.‬‬

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‫ﻃﻠﺐ ﺗﻘﺮﻳﺮ ﻣﻘﻴﻢ‬

‫‪Dependents‬‬

‫‪Number of dependents‬‬ ‫‪0‬‬ ‫ﻋﺪﺩ ﺍﻟﺘﺎﺑﻌﻴﻦ‬

‫‪Dep. Inside‬‬ ‫‪0‬‬ ‫ﻋﺪﺩ ﺍﻟﺘﺎﺑﻌﻴﻦ ﺩﺍﺧﻞ ﺍﻟﻤﻤﻠﻜﺔ‬

‫‪Dep. Outside‬‬ ‫‪0‬‬ ‫ﻋﺪﺩ ﺍﻟﺘﺎﺑﻌﻴﻦ ﺧﺎﺭﺝ ﺍﻟﻤﻤﻠﻜﺔ‬

‫ﻣﺪﺓ ﺻﻼﺣﻴﺔ ﺍﻟﺴﺠﻞ ‪ 30‬ﻳﻮﻣﺎً ﺍﻋﺘﺒﺎﺭﺍً ﻣﻦ ﺗﺎﺭﻳﺦ ﺍﻹﺻﺪﺍﺭ ‪ 16/03/2020‬ﻡ‬

‫ﻳﻤﻜﻦ ﺍﻟﺘﺤﻘﻖ ﻣﻦ ﺻﺤﺔ ﺍﻟﺴﺠﻞ ﻣﻦ ﺧﻼﻝ ﺧﺪﻣﺔ ﺍﻻﺳﺘﻌﻼﻡ ﻋﺒﺮ ﺃﺑﺸﺮ ﻭﺫﻟﻚ ﺑﺎﺳﺘﺨﺪﺍﻡ ﺍﻟﺮﻗﻢ ﺍﻟﻤﺮﺟﻌﻲ‬
‫ﻋﻠﻰ ﺍﻟﺮﺍﺑﻂ )‪ ،(www.absher.sa‬ﺍﻟﺒﻴﺎﻧﺎﺕ ﺍﻟﻤﻌﺮﻭﺿﺔ ﺗﺸﻤﻞ ﺍﻟﺒﻴﺎﻧﺎﺕ ﺍﻟﻤﺴﺠﻠﺔ ﺃﺛﻨﺎﺀ ﻋﻤﻠﻴﺔ ﺍﻹﺻﺪﺍﺭ‬
‫ﻭﺍﻟﻄﺒﺎﻋﺔ‪ ،‬ﻋﻠﻤﺎً ﺃﻧﻪ ﺳﻴﺘﻢ ﻋﺮﺽ ﺍﻟﺒﻴﺎﻧﺎﺕ ﺍﻟﻤﺴﺠﻠﺔ ﺑﺎﻟﻨﻈﺎﻡ ﻋﻨﺪ ﺍﻻﺳﺘﻔﺴﺎﺭ‪.‬‬

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