‫ﻧﻤﻮذج ﺗﻮﻇﯿﻒ رﺟﺎل‬

Employment Application (Male)

O B Date: :‫ﺍﻟﺘﺎﺭﻳﺦ‬

Address in Saudi Arabia ‫ﺍﻟﻌﻨﻮﺍﻥ ﺩﺍﺧﻞ ﺍﻟﻤﺪﻳﻨﺔ‬

E-mail Address ‫ ﺍﻟﺒﺮﻳﺪ ﺍﻹﻟﻜﺘﺮﻭﻧﻲ‬Street ‫ﺍﻟﺸﺎﺭﻉ‬ District ‫ ﺍﻟﺤﻲ‬City ‫ﺍﻟﻤﺪﻳﻨﺔ‬

Mobile No ‫ ﺭﻗﻢ ﺍﻟﺠﻮﺍﻝ‬Phone No. ‫ ﺭﻗﻢ ﺍﻟﻬﺎﺗﻒ‬Postal Code ‫ ﺍﻟﺮﻣﺰ ﺍﻟﺒﺮﻳﺪﻱ‬P.O Box ‫ﺻﻨﺪﻭﻕ ﺍﻟﺒﺮﻳﺪ‬

Educational Qualifications ‫ﺍﻟﻤﺆﻫﻼﺕ ﺍﻟﺪﺭﺍﺳﻴﺔ‬

Name of School ‫ﺍﺳﻢ ﺍﻟﻤﺆﺳﺴﺔ ﺍﻟﺪﺭﺍﺳﻴﺔ‬ Date ‫ﺗﺎﺭﻳﺦ ﺍﻟﻤﺆﻫﻞ‬ Major ‫ﺍﻟﺘﺨﺼﺺ‬ Degree Name ‫ﺍﻟﻤﺆﻫﻞ ﺍﻟﺪﺭﺍﺳﻲ‬

Professional Experience Registered in G.O.S.I. (Please list last Position First) (‫ﺍﻹﺟﺘﻤﺎﻋﻴﺔ )ﺭﺗﺒﻬﺎ ﺗﻨﺎﺯﻟﻴًﺎ ﺑﺂﺧﺮ ﻭﻇﻴﻔﺔ‬ ‫ﺑﻴﺎﻥ ﺑﺎﻟﺨﺒﺮﺍﺕ ﺍﻟﻌﻤﻠﻴﺔ ﺍﻟﻤﺴﺠﻠﺔ ﻓﻲ ﺍﻟﺘﺄﻣﻴﻨﺎﺕ‬
Reason for Leaving ‫ﺳﺒﺐ ﺗﺮﻙ ﺍﻟﻌﻤﻞ‬ Employment Date ‫ﺗﺎﺭﻳﺦ ﺍﻟﺘﻮﻇﻴﻒ‬ Organization Name ‫ﺟﻬﺔ ﺍﻟﻌﻤﻞ‬ Job Title ‫ﺍﻟﻤﺴﻤﻰ ﺍﻟﻮﻇﻴﻔﻲ‬

To ‫ﺇﻟﻰ‬ From ‫ﻣﻦ‬

Y Y Y Y MM Y Y Y Y MM

Email ................................................‫ﺍﻟﺒﺮﻳﺪ ﺍﻹﻟﻜﺘﺮﻭﻧﻲ ﺍﻟﺨﺎﺹ ﺑﻪ‬ Contact No. ................................................‫ﺭﻗﻢ ﺍﻟﺘﻮﺍﺻﻞ‬ Previous Employer ................................................‫ﺍﺳﻢ ﻣﺪﻳﺮﻙ ﻓﻲ ﺁﺧﺮ ﺷﺮﻛﺔ ﻣﺴﺠﻞ ﺑﻬﺎ‬

Have you ever convicted of a crime or immoral act? No ‫ﻻ‬ Yes ‫ﻧﻌﻢ‬ ‫ﻫﻞ ﺳﺒﻖ ﺃﻥ ﺣﻜﻢ ﻋﻠﻴﻚ ﺑﺤﺪ ﺷﺮﻋﻲ ﺃﻭ ﺟﺮﻳﻤﺔ ﻣﺨﻠﺔ ﺑﺎﻟﺸﺮﻑ ﻭﺍﻷﻣﺎﻧﺔ؟‬

Have you ever been punitively terminated from a job? No ‫ﻻ‬ Yes ‫ﻧﻌﻢ‬ ‫ﻫﻞ ﺳﺒﻖ ﺃﻥ ﻓﺼﻠﺖ ﻣﻦ ﺍﻟﺨﺪﻣﺔ ﻷﺳﺒﺎﺏ ﺗﺄﺩﻳﺒﻴﺔ؟‬

Are you currently under litigation and/or investigation? No ‫ﻻ‬ Yes ‫ﻧﻌﻢ‬ ‫ﻫﻞ ﺍﻧﺖ ﻣﺤﺎﻝ ﻟﻠﺘﺤﻘﻴﻖ ﺃﻭ ﺍﻟﻤﺤﻜﻤﺔ ﻓﻲ ﺍﻟﻮﻗﺖ ﺍﻟﺤﺎﺿﺮ؟‬

Employee Information ‫ﻣﻌﻠﻮﻣﺎﺕ ﻋﻦ ﺍﻟﻤﻮﻇﻒ‬

• Please write the name as it should appear on the card in English for you and your dependents ‫• ﻳﺮﺟﻰ ﻛﺘﺎﺑﺔ ﺍﻻﺳﻢ ﻛﻤﺎ ﺳﻴﻈﻬﺮ ﻋﻠﻰ ﺍﻟﺒﻄﺎﻗﺔ ﺑﺎﻟﻠﻐﺔ ﺍﻹﻧﺠﻠﻴﺰﻳﺔ ﻟﻚ ﻭﻷﻓﺮﺍﺩ ﻋﺎﺋﻠﺘﻚ‬
• Please make sure to write the date of birth by Gregorian date for your dependents ‫• ﻳﺮﺟﻰ ﺍﻟﺘﺄﻛﺪ ﻣﻦ ﻛﺘﺎﺑﺔ ﺗﺎﺭﻳﺦ ﺍﻟﻤﻴﻼﺩ ﺑﺎﻟﺘﺎﺭﻳﺦ ﺍﻟﻤﻴﻼﺩﻱ ﻟﻚ ﻭﻷﻓﺮﺍﺩ ﻋﺎﺋﻠﺘﻚ‬
• Please attach a copy of your family card or birth certificate ‫• ﻳﺮﺟﻰ ﺇﺭﻓﺎﻕ ﺻﻮﺭﺓ ﻣﻦ ﻛﺮﺕ ﺍﻟﻌﺎﺋﻠﺔ ﺃﻭ ﺷﻬﺎﺩﺓ ﺍﻟﻤﻴﻼﺩ‬

Family name ‫ ﺍﺳﻢ ﺍﻟﻌﺎﺋﻠﺔ‬Grandfather Name ‫ﺍﺳﻢ ﺍﻟﺠﺪ‬ Father name ‫ ﺍﺳﻢ ﺍﻻﺏ‬First name ‫ﺍﻻﺳﻢ ﺍﻻﻭﻝ‬

ID No. ‫ ﺭﻗﻢ ﺍﻟﻬﻮﻳﺔ‬Date of birth ‫ﺗﺎﺭﻳﺦ ﺍﻟﻤﻴﻼﺩ‬ Marital status Married ‫ ﻣﺘﺰﻭﺝ‬single ‫ﺃﻋﺰﺏ‬ ‫ﺍﻟﺤﺎﻟﺔ ﺍﻻﺟﺘﻤﺎﻋﻴﺔ‬
(as per passport) (‫)ﺣﺴﺐ ﺟﻮﺍﺯ ﺍﻟﺴﻔﺮ‬

Dependents Information ‫ﻣﻌﻠﻮﻣﺎﺕ ﺃﻓﺮﺍﺩ ﺍﻟﻌﺎﺋﻠﺔ‬

Dependents name ‫ﺍﺳﻤﺎﺀ ﺃﻓﺮﺍﺩ ﺍﻟﻌﺎﺋﻠﺔ‬ Relationship ‫ﺻﻠﺔ ﺍﻟﻘﺮﺍﺑﺔ‬ Date of birth (Gregorian) (‫ﺗﺎﺭﻳﺦ ﺍﻟﻤﻴﻼﺩ )ﺍﻟﺘﺎﺭﻳﺦ ﺍﻟﻤﻴﻼﺩﻱ‬

‫ﺇﺑﻨﻪ‬ ‫ﺇﺑﻦ‬ ‫ﺯﻭﺟﺔ‬

1
Daughter Son Wife Y Y Y Y MM D D
‫ﺇﺑﻨﻪ‬ ‫ﺇﺑﻦ‬ ‫ﺯﻭﺟﺔ‬
2
Daughter Son Wife Y Y Y Y MM D D
‫ﺇﺑﻨﻪ‬ ‫ﺇﺑﻦ‬ ‫ﺯﻭﺟﺔ‬
3
Daughter Son Wife Y Y Y Y MM D D
‫ﺇﺑﻨﻪ‬ ‫ﺇﺑﻦ‬ ‫ﺯﻭﺟﺔ‬
4
Daughter Son Wife Y Y Y Y MM D D

Declaration
I, the undersigned hereby attest and declare that all information appearing above and all documentation
accompanying this application is true to the best of my knowledge. And that I shall fully bear the
consequences of any evidence found to the contrary. As per the existing regulation in this respect, I also
declare that the above information is true and I shall notify SNB of any change in address. And that this
address is valid for all written communication unless I notify SNB and provide an alternate mailing address.
‫ﺇﻗــــــــــﺮﺍﺭ‬
‫ﺃﻗﺮ ﺃﻧﺎ ﺍﻟﻤﻮﻗﻊ ﺃﺩﻧﺎﻩ ﺑﺄﻥ ﺍﻟﻤﻌﻠﻮﻣﺎﺕ ﺍﻟﻤﺪﻭﻧﺔ ﻓﻲ ﻧﻤﻮﺫﺝ ﺍﻟﺘﻮﻇﻴﻒ ﺻﺤﻴﺤﺔ ﻭﻓﻲ ﺣﺎﻟﺔ ﺛﺒﻮﺕ ﻏﻴﺮ ﺫﻟﻚ ﻓﺈﻧﻨﻲ ﺃﺗﺤﻤﻞ ﺟﻤﻴﻊ ﻣﺎ ﺗﻘﺮﻩ‬
‫ ﻛﻤﺎ ﺃﻗﺮ ﺃﻥ ﺃﻱ ﺍﺗﺼﺎﻝ‬، ‫ﺍﻷﻧﻈﻤﺔ ﻭﺍﻟﺘﻌﻠﻴﻤﺎﺕ ﺍﻟﻨﺎﻓﺬﺓ ﺑﻬﺬﺍ ﺍﻟﺨﺼﻮﺹ ﻭﻛﻤﺎ ﺃﺗﻌﻬﺪ ﺑﺈﺧﻄﺎﺭ ﺍﻟﺒﻨﻚ ﺑﺄﻱ ﺗﻐﻴﺮ ﻓﻲ ﺍﻟﺒﻴﺎﻧﺎﺕ ﺍﻟﻮﺍﺭﺩﺓ ﺃﻋﻼﻩ‬
.‫ﺧﻄﻲ ﻳﻮﺟﻪ ﻟﻲ ﻋﻠﻰ ﺍﻟﻌﻨﻮﺍﻥ ﺃﻋﻼﻩ ﻳﻌﺪ ﺻﺤﻴﺤﺎً ﻟﺤﻴﻦ ﻭﺭﻭﺩ ﻫﺬﺍ ﺍﻹﺧﻄﺎﺭ‬

Date ‫ﺍﻟﺘﺎﺭﻳﺦ‬ Signature ‫ﺍﻟﺘﻮﻗﻴﻊ‬ Name ‫ﺍﻻﺳﻢ‬

18-HR-540

4030001588 ‫ ت‬. ‫ | س‬300002471110003 ‫ رﯾﺎل ﺳﻌﻮدي ﻣﺪﻓﻮع ﺑﺎﻟﮑﺎﻣﻞ | اﻟﺮﻗﻢ اﻟﻀﺮﯾﺒﻲ‬44,780,000,000 ‫اﻟﺒﻨﻚ اﻷهﻠﻲ اﻟﺴﻌﻮدي ﺷﺮﮐﺔ ﻣﺴﺎهﻤﺔ ﺳﻌﻮدﯾﺔ | رأس اﳌﺎل‬
‫ م‬1953/12/26 ‫ هـ اﳌﻮاﻓﻖ‬1373/4/20 ‫ و ﺗﺎرﯾﺦ‬3737 ‫ﺧﺎﺿﻌﺔ ﻹﺷﺮاف ورﻗﺎﺑﺔ اﻟﺒﻨﻚ اﳌﺮﮐﺰي اﻟﺴﻌﻮدي | ﻣﺮﺧﺺ ﻟﻬﺎ ﺑﻤﻮﺟﺐ اﻷﻣﺮ اﻟﺴﺎﻣﻲ رﻗﻢ‬
10/1
13511 ‫ﺑﺮج اﻟﺒﻨﻚ اﻷهﻠﻲ اﻟﺴﻌﻮدي ﻣﺮﮐﺰ اﳌﻠﻚ ﻋﺒﺪ اﷲ اﳌﺎﻟﻲ | ﻃﺮﯾﻖ اﳌﻠﻚ ﻓﻬﺪ | ﺣﻲ اﻟﻌﻘﯿﻖ | اﻟﺮﯾﺎض‬
 ‫ﺷﺮوط اﻟﺘﻮﻇﯿﻒ )رﺟﺎل(‬
‫)‪Employment Conditions (Male‬‬
‫‪O‬‬ ‫‪B‬‬ ‫‪Date:‬‬ ‫ﺍﻟﺘﺎﺭﻳﺦ‪:‬‬

‫‪1‬‬ ‫‪I understand to attend and leave the bank at the specified times and not to leave the‬‬ ‫ﺍﺗﻌﻬــﺪ ﺑﺎﻟﻤﺤﺎﻓﻈــﺔ ﻋﻠــﻰ ﺍﻟﺤﻀــﻮﺭ ﻭﺍﻻﻧﺼــﺮﺍﻑ ﻓــﻲ ﺍﻟﻤﻮﺍﻋﻴــﺪ ﺍﻟﻤﻘــﺮﺭﺓ ﻟﻠﻌﻤــﻞ ﻭﻋــﺪﻡ ﻣﻐــﺎﺩﺭﺓ ﻣﻘــﺮ‬ ‫‪1‬‬
‫‪office during working hours except with the consent and prior permission of the‬‬ ‫ﺍﻟﻌﻤــﻞ ﺃﺛﻨــﺎﺀ ﺍﻟــﺪﻭﺍﻡ ﺃﻭ ﺍﻟﺘﻐﻴــﺐ ﻣﻬﻤــﺎ ﻛﺎﻧــﺖ ﺍﻷﺳــﺒﺎﺏ ﺇﻻ ﺑﻌــﺪ ﺍﻻﺳــﺘﺌﺬﺍﻥ ﻣــﻦ ﺍﻟﺮﺋﻴــﺲ ﺍﻟﻤﺒﺎﺷــﺮ ﻭﻓﻘ ـ ًﺎ‬
‫‪relevant authority, in accordance with the bank policy.‬‬ ‫ﻟﻠﺘﻌﻠﻴﻤﺎﺕ ﺍﻟﺘﻲ ﺗﻀﻌﻬﺎ ﺇﺩﺍﺭﺓ ﺍﻟﺒﻚ‪.‬‬

‫‪2 I undertake to carry out all daily work required within the bank's official working hours‬‬ ‫ﺃﺗﻌﻬــﺪ ﺑﺈﻧﺠــﺎﺯ ﺍﻟﻌﻤــﻞ ﺍﻟﻴﻮﻣــﻲ ﺍﻟﻤﻄﻠــﻮﺏ ﻗﺒــﻞ ﺍﻧﺘﻬــﺎﺀ ﺍﻟــﺪﻭﺍﻡ ﻭﻣﻠــﺰﻡ ﺑﺎﻟﺤﻀــﻮﺭ ﻹﻧﻬــﺎﺀ ﺍﻟﻤﻌﺎﻣــﻼﺕ‬ ‫‪2‬‬
‫‪and never postpone any transactions to the next day.‬‬ ‫ﺍﻟﻤﺘﺒﻘﻴﺔ ﺑﺤﻴﺚ ﻻ ﺃﻣﺎﺭﺱ ﻓﻲ ﺻﺒﺎﺡ ﺍﻟﻴﻮﻡ ﺍﻟﺘﺎﻟﻲ ﺇﻻ ﻣﻌﺎﻣﻼﺕ ﺍﻟﻴﻮﻡ ﻧﻔﺴﻪ‪.‬‬

‫‪3‬‬ ‫‪I undertake to keep and lock all documents and files inside drawers or cabinets‬‬ ‫ﺃﺗﻌﻬــﺪ ﺑﺈﻳــﺪﺍﻉ ﻛﺎﻓــﺔ ﺍﻷﻭﺭﺍﻕ ﻭﺍﻟﻤﺴــﺘﻨﺪﺍﺕ ﺍﻟﺘــﻲ ﺑﻌﻬﺪﺗــﻲ ﻭﺍﻟﺘــﻲ ﻟــﻢ ﺗﻜﺘﻤــﻞ ﺇﺟﺮﺍﺀﺍﺗﻬــﺎ ﻷﺳــﺒﺎﺏ ﻗﺎﻫــﺮﺓ‬ ‫‪3‬‬
‫‪before leaving the bank's offices and, in the event of loss of any documents, the‬‬ ‫ﺩﺍﺧــﻞ ﺃﺩﺭﺍﺝ ﺍﻟﻤﻜﺘــﺐ ﻭﺇﻗﻔﺎﻟــﻪ ﻋﻨــﺪ ﺍﻧﺘﻬــﺎﺀ ﺍﻟــﺪﻭﺍﻡ ﻋﻠــﻰ ﺃﻥ ﺃﻛــﻮﻥ ﻣﺴــﺆﻭ ً‬
‫ﻻ ﺃﻣــﺎﻡ ﺍﻹﺩﺍﺭﺓ ﻋــﻦ ﺿﻴــﺎﻉ ﺃﻭ‬
‫‪bank may impose penalties.‬‬ ‫ﻓﻘــﺪﺍﻥ ﺃﻱ ﻣﺴــﺘﻨﺪ ﺃﻭ ﺗﺴــﺮﺏ ﺃﻳــﺔ ﻣﻌﻠﻮﻣــﺔ ﻧﺘﻴﺠــﺔ ﻟﺬﻟــﻚ ﻭﺑﺎﻟﺘﺎﻟــﻲ ﺍﺳــﺘﺤﻖ ﺍﻟﻌﻘﻮﺑــﺔ ﺍﻟﺘــﻲ ﺗﻘﺮﺭﻫــﺎ‬
‫ﺍﻹﺩﺍﺭﺓ ﻭﺣﻔﺎﻇ ًﺎ ﻋﻠﻰ ﻣﺼﻠﺤﺔ ﺍﻟﻌﻤﻞ‪.‬‬
‫‪4‬‬ ‫‪I undertake to ensure good moral conduct and behavior both inside and outside the‬‬
‫‪place of work, and extend courtesy and fullest cooperation towards colleagues and‬‬ ‫ﺃﺗﻌﻬــﺪ ﺑﺎﻟﺘﻤﺴــﻚ ﺑﺎﻷﺧــﻼﻕ ﺍﻟﻔﺎﺿﻠــﺔ ﺃﺛﻨــﺎﺀ ﺍﻟﻌﻤــﻞ ﻭﺧﺎﺭﺟــﻪ ﻭﻣﻌﺎﻣﻠــﺔ ﺍﻟﺰﻣــﻼﺀ ﻭﺍﻟﻌﻤــﻼﺀ ﺑﺎﻟﺤﺴــﻨﻰ‬ ‫‪4‬‬
‫‪customers.‬‬ ‫ﻭﺍﻟﺘﻌﺎﻭﻥ ﻣﻌﻬﻢ ﻋﻠﻰ ﺇﻧﺠﺎﺯ ﺍﻟﻌﻤﻞ ﺍﻟﻤﻄﻠﻮﺏ ﻗﺒﻞ ﺍﻧﺘﻬﺎﺀ ﺍﻟﺪﻭﺍﻡ‪.‬‬

‫‪5‬‬ ‫‪I undertake to assist the bank's customers in completing their transactions carefully‬‬ ‫ﺃﺗﻌﻬــﺪ ﺑﺎﻟﻤﺤﺎﻓﻈــﺔ ﻋﻠــﻰ ﻣﻌﺎﻣﻠــﺔ ﻋﻤــﻼﺀ ﺍﻟﺒﻨــﻚ ﺑﺎﻟﺤﺴــﻨﻰ ﻭﻣﺴــﺎﻋﺪﺗﻬﻢ ﻓــﻲ ﺍﻧﺠــﺎﺯ ﺃﻋﻤﺎﻟﻬــﻢ ﺑﺪﻗــﺔ‬ ‫‪5‬‬
‫‪and accurately.‬‬ ‫ﻭﻋﺪﻡ ﺗﻌﻄﻴﻞ ﻣﺼﺎﻟﺤﻬﻢ ﻭﺗﻘﺪﻳﻢ ﻛﻞ ﻋﻮﻥ ﻭﻣﺴﺎﻋﺪﺓ ﻟﻬﻢ ﺗﺤﻘﻴﻘ ًﺎ ﻟﺮﻏﺒﺔ ﺇﺩﺍﺭﺓ ﺍﻟﺒﻨﻚ‪.‬‬

‫‪6‬‬ ‫‪I undertake to abstain from divulging and customer secrets intentionally or‬‬ ‫ﺃﺗﻌﻬــﺪ ﺑﺎﻟﻤﺤﺎﻓﻈــﺔ ﻋﻠــﻰ ﺍﻷﺳــﺮﺍﺭ ﺍﻟﺘــﻲ ﺗﺨــﺺ ﺍﻟﺒﻨــﻚ ﻭﻋﻤﻼﺋــﻪ ﻭﻋــﺪﻡ ﺍﻹﺑﺎﺣــﺔ ﺑﻬــﺎ ﺳــﻮﺍﺀ ﺑﻘﺼــﺪ ﺃﻭ‬ ‫‪6‬‬
‫‪unintentionally to any unauthorized persons and in the event of violation, the bank‬‬ ‫ﺑــﺪﻭﻥ ﻗﺼــﺪ ﻭﺍﻟﺘــﻲ ﻣــﻦ ﺷــﺄﻧﻬﺎ ﺍﻹﺿــﺮﺍﺭ ﺑﻤﺼﻠﺤــﺔ ﺍﻟﻌﻤــﻞ ﻭﻓــﻲ ﺣﺎﻟــﺔ ﻣﺨﺎﻟﻔﺘــﻲ ﺃﻭ ﻧﻘﻀــﻲ ﻟﻬــﺬﺍ ﻓــﺈﻥ‬
‫‪has the right to terminate my services.‬‬ ‫ﻟﻠﺒﻨﻚ ﺍﻟﺤﻖ ﺑﺈﻧﻬﺎﺀ ﺧﺪﻣﺎﺗﻲ‪.‬‬

‫‪7‬‬ ‫‪I undertake to safeguard the bank's furniture and other properties.‬‬ ‫ﺃﺗﻌﻬــﺪ ﺑﺎﻟﻤﺤﺎﻓﻈــﺔ ﻋﻠــﻰ ﺃﺛــﺎﺙ ﺍﻟﺒﻨــﻚ ﺍﻟــﺬﻱ ﻳﻌﻬــﺪ ﺇﻟــﻲ ﻭﻋﻠــﻰ ﺟﻤﻴــﻊ ﺍﻷﺩﻭﺍﺕ ﺍﻟﺘــﻲ ﻳﺘــﻢ ﺍﺳــﺘﺨﺪﺍﻣﻬﺎ ﺃﺛﻨــﺎﺀ‬ ‫‪7‬‬
‫ﺍﻟﻌﻤﻞ‪.‬‬
‫‪8 I undertake to inform the bank of any change in my residential address and telephone‬‬
‫‪number.‬‬ ‫ﺃﺗﻌﻬﺪ ﻓﻲ ﺣﺎﻟﺔ ﺗﻐﻴﻴﺮ ﻋﻨﻮﺍﻥ ﺳﻜﻨﻲ ﺃﻥ ﺍﺷﻌﺮ ﺍﻟﺒﻨﻚ ﺑﻌﻨﻮﺍﻥ ﺳﻜﻨﻲ ﺍﻟﺠﺪﻳﺪ ﻭﺭﻗﻢ ﻫﺎﺗﻔﻲ‪.‬‬ ‫‪8‬‬

‫‪9‬‬ ‫‪I undertake to declare that there is no conflict of schedule whatsoever between my‬‬ ‫ﺃﺗﻌﻬــﺪ ﻓــﻲ ﺣﺎﻟــﺔ ﺗﻌﺎﺭﺿــﺖ ﺃﻭﻗــﺎﺕ ﺩﺭﺍﺳــﺘﻲ ﺑﺎﻟﺠﺎﻣﻌــﺔ ﺃﻭ ﺍﻟﻤﺪﺭﺳــﺔ‪ ...‬ﺇﻟــﺦ‪ .‬ﻣــﻊ ﺃﻭﻗــﺎﺕ ﺍﻟــﺪﻭﺍﻡ ﺍﻟﺮﺳــﻤﻲ‬ ‫‪9‬‬
‫‪official working hours and with any academic body, such as schools or universities,‬‬ ‫ﻟﻠﺒﻨــﻚ ﺃﻥ ﺃﺗــﺮﻙ ﺍﻟﺪﺭﺍﺳــﺔ ﺃﻭ ﺍﻟﻌﻤــﻞ ﺑﺎﻟﺒﻨــﻚ‪ ،‬ﻛﻤــﺎ ﺃﺗﻌﻬــﺪ ﺑﻌــﺪﻡ ﺗــﺮﻙ ﻣﻘــﺮ ﻋﻤﻠــﻲ ﺃﺛﻨــﺎﺀ ﺍﻟــﺪﻭﺍﻡ ﺍﻟﺮﺳــﻤﻲ‬
‫‪etc., and I also I undertake to declare that I will not leave my work duty to attend‬‬ ‫ﻟﺤﻀــﻮﺭ ﻣﺤﺎﺿــﺮﺍﺕ ﻳﻜــﻮﻥ ﻭﻗﺘﻬــﺎ ﻣﺘﻌــﺎﺭﺽ ﻣــﻊ ﺃﻭﻗــﺎﺕ ﺍﻟﻌﻤــﻞ ﻭﻓــﻲ ﺣــﺎﻝ ﻣﺨﺎﻟﻔﺘــﻲ ﺃﻭ ﻧﻘﻀــﻲ ﻟﻬــﺬﺍ‬
‫‪classes or lectures, etc. otherwise the bank has the right to terminate my services.‬‬ ‫ﻓﺈﻥ ﻟﻠﺒﻨﻚ ﺍﻟﺤﻖ ﺑﺈﻧﻬﺎﺀ ﺧﺪﻣﺎﺗﻲ‪.‬‬

‫‪10 I undertake not to work for any other organization, paid or unpaid, especially with‬‬ ‫‪ 10‬ﺃﺗﻌﻬــﺪ ﺃﻥ ﺃﺗﻔــﺮﻍ ﻟﻠﻌﻤــﻞ ﻓــﻲ ﺍﻟﺒﻨــﻚ ﻭﻋــﺪﻡ ﺍﻻﺭﺗﺒــﺎﻁ ﺑــﺄﻱ ﻋﻤــﻞ ﺧــﺎﺹ ﻭﻟﺤﺴــﺎﺏ ﺍﻵﺧﺮﻳــﻦ ﻭﺑﺼﻔــﺔ‬
‫‪competitors or organizations practicing in the same field, during my employment‬‬ ‫ﺧﺎﺻــﺔ ﺍﻟﺠﻬــﺎﺕ ﺍﻟﻤﻨﺎﻓﺴــﺔ ﺃﺛﻨــﺎﺀ ﺃﻳــﺎﻡ ﺍﻟﻌﻤــﻞ ﺃﻭ ﺍﻹﺟــﺎﺯﺍﺕ ﺳــﻮﺍﺀ ﺑﺄﺟــﺮ ﺃﻭ ﺑــﺪﻭﻥ ﺃﺟــﺮ ﻭﻓــﻲ ﺣــﺎﻝ ﺣــﺪﻭﺙ‬
‫‪with the bank and in the event of violation, the bank has the right to terminate my‬‬ ‫ﺧــﻼﻑ ﺫﻟــﻚ ﻓــﻺﺩﺍﺭﺓ ﺍﻟﺒﻨــﻚ ﺍﻟﺤــﻖ ﻓــﻲ ﺍﻋﺘﺒــﺎﺭ ﺧﺪﻣﺎﺗــﻲ ﻣﻨﺘﻬﻴــﺔ ﻭﺃﻛــﻮﻥ ﻓــﻲ ﺣﻜــﻢ ﺍﻟﻤﺴــﺘﻘﻴﻞ ﺩﻭﻥ ﺃﻱ‬
‫‪services, attributed to the fault of the employee.‬‬ ‫ﺍﻋﺘﺮﺍﺽ ﻣﻨﻲ‪.‬‬

‫‪11 I undertake to inform the bank in case of any actions and violation that may offend‬‬ ‫‪ 11‬ﺃﺗﻌﻬــﺪ ﺑﺈﺑــﻼﻍ ﺇﺩﺍﺭﺓ ﺍﻟﺒﻨــﻚ ﺑــﺄﻱ ﻣﺨﺎﻟﻔــﺎﺕ ﺃﻭ ﺃﻋﻤــﺎﻝ ﺗﺴــﻲﺀ ﺇﻟــﻰ ﺳــﻤﻌﺔ ﺍﻟﺒﻨــﻚ ﺃﻭ ﻗــﺪ ﺗﺸــﻜﻞ ﺧﻄــﺮﺍً ﻋﻠــﻰ‬
‫‪the bank's reputation or may constitute danger to the bank employee and‬‬ ‫ﺣﻴﺎﺓ ﺍﻟﻤﻮﻇﻔﻴﻦ ﺃﻭ ﻣﻤﺘﻠﻜﺎﺕ ﺍﻟﺒﻨﻚ‪.‬‬
‫‪properties.‬‬
‫‪ 12‬ﺃﺗﻌﻬــﺪ ﺑــﺄﻥ ﺃﻭﺍﻓــﻖ ﺑﺼــﻮﺭﺓ ﺷــﺎﻣﻠﺔ ﻏﻴــﺮ ﻣﻘﻴــﺪﺓ ﻋﻠــﻰ ﺗﻨﻔﻴــﺬ ﻛﺎﻓــﺔ ﺍﻟﺘﻌﻠﻴﻤــﺎﺕ ﺍﻟﺘــﻲ ﺗﻀﻌﻬــﺎ ﺇﺩﺍﺭﺓ ﺍﻟﺒﻨــﻚ‬
‫‪12 I undertake to agree on executing all instructions set by the bank management or‬‬ ‫ﺃﻭ ﺭﺋﻴــﺲ ﺍﻟﻌﻤــﻞ ﺍﻟﻤﺒﺎﺷــﺮ ﻭﻋﻠــﻰ ﺟﻤﻴــﻊ ﺍﻟﻠﻮﺍﺋــﺢ ﻭﺍﻟﻌﻘﻮﺑــﺎﺕ ﻭﻛﻞ ﺗﻨﻈﻴــﻢ ﻳﻬــﺪﻑ ﺇﻟــﻰ ﻣﺼﻠﺤــﺔ ﻭﺿﻤــﺎﻥ‬
‫‪my direct supervisor, which is aimed at the best interest of the bank.‬‬ ‫ﺳﻴﺮ ﺍﻟﻌﻤﻞ‪.‬‬

‫‪13 I undertake to declare that information given in the employment application, as well‬‬ ‫‪ 13‬ﺃﺗﻌﻬــﺪ ﺑــﺄﻥ ﺍﻟﻤﻌﻠﻮﻣــﺎﺕ ﺍﻟﺘــﻲ ﻗﺪﻣﺘﻬــﺎ ﻭﺿﻤﻨﺘﻬــﺎ ﺍﺳــﺘﻤﺎﺭﺓ ﻧﻤــﻮﺫﺝ ﺍﻟﺘﻮﻇﻴــﻒ ﻭﻛﺬﻟــﻚ ﺟﻤﻴــﻊ ﺍﻟﻮﺛﺎﺋــﻖ‬
‫‪as all documents attached thereto, are true and correct, and, if discovered‬‬ ‫ﻭﺍﻟﺸــﻬﺎﺩﺍﺕ ﺻﺤﻴﺤــﺔ ﻭﻛﺬﻟــﻚ ﺍﻟﺘﻘﻴــﺪ ﺑﻜﺎﻓــﺔ ﺍﻟﺘﻌﻬــﺪﺍﺕ ﺍﻟﻤﺤــﺮﺭﺓ ﺑﺸــﺮﻭﻁ ﺍﻟﻌﻤــﻞ ﻭﻓــﻲ ﺣﺎﻟــﺔ ﺛﺒــﻮﺕ‬
‫‪otherwise, the bank has the right to terminate my services.‬‬ ‫ﻋــﺪﻡ ﺻﺤــﺔ ﺫﻟــﻚ ﺃﻭ ﺣــﺪﻭﺙ ﺧــﻼﻑ ﺫﻟــﻚ ﺣﺎﺿــﺮﺍ ﺃﻭ ﻣﺴــﺘﻘﺒ ً‬
‫ﻼ ﻓــﻺﺩﺍﺭﺓ ﺍﻟﺒﻨــﻚ ﺍﻟﺤــﻖ ﺑﻔﺼﻠــﻲ ﺃﻭ ﺣﺮﻣﺎﻧــﻲ‬
‫ﻣﻦ ﺍﻟﻌﻤﻞ‪.‬‬

‫‪Declaration‬‬ ‫ﺇﻗــــــــــﺮﺍﺭ‬
‫‪I, the undersigned hereby declare that I have read the employment conditions stated above‬‬ ‫ﺍﻗﺮ ﺃﻧﺎ ﺍﻟﻤﻮﻗﻊ ﺃﺩﻧﺎﻩ ﻋﻠﻰ ﺷﺮﻭﻁ ﺍﻟﻌﻤﻞ ﺍﻟﻤﺬﻛﻮﺭﺓ ﻭﺃﺗﻌﻬﺪ ﺑﺘﻨﻔﻴﺬﻫﺎ ﻭﺍﻟﺘﻘﻴﺪ ﺑﻬﺎ ﻧﺼﺤﺎً ﻭﺭﻭﺣﺎً‪.‬‬
‫‪and undertake to abide thereby accordingly.‬‬

‫‪Date‬‬ ‫ﺍﻟﺘﺎﺭﻳﺦ‬ ‫‪Signature‬‬ ‫ﺍﻟﺘﻮﻗﻴﻊ‬ ‫‪Name‬‬ ‫ﺍﻻﺳﻢ‬

‫‪18-HR-540‬‬

‫اﻟﺒﻨﻚ اﻷهﻠﻲ اﻟﺴﻌﻮدي ﺷﺮﮐﺔ ﻣﺴﺎهﻤﺔ ﺳﻌﻮدﯾﺔ | رأس اﳌﺎل ‪ 44,780,000,000‬رﯾﺎل ﺳﻌﻮدي ﻣﺪﻓﻮع ﺑﺎﻟﮑﺎﻣﻞ | اﻟﺮﻗﻢ اﻟﻀﺮﯾﺒﻲ ‪ | 300002471110003‬س ‪ .‬ت ‪4030001588‬‬
‫ﺧﺎﺿﻌﺔ ﻹﺷﺮاف ورﻗﺎﺑﺔ اﻟﺒﻨﻚ اﳌﺮﮐﺰي اﻟﺴﻌﻮدي | ﻣﺮﺧﺺ ﻟﻬﺎ ﺑﻤﻮﺟﺐ اﻷﻣﺮ اﻟﺴﺎﻣﻲ رﻗﻢ ‪ 3737‬و ﺗﺎرﯾﺦ ‪ 1373/4/20‬هـ اﳌﻮاﻓﻖ ‪ 1953/12/26‬م‬
‫‪10/2‬‬
‫ﺑﺮج اﻟﺒﻨﻚ اﻷهﻠﻲ اﻟﺴﻌﻮدي ﻣﺮﮐﺰ اﳌﻠﻚ ﻋﺒﺪ اﷲ اﳌﺎﻟﻲ | ﻃﺮﯾﻖ اﳌﻠﻚ ﻓﻬﺪ | ﺣﻲ اﻟﻌﻘﯿﻖ | اﻟﺮﯾﺎض ‪13511‬‬
 (‫ﺗﻀﺎرب اﳌﺼﺎﻟﺢ )رﺟﺎل‬
Conflicts of Interest (Male)
O B
Concept
Conflict of interest means “a staff member who commits deliberate acts or practices certain
activity that incurs potential harm for the ban; or put himself in a position of being exposed
to negligence in the Bank Interest versus his personal interest.”
Objective
It has been stated in the “Business Principles” adopted by the Bank that “we insist on
personal integrity” as it is one of SNB core values which the bank maintains and develops
through SNB staff concern to leave far behind activities and practices that conflict with the
bank’s interest.
Policy
The bank management being fully confident in all SNB staff loyalties and their sense of
integrity therein, declares that practices which are in conflict with the Bank interest,
whereby employees shall never practice, involve in the following aspects:
1 Using official working hours in handling and following up their own personal business
or, any other business irrelevant to the bank
2 Using office work materials and the bank’s facilities such as machines, equipment
and communication media in pursuit of personal business.
3 Using official capacity in achieving financial gain or moral interest outside the Bank
which could not be achieved otherwise.
4 Preferring one supplier to another due to tie of kin or common business linking the
supplier and the concerned employee or one of his relatives or extended family, up
to the second generation
5 Accepting gifts in kind or in cash, or benefits from suppliers or customer broker,
against services offered to the supplier or customer, whether offered by the
employee himself or through another middleman.
6 Participating in conducting a study for granting credit facilities to one of the bank’s
customers who is involved in interest, or his next of kin or extended family up to the
second generation.
7 I Staff using his influence, authority or relations in the bank for granting credit facilities
to a customer in conflict with the practiced rules and principles in order to
accomplish a financial gain or moral benefit for him or for anyone of his relatives due
to tie of kin or relationship up to the second generation.
8 Disclosing data or decision or negotiation being made in the process of taking
decision, to anyone to be used in achieving self-interest inside or outside the bank,
whether this act has been made with or without payment (in cash or in kind
9 Staff practicing actual executive business in one of the commercial or industrial
companies in the Kingdom, whether this practice is for full or part time, with or
without payment, (in cash or in kind
10 Staff is a partner in one of the commercial or industrial companies using his influence
or authority in achieving interest for such company that may incur potential harm to
the bank
Concealing of facts, evidence of such action or breaches of rules shall expose the
employee to disciplinary actions by the Bank, which may include termination. The bank
management is confident in its staff’s commitment to accuracy and full integrity in not
disclosing what information they possess.
As contribution of SNB Top Management in assisting the employee to take his decision
in avoiding conflict of interest, if any the Senior Personnel Committee has been assigned
to study all cases and inquiries referred there to and take the appropriate decision there
of notifying the employee of what to do in accordance with the procedures which will be
established and announced by committee in this concern to all employees.
Finally, each employee has to complete the attached declaration / undertaking as a
confirmation of his knowledge and commitment to the afore noted Bank Policy.
Date ‫ﺍﻟﺘﺎﺭﻳﺦ‬ Signature
18-HR-540
4030001588 ‫ ت‬. ‫ | س‬300002471110003 ‫ رﯾﺎل ﺳﻌﻮدي ﻣﺪﻓﻮع ﺑﺎﻟﮑﺎﻣﻞ | اﻟﺮﻗﻢ اﻟﻀﺮﯾﺒﻲ‬44,780,000,000 ‫اﻟﺒﻨﻚ اﻷهﻠﻲ اﻟﺴﻌﻮدي ﺷﺮﮐﺔ ﻣﺴﺎهﻤﺔ ﺳﻌﻮدﯾﺔ | رأس اﳌﺎل‬
10/3 ‫ م‬1953/12/26 ‫ هـ اﳌﻮاﻓﻖ‬1373/4/20 ‫ و ﺗﺎرﯾﺦ‬3737 ‫ﺧﺎﺿﻌﺔ ﻹﺷﺮاف ورﻗﺎﺑﺔ اﻟﺒﻨﻚ اﳌﺮﮐﺰي اﻟﺴﻌﻮدي | ﻣﺮﺧﺺ ﻟﻬﺎ ﺑﻤﻮﺟﺐ اﻷﻣﺮ اﻟﺴﺎﻣﻲ رﻗﻢ‬
13511 ‫ﺑﺮج اﻟﺒﻨﻚ اﻷهﻠﻲ اﻟﺴﻌﻮدي ﻣﺮﮐﺰ اﳌﻠﻚ ﻋﺒﺪ اﷲ اﳌﺎﻟﻲ | ﻃﺮﯾﻖ اﳌﻠﻚ ﻓﻬﺪ | ﺣﻲ اﻟﻌﻘﯿﻖ | اﻟﺮﯾﺎض‬
Date: :‫ﺍﻟﺘﺎﺭﻳﺦ‬
‫ﺍﻟﻤﻔﻬﻮﻡ‬
‫ﻳﻘﺼﺪ ﺑﺘﻀﺎﺭﺏ ﺍﻟﻤﺼﺎﻟﺢ ﺃﻥ ﻳﺄﺗﻲ ﺍﻟﻤﻮﻇﻒ ﻣﺘﻌﻤﺪﺍً ﺑﺄﻓﻌﺎﻝ ﺃﻭ ﻳﻤﺎﺭﺱ ﻧﺸﺎﻃﺎً ﻣﻦ ﺍﻷﻧﺸﻄﺔ ﻣﻦ ﺷﺄﻧﻬﺎ ﺃﻭ ﻳﺘﺮﺗﺐ‬
‫ﻼ ﻟﻠﺒﻨﻚ ﺃﻭ ﻳﻀﻊ ﻧﻔﺴﻪ ﻓﻲ ﻣﻮﻗﻒ ﻳﻌﺮﺿﻪ ﺇﻟﻰ ﺍﻟﺘﻬﺎﻭﻥ ﻓﻲ ﻣﺼﻠﺤﺔ ﺍﻟﺒﻨﻚ ﻣﻘﺎﺑﻞ ﻣﺼﻠﺤﺘﻪ‬ ً ‫ﻋﻠﻴﻬﺎ ﺿﺮﺭﺍً ﻣﺤﺘﻤ‬
.‫ﺍﻟﺸﺨﺼﻴﺔ‬
‫ﺍﻟﻬﺪﻑ‬
‫ﻭﺭﺩ ﻓﻲ ﻗﻮﺍﻋﺪ ﺍﻟﻌﻤﻞ ﺍﻟﻤﺼﺮﻓﻲ ﺍﻟﺘﻲ ﻳﺘﺒﻨﺎﻫﺎ ﺍﻟﺒﻨﻚ ﺃﻧﻨﺎ ﻧﺼﺮ ﻋﻠﻰ ﻣﺒﺪﺃ ﺍﻻﺳﺘﻘﺎﻣﺔ ﺍﻟﺸﺨﺼﻴﺔ ﺑﺎﻋﺘﺒﺎﺭﻫﺎ ﻣﻦ‬
‫ﺍﻟﻘﻴﻢ ﺍﻟﺠﻮﻫﺮﻳﺔ ﻟﻠﺒﻨﻚ ﻭﺍﻟﺘﻲ ﻳﺤﺎﻓﻆ ﻋﻠﻴﻬﺎ ﻭﻳﻨﻤﻴﻬﺎ ﻣﻦ ﺧﻼﻝ ﺍﻫﺘﻤﺎﻡ ﻣﻨﺴﻮﺑﻲ ﺍﻟﺒﻨﻚ ﺑﺄﻥ ﻳﻨﺄﻭﺍ ﺑﺄﻧﻔﺴﻬﻢ ﻋﻦ‬
‫ﻥ‬.‫ﺍﻟﻨﺸﺎﻃﺎﺕ ﻭﺍﻟﻤﻤﺎﺭﺳﺎﺕ ﺍﻟﺘﻲ ﺗﺘﻌﺎﺭﺽ ﻣﻌﻪ‬
‫ﺍﻟﺴﻴﺎﺳﺔ‬
‫ﺇﻥ ﺇﺩﺍﺭﺓ ﺍﻟﺒﻨــﻚ ﻋﻠــﻰ ﺛﻘــﺔ ﺗﺎﻣــﺔ ﻣــﻦ ﻭﻻﺀ ﻛﺎﻓــﺔ ﻣﻮﻇﻔﻴﻬــﺎ ﻭﺇﺣﺴﺎﺳــﻬﻢ ﺑﺎﻻﻧﺘﻤــﺎﺀ ﻟــﻪ ﻭﻳﺠــﺐ ﻋﻠﻴﻬــﻢ ﻋــﺪﻡ‬
:‫ﺍﻟﻘﻴﺎﻡ ﺑﺎﻟﻤﻤﺎﺭﺳﺎﺕ ﺍﻟﺘﻲ ﺗﺘﻌﺎﺭﺽ ﻣﻊ ﻣﺼﺎﻟﺢ ﺍﻟﺒﻨﻚ ﻭﺍﻟﺘﻲ ﺗﺘﻤﺜﻞ ﻓﻲ ﺍﻷﻣﻮﺭ ﺍﻟﺘﺎﻟﻴﺔ‬
‫ ﺍﺳﺘﻐﻼﻝ ﺃﻭﻗﺎﺕ ﺍﻟﻌﻤﻞ ﺍﻟﺮﺳﻤﻴﺔ ﻓﻲ ﻣﺒﺎﺷﺮﺓ ﺃﻭ ﻣﺘﺎﺑﻌﺔ ﺍﻷﻋﻤﺎﻝ ﺍﻟﺸﺨﺼﻴﺔ ﺃﻭ ﺃﻱ ﺃﻋﻤﺎﻝ ﺃﺧﺮﻯ ﻻ ﺗﺨﺺ‬1
.‫ﺍﻟﺒﻨﻚ‬
‫ ﺍﺳــﺘﺨﺪﺍﻡ ﺃﺩﻭﺍﺕ ﺍﻟﻌﻤــﻞ ﺍﻟﻤﻜﺘﺒﻴــﺔ ﻭﺇﻣﻜﺎﻧﻴــﺎﺕ ﺍﻟﺒﻨــﻚ ﻣــﻦ ﺃﺟﻬﺰﺓ ﻭﻣﻌﺪﺍﺕ ﻭﻭﺳــﺎﺋﻞ ﺍﺗﺼــﺎﻝ ﻓﻲ ﺍﻷﻋﻤﺎﻝ‬2
.‫ﺍﻟﺸﺨﺼﻴﺔ‬
‫ﺍﺳــﺘﺨﺪﺍﻡ ﺍﻟﺼﻔــﺔ ﺍﻟﻮﻇﻴﻔﻴــﺔ ﺑﺎﻟﺒﻨــﻚ ﻓــﻲ ﺗﺤﻘﻴــﻖ ﻣﺼﻠﺤــﺔ ﻣﺎﺩﻳــﺔ ﺃﻭ ﻣﻌﻨﻮﻳــﺔ ﺧــﺎﺭﺝ ﺍﻟﺒﻨــﻚ ﻭﺍﻟﺘــﻲ ﻻ‬ 3
.‫ﺗﺘﺤﻘﻖ ﺇﻻ ﺑﻬﺬﻩ ﺍﻟﺼﻔﺔ‬
‫ ﺗﻔﻀﻴــﻞ ﻣــﻮﺭﺩ ﻋﻠــﻰ ﺁﺧــﺮ ﺑﺴــﺒﺐ ﻭﺟــﻮﺩ ﺻﻠــﺔ ﻗﺮﺍﺑــﺔ ﺃﻭ ﻣﺼﻠﺤــﺔ ﺃﻭ ﻋﻤــﻞ ﻣﺸــﺘﺮﻙ ﻳﺮﺑــﻂ ﺑﻴــﻢ ﺍﻟﻤــﻮﺭﺩ‬4
.‫ﻭﺍﻟﻤﻮﻇﻒ ﺍﻟﻤﺨﺘﺺ ﺃﻭ ﻋﻼﻗﺔ ﻗﺮﺍﺑﺔ ﺃﻭ ﻣﺼﺎﻫﺮﺓ ﺣﺘﻰ ﻣﻦ ﺍﻟﺪﺭﺟﺔ ﺍﻟﺜﺎﻧﻴﺔ‬
‫ﻗﺒــﻮﻝ ﻫﺪﺍﻳــﺎ ﻋﻴﻨﻴــﺔ ﺃﻭ ﻣﺒﺎﻟــﻎ ﻧﻘﺪﻳــﺔ ﺃﻭ ﻣﺰﺍﻳــﺎ ﻣــﻦ ﺃﺣــﺪ ﺍﻟﻤﻮﺭﺩﻳــﻦ ﺃﻭ ﺍﻟﻌﻤــﻼﺀ ﺃﻭ ﺍﻟﻮﺳــﻄﺎﺀ ﻣﻘﺎﺑــﻞ‬ 5
‫ﺧﺪﻣــﺔ ﺗــﺆﺩﻯ ﻟﻠﻤــﻮﺭﺩ ﺃﻭ ﺍﻟﻌﻤﻴــﻞ ﺳــﻮﺍﺀ ﻗــﺎﻡ ﺍﻟﻤﻮﻇــﻒ ﺑﺘﺄﺩﻳﺘﻬــﺎ ﺑﻨﻔﺴــﻪ ﺃﻭ ﺑﺎﻟﻮﺍﺳــﻄﺔ ﻋــﻦ ﻃﺮﻳــﻖ‬
.‫ﻣﻮﻇﻒ ﺁﺧﺮ‬
‫ﺍﻻﺷــﺘﺮﺍﻙ ﻓــﻲ ﺇﺟــﺮﺍﺀ ﺩﺭﺍﺳــﺔ ﻟﻤﻨــﺢ ﺗﺴــﻬﻴﻼﺕ ﺍﺋﺘﻤﺎﻧﻴــﺔ ﻷﺣــﺪ ﻋﻤــﻼﺀ ﺍﻟﺒﻨــﻚ ﺍﻟﺬﻳــﻦ ﺗﺮﻳﻄﻬــﻢ‬ 6
.‫ﺑﺎﻟﻤﻮﻇﻒ ﻣﺼﻠﺤﺔ ﺃﻭ ﻋﻼﻗﺔ ﻗﺮﺍﺑﺔ ﺃﻭ ﻣﺼﺎﻫﺮﺓ ﺣﺘﻰ ﻣﻦ ﺍﻟﺪﺭﺟﺔ ﺍﻟﺜﺎﻧﻴﺔ‬
‫ ﺍﺳــﺘﺨﺪﺍﻡ ﺍﻟﻤﻮﻇــﻒ ﺃﻭ ﻋﻼﻗﺎﺗــﻪ ﺑﺎﻟﺒﻨــﻚ ﺗﺴــﻬﻴﻼﺕ ﺍﺋﺘﻤﺎﻧﻴــﺔ ﻷﺣــﺪ ﺍﻟﻌﻤــﻼﺀ ﺑﻤﺨﺎﻟﻔــﺔ ﺍﻟﻘﻮﺍﻋــﺪ ﻭﺍﻷﺻــﻮﻝ‬7
‫ﺍﻟﻤﺘﺒﻌــﺔ ﺑﻐــﺮﺽ ﺗﺤﻘﻴــﻖ ﻣﻨﻔﻌــﺔ ﻣﺎﺩﻳــﺔ ﺃﻭ ﻣﻌﻨﻮﻳــﺔ ﻟــﻪ ﺃﻭ ﻷﺣــﺪ ﺃﻗﺎﺭﺑــﻪ ﺃﻭ ﺑﺴــﺒﺐ ﻭﺟــﻮﺩ ﻋﻼﻗــﺔ‬
.‫ﻗﺮﺍﺑﺔ ﺃﻭ ﻣﺼﺎﻫﺮﺓ ﺣﺘﻰ ﻣﻦ ﺍﻟﺪﺭﺟﺔ ﺍﻟﺜﺎﻧﻴﺔ‬
‫ﺍﻟﻜﺸــﻒ ﻋــﻦ ﺑﻴﺎﻧــﺎﺕ ﺃﻭ ﻗــﺮﺍﺭﺍﺕ ﺃﻭ ﻣــﺪﺍﻭﻻﺕ ﺗﺘــﻢ ﻻﺗﺨــﺎﺫ ﻗــﺮﺍﺭ ﻣــﺎ ﺇﻟــﻰ ﺃﺣــﺪ ﺍﻷﺷــﺨﺎﺹ ﺑﻐــﺮﺽ‬ 8
‫ﺍﺳــﺘﺨﺪﺍﻣﻬﺎ ﻓــﻲ ﺗﺤﻘﻴــﻖ ﻣﺼﻠﺤــﺔ ﻟــﻪ ﺩﺍﺧــﻞ ﺃﻭ ﺧــﺎﺭﺝ ﺍﻟﺒﻨــﻚ ﺳــﻮﺍﺀ ﺗــﻢ ﺫﻟــﻚ ﺑﻤﻘﺎﺑــﻞ ﺃﻭ ﺑــﺪﻭﻥ‬
.‫ﻣﻘﺎﺑﻞ‬
‫ﻼ ﺗﻨﻔﻴﺬﻳﺎً ﻓﻌﻠﻴﺎً ﺑﺈﺣﺪﻯ ﺍﻟﺸﺮﻛﺎﺕ ﺍﻟﺘﺠﺎﺭﻳﺔ ﺃﻭ ﺍﻟﺼﻨﺎﻋﻴﺔ ﺩﺍﺧﻞ ﺍﻟﻤﻤﻠﻜﺔ ﺳﻮﺍﺀ‬
ً ‫ ﺃﻥ ﻳﻤﺎﺭﺱ ﺍﻟﻤﻮﻇﻒ ﻋﻤ‬9
.‫ﻛﺎﻧﺖ ﻣﻤﺎﺭﺳﺔ ﺍﻟﻤﻮﻇﻒ ﻟﻬﺬﺍ ﺍﻟﻌﻤﻞ ﺑﻜﺎﻣﻞ ﺍﻟﻮﻗﺖ ﺃﻭ ﺟﺰﺀ ﻣﻨﻪ ﻭﺳﻮﺍﺀ ﻛﺎﻥ ﺑﻤﻘﺎﺑﻞ ﺃﻭ ﺑﺪﻭﻥ ﻣﻘﺎﺑﻞ‬
‫ﺃﻥ ﻳﻜــﻮﻥ ﺍﻟﻤﻮﻇــﻒ ﺷــﺮﻳﻜﺎً ﻓــﻲ ﺇﺣــﺪﻯ ﺍﻟﺸــﺮﻛﺎﺕ ﺍﻟﺘﺠﺎﺭﻳــﺔ ﺃﻭ ﺍﻟﺼﻨﺎﻋﻴــﺔ ﻭﻳﺴــﺘﺨﺪﻡ ﻭﺿﻌــﻪ‬ 10
ً ‫ﺍﻟﻮﻇﻴﻔﻲ ﻓﻲ ﺗﺤﻘﻴﻖ ﻣﺼﻠﺤﺔ ﻟﻬﺬﻩ ﺍﻟﺸﺮﻛﺔ ﻳﺘﺮﺗﺐ ﻋﻠﻴﻬﺎ ﺿﺮﺭﺍً ﻣﺤﺘﻤ‬
.‫ﻼ ﻟﻠﺒﻨﻚ‬
‫ﺇﻥ ﻋــﺪﻡ ﺇﺑــﺪﺍﺀ ﺍﻟﺤﻘﻴﻘــﺔ ﺳــﻮﻑ ﻳﻌــﺮﺽ ﺍﻟﻤﻮﻇــﻒ ﻹﺟــﺮﺍﺀﺍﺕ ﻧﻈﺎﻣﻴــﺔ ﻓــﻲ ﺣﻘــﻪ ﻣــﻦ ﺟﺎﻧــﺐ ﺍﻟﺒﻨــﻚ ﻗــﺪ‬
‫ﺗﺼــﻞ ﺇﻟــﻰ ﺣــﺪ ﺇﻧﻬــﺎﺀ ﺍﻟﺨﺪﻣــﺔ ﻭﺇﺩﺍﺭﺓ ﺍﻟﺒﻨــﻚ ﻟﻌﻠــﻰ ﺛﻘــﺔ ﻣــﻦ ﺍﻟﺘــﺰﺍﻡ ﻛﺎﻓــﺔ ﻣﻮﻇﻔﻴﻬــﺎ ﺑﺎﻟﺪﻗــﺔ ﻭﺍﻷﻣﺎﻧــﺔ‬
.‫ﺍﻟﺘﺎﻣﺔ ﻓﻲ ﺇﺑﺪﺍﺀ ﻣﺎ ﻟﺪﻳﻬﻢ ﻣﻦ ﻣﻌﻠﻮﻣﺎﺕ‬
‫ﻫــﺬﺍ ﻭﻣﺴــﺎﻫﻤﺔ ﻣــﻦ ﺍﻹﺩﺍﺭﺓ ﺍﻟﻌﻠﻴــﺎ ﻓــﻲ ﻣﺴــﺎﻋﺪﺓ ﺍﻟﻤﻮﻇــﻒ ﻋﻠــﻰ ﺃﻥ ﻳﺘﺨــﺬ ﻗــﺮﺍﺭﺍً ﺑﺘﻼﻓــﻲ ﺃﻭﺟــﻪ ﺗﻀــﺎﺭﺏ‬
‫ﺍﻟﻤﺼﺎﻟــﺢ )ﺇﻥ ﻭﺟــﺪ( ﻓﻘــﺪ ﺗــﻢ ﺗﻜﻠﻴــﻒ ﺍﻟﻠﺠﻨــﺔ ﺍﻟﻌﻠﻴــﺎ ﻟﺸــﺌﻮﻥ ﺍﻟﻤﻮﻇﻔﻴــﻦ ﺑﺪﺭﺍﺳــﺔ ﻣــﺎ ﻳﻌــﺮﺽ ﻋﻠﻴﻬــﺎ ﻣــﻦ‬
‫ﺣــﺎﻻﺕ ﻭﺍﺳﺘﻔﺴــﺎﺭﺍﺕ ﻭﺍﺗﺨــﺎﺫ ﺍﻟﻘــﺮﺍﺭ ﺍﻟﻤﻨﺎﺳــﺐ ﺑﺸــﺄﻧﻬﺎ ﻭﺇﺧﻄــﺎﺭ ﺍﻟﻤﻮﻇــﻒ ﺑﻤــﺎ ﻳﺠــﺐ ﻋﻠﻴــﻪ ﻓﻌﻠــﻪ ﻭﺫﻟــﻚ‬
.‫ﺣﺴﺐ ﺍﻹﺟﺮﺍﺀﺍﺕ ﺍﻟﺘﻲ ﺳﺘﻨﻈﻤﻬﺎ ﺍﻟﻠﺠﻨﺔ ﺑﻬﺬﺍ ﺍﻟﺸﺄﻥ ﻭﺗﻌﻠﻢ ﺑﻬﺎ ﺍﻟﻤﻮﻇﻒ‬
‫ﻭﺃﺧﻴــﺮﺍً ﻓــﺈﻥ ﻋﻠــﻰ ﻛﻞ ﻣﻮﻇــﻒ ﺗﻌﺒﺌــﺔ ﺍﻹﻗــﺮﺍﺭ ﺍﻟﻤﺮﻓــﻖ ﺗﺄﻛﻴــﺪﺍً ﻣﻨــﻪ ﺑﺎﻟﻌﻠــﻢ ﻭﺍﻻﻟﺘــﺰﺍﻡ ﺑﺴﻴﺎﺳــﺔ ﺍﻟﺒﻨــﻚ‬
.‫ﺍﻟﻤﺬﻛﻮﺭﺓ‬
‫ﺍﻟﺘﻮﻗﻴﻊ‬ Name ‫ﺍﻻﺳﻢ‬
 (‫ﺗﻀﺎرب اﳌﺼﺎﻟﺢ )رﺟﺎل‬
Conflicts of Interest (Male)
O B Date: :‫ﺍﻟﺘﺎﺭﻳﺦ‬

Declaration ‫ﺇﻗــــــــــﺮﺍﺭ‬
I, the undersigned hereby noted employee confirm that I have gone through the Bank concerning ‫ ﻛﻤﺎ ﺃﻗﺮ‬،‫ﺃﻗﺮ ﺃﻧﺎ ﺍﻟﻤﻮﻗﻊ ﺃﺩﻧﺎﻩ ﺑﺄﻧﻨﻲ ﻗﺪ ﺍﻃﻠﻌﺖ ﻋﻠﻰ ﺳﻴﺎﺳﺔ ﺗﻀﺎﺭﺏ ﺍﻟﻤﺼﺎﻟﺢ ﻭﻋﻠﻤﺖ ﺑﺎﻷﻋﻤﺎﻝ ﺍﻟﻤﺤﻈﻮﺭ ﻋﻠﻲ ﺍﻟﻘﻴﺎﻡ ﺑﻬﺎ‬
Conflict of Interest and being aware of the prohibited business not to be conducted by me also I :‫ﺑﺄﻧﻨﻲ‬
undertake.

I do not practice any of such activities currently, and undertake to inform Bank Management in ً ‫ﻻ ﺃﻣﺎﺭﺱ ﺃﻳﺎ ﻣﻨﻬﺎ ﺣﺎﻟﻴﺎً ﻭﺃﺗﻌﻬﺪ ﺑﺈﺑﻼﻍ ﺇﺩﺍﺭﺓ ﺍﻟﺒﻨﻚ ﺑﺄﻱ ﻧﺸﺎﻁ ﻟﻲ ﻣﺴﺘﻘﺒ‬
‫ﻼ ﺑﺘﻌﺒﺌﺔ ﻫﺬﺍ ﺍﻟﻨﻤﻮﺫﺝ ﻣﺮﺓ ﺃﺧﺮﻯ‬
future of any activity in which I might be involved through refilling this form with the new .‫ﺑﺎﻟﺒﻴﺎﻧﺎﺕ ﺍﻟﺠﺪﻳﺪﺓ ﻭﺫﻟﻚ ﺧﻼﻝ ﺃﺳﺒﻮﻉ ﻣﻦ ﺻﺪﻭﺭ ﺍﻟﻤﻮﺍﻓﻘﺔ ﻭﺗﺼﺮﻳﺢ ﺍﻟﻌﻤﻞ‬
information within one week from the approval of competent authorities.

I do practice an executive business/ commercial activity described as follows :‫ ﻧﺸﺎﻃﺎً ﺗﺠﺎﺭﻳﺎً ﻋﻠﻰ ﺍﻟﺘﻔﺼﻴﻞ ﺍﻟﺘﺎﻟﻲ‬/ً‫ﻼ ﺗﻨﻔﻴﺬﻳﺎ‬
ً ‫ﺃﻣﺎﺭﺱ ﻋﻤ‬

Name of Company ‫ﺍﺳﻢ ﺍﻟﺸﺮﻛﺔ‬

Type of Company ‫ﻧﻮﻉ ﺍﻟﺸﺮﻛﺔ‬

Address ‫ﻋﻨﻮﺍﻧﻬﺎ‬

Nature of Business ‫ﻃﺒﻴﻌﺔ ﻧﺸﺎﻃﻬﺎ‬

Position/Capacity ‫ﺻﻔﺘﻲ ﺑﺎﻟﺸﺮﻛﺔ‬

Remuneration/Bonus ‫ ﺍﻟﻤﻜﺎﻓﺎﺓ‬/ ‫ﻗﻴﻤﺔ ﺍﻷﺟﺮ‬

Name of Company ‫ﺍﺳﻢ ﺍﻟﺸﺮﻛﺔ‬

Type of Company ‫ﻧﻮﻉ ﺍﻟﺸﺮﻛﺔ‬

Address ‫ﻋﻨﻮﺍﻧﻬﺎ‬

Nature of Business ‫ﻃﺒﻴﻌﺔ ﻧﺸﺎﻃﻬﺎ‬

Position/Capacity ‫ﺻﻔﺘﻲ ﺑﺎﻟﺸﺮﻛﺔ‬

Remuneration/Bonus ‫ ﺍﻟﻤﻜﺎﻓﺎﺓ‬/ ‫ﻗﻴﻤﺔ ﺍﻷﺟﺮ‬

I leave it to higher committee of the compliance division to evaluate any conflict of interest or not and ‫ ﻭﻫﺬﺍ ﺇﻗﺮﺍﺭ ﻣﻨﻲ‬،‫ﻭﺑﻬﺬﺍ ﺃﺗﺮﻙ ﺇﻟﻰ ﺍﻟﻠﺠﻨﺔ ﺍﻟﻌﻠﻴﺎ ﻹﺩﺍﺭﺓ ﺍﻻﻟﺘﺰﺍﻡ ﺗﻘﺪﻳﺮ ﻭﺟﻮﺩ ﺗﻀﺎﺭﺏ ﺍﻟﻤﺼﺎﻟﺢ ﻣﻦ ﻋﺪﻣﻪ ﻭﺇﺧﻄﺎﺭﻱ ﺑﺬﻟﻚ‬
update me on this and this is a recognition and undertake from me. .‫ﻭﺗﻌﻬﺪ ﺑﺬﻟﻚ‬

Undertaking ‫ﺗــــﻌــﻬـــــﺪ‬
I thereby leave the decision to the senior Personnel Committee to estimate whether a Conflict of Interest ‫ﺃﺗﻌﻬﺪ ﺃﻧﺎ ﺍﻟﻤﻮﻗﻊ ﺃﺩﻧﺎﻩ ﻭﻣﻦ ﺧﻼﻝ ﻋﻤﻠﻲ ﺑﺎﻟﺒﻨﻚ ﺍﻷﻫﻠﻲ ﺍﻟﺴﻌﻮﺩﻱ ﺃﻥ ﻻ ﺃﻗﻮﻡ ﺑﺘﻤﺮﻳﺮ ﺃﻱ ﻋﻤﻠﻴﺔ ﺑﻨﻜﻴﺔ ﻟﺼﺎﻟﺢ ﺍﻟﻤﻨﺸﺄﺓ ﺍﻟﺘﻲ‬
in my current activity exists, and to inform me accordingly. .‫ﺗﺨﺼﻨﻲ ﻭﺍﻟﺘﻲ ﺃﻋﻤﻞ ﻓﻴﻬﺎ ﻛﻨﺸﺎﻁ ﺧﺎﺭﺝ ﺍﻟﺒﻨﻚ ﻭﺍﻟﻤﻮﺍﻓﻖ ﻋﻠﻴﻬﺎ ﻣﻦ ﺇﺩﺍﺭﺓ ﺍﻻﻟﺘﺰﺍﻡ‬

Date ‫ﺍﻟﺘﺎﺭﻳﺦ‬ Signature ‫ﺍﻟﺘﻮﻗﻴﻊ‬ Name ‫ﺍﻻﺳﻢ‬

18-HR-540

4030001588 ‫ ت‬. ‫ | س‬300002471110003 ‫ رﯾﺎل ﺳﻌﻮدي ﻣﺪﻓﻮع ﺑﺎﻟﮑﺎﻣﻞ | اﻟﺮﻗﻢ اﻟﻀﺮﯾﺒﻲ‬44,780,000,000 ‫اﻟﺒﻨﻚ اﻷهﻠﻲ اﻟﺴﻌﻮدي ﺷﺮﮐﺔ ﻣﺴﺎهﻤﺔ ﺳﻌﻮدﯾﺔ | رأس اﳌﺎل‬
10/4 ‫ م‬1953/12/26 ‫ هـ اﳌﻮاﻓﻖ‬1373/4/20 ‫ و ﺗﺎرﯾﺦ‬3737 ‫ﺧﺎﺿﻌﺔ ﻹﺷﺮاف ورﻗﺎﺑﺔ اﻟﺒﻨﻚ اﳌﺮﮐﺰي اﻟﺴﻌﻮدي | ﻣﺮﺧﺺ ﻟﻬﺎ ﺑﻤﻮﺟﺐ اﻷﻣﺮ اﻟﺴﺎﻣﻲ رﻗﻢ‬
13511 ‫ﺑﺮج اﻟﺒﻨﻚ اﻷهﻠﻲ اﻟﺴﻌﻮدي ﻣﺮﮐﺰ اﳌﻠﻚ ﻋﺒﺪ اﷲ اﳌﺎﻟﻲ | ﻃﺮﯾﻖ اﳌﻠﻚ ﻓﻬﺪ | ﺣﻲ اﻟﻌﻘﯿﻖ | اﻟﺮﯾﺎض‬
 ‫ﻧﻤﻮذج اﻟﺘﻌﺮﯾﻒ اﻻول )رﺟﺎل(‬

‫‪O‬‬ ‫‪B‬‬ ‫‪Date:‬‬ ‫ﺍﻟﺘﺎﺭﻳﺦ‪:‬‬

‫ﺃﻗﺮ ﺃﻧﺎ‬

‫ﺑﻤﻮﺟﺐ ﺑﻄﺎﻗﺔ ﺃﺣﻮﺍﻝ ﺭﻗﻢ‬

‫‪Y Y Y Y MM D D‬‬ ‫ﺑﺘﺎﺭﻳﺦ‬

‫ﺍﻟﺼﺎﺩﺭﺓ ﻣﻦ‬

‫ﺑﺄﻥ ﺍﻟﺴﻴﺪ‬

‫ﺍﻟﺬﻱ ﺗﻘﺪﻡ ﻟﻠﻌﻤﻞ ﻟﺪﻳﻜﻢ ﻣﻌﺮﻭﻑ ﻟﺪﻱ ﻭﻣﺴﺘﻌﺪ ﻹﺣﻀﺎﺭﻩ ﺃﻭ ﺍﻟﺪﻻﻟﺔ ﻋﻠﻰ ﻣﻜﺎﻥ ﺗﻮﺍﺟﺪﻩ ﻋﻨﺪ ﺍﻟﻄﻠﺐ ﻭﻋﻠﻰ ﻫﺬﺍ ﺃﻭﻗﻊ‪.‬‬

‫ﺍﻟﺘﻮﻗﻴﻊ‬

‫ﺍﻟﻤﻌﺮﻑ‬
‫ﻋﻨﻮﺍﻥ ُ‬

‫ﺍﻟﻤﺪﻳﻨﺔ‬

‫ﺍﻟﺤﻲ‬

‫ﺍﻟﺸﺎﺭﻉ‬

‫ﺭﻗﻢ ﺍﻟﺠﻮﺍﻝ‬

‫ﺭﻗﻢ ﺍﻟﻤﻨﺰﻝ‬

‫ﺻﻨﺪﻭﻕ ﺍﻟﺒﺮﻳﺪ‬

‫ﺍﻟﺮﻣﺰ ﺍﻟﺒﺮﻳﺪﻱ‬

‫ﻟﻠﻤﻌﺮﻑ ﺍﻷﻭﻝ‬
‫*ﻣﻼﺣﻈﺔ‪ :‬ﻳﺮﺟﻰ ﺇﺭﻓﺎﻕ ﺻﻮﺭﺓ ﻣﻦ ﺑﻄﺎﻗﺔ ﺍﻷﺣﻮﺍﻝ ُ‬

‫ﻟﻠﻤﻌﺮﻑ )ﺟﻬﺔ ﺍﻟﻌﻤﻞ – ﺍﻟﻌﻤﺪﺓ – ﺍﻟﺸﺮﻃﺔ(‬

‫ﺗﻌﺒﺄ ﻣﻦ ﺍﻟﺠﻬﺔ ﺍﻟﻤﺼﺎﺩﻗﺔ ُ‬
‫ﻧﺼﺎﺩﻕ ﻋﻠﻰ ﺻﺤﺔ ﺗﻮﻗﻴﻊ ﺍﻟﻤﺬﻛﻮﺭ ﺃﻋﻼﻩ‬

‫‪Date‬‬ ‫ﺍﻟﺘﺎﺭﻳﺦ‬ ‫‪Signature‬‬ ‫ﺍﻟﺘﻮﻗﻴﻊ‬ ‫‪Name‬‬ ‫ﺍﻻﺳﻢ‬

‫اﻟﺒﻨﻚ اﻷهﻠﻲ اﻟﺴﻌﻮدي ﺷﺮﮐﺔ ﻣﺴﺎهﻤﺔ ﺳﻌﻮدﯾﺔ | رأس اﳌﺎل ‪ 44,780,000,000‬رﯾﺎل ﺳﻌﻮدي ﻣﺪﻓﻮع ﺑﺎﻟﮑﺎﻣﻞ | اﻟﺮﻗﻢ اﻟﻀﺮﯾﺒﻲ ‪ | 300002471110003‬س ‪ .‬ت ‪4030001588‬‬
‫‪18-HR-540‬‬

‫‪10/5‬‬ ‫ﺧﺎﺿﻌﺔ ﻹﺷﺮاف ورﻗﺎﺑﺔ اﻟﺒﻨﻚ اﳌﺮﮐﺰي اﻟﺴﻌﻮدي | ﻣﺮﺧﺺ ﻟﻬﺎ ﺑﻤﻮﺟﺐ اﻷﻣﺮ اﻟﺴﺎﻣﻲ رﻗﻢ ‪ 3737‬و ﺗﺎرﯾﺦ ‪ 1373/4/20‬هـ اﳌﻮاﻓﻖ ‪ 1953/12/26‬م‬
‫ﺑﺮج اﻟﺒﻨﻚ اﻷهﻠﻲ اﻟﺴﻌﻮدي ﻣﺮﮐﺰ اﳌﻠﻚ ﻋﺒﺪ اﷲ اﳌﺎﻟﻲ | ﻃﺮﯾﻖ اﳌﻠﻚ ﻓﻬﺪ | ﺣﻲ اﻟﻌﻘﯿﻖ | اﻟﺮﯾﺎض ‪13511‬‬
 ‫ﻧﻤﻮذج اﻟﺘﻌﺮﯾﻒ اﻟﺜﺎﻧﻲ )رﺟﺎل(‬

‫‪O‬‬ ‫‪B‬‬ ‫‪Date:‬‬ ‫ﺍﻟﺘﺎﺭﻳﺦ‪:‬‬

‫ﺃﻗﺮ ﺃﻧﺎ‬

‫ﺑﻤﻮﺟﺐ ﺑﻄﺎﻗﺔ ﺃﺣﻮﺍﻝ ﺭﻗﻢ‬

‫‪Y Y Y Y MM D D‬‬ ‫ﺑﺘﺎﺭﻳﺦ‬

‫ﺍﻟﺼﺎﺩﺭﺓ ﻣﻦ‬

‫ﺑﺄﻥ ﺍﻟﺴﻴﺪ‬

‫ﺍﻟﺬﻱ ﺗﻘﺪﻡ ﻟﻠﻌﻤﻞ ﻟﺪﻳﻜﻢ ﻣﻌﺮﻭﻑ ﻟﺪﻱ ﻭﻣﺴﺘﻌﺪ ﻹﺣﻀﺎﺭﻩ ﺃﻭ ﺍﻟﺪﻻﻟﺔ ﻋﻠﻰ ﻣﻜﺎﻥ ﺗﻮﺍﺟﺪﻩ ﻋﻨﺪ ﺍﻟﻄﻠﺐ ﻭﻋﻠﻰ ﻫﺬﺍ ﺃﻭﻗﻊ‪.‬‬

‫ﺍﻟﺘﻮﻗﻴﻊ‬

‫ﺍﻟﻤﻌﺮﻑ‬
‫ﻋﻨﻮﺍﻥ ُ‬

‫ﺍﻟﻤﺪﻳﻨﺔ‬

‫ﺍﻟﺤﻲ‬

‫ﺍﻟﺸﺎﺭﻉ‬

‫ﺭﻗﻢ ﺍﻟﺠﻮﺍﻝ‬

‫ﺭﻗﻢ ﺍﻟﻤﻨﺰﻝ‬

‫ﺻﻨﺪﻭﻕ ﺍﻟﺒﺮﻳﺪ‬

‫ﺍﻟﺮﻣﺰ ﺍﻟﺒﺮﻳﺪﻱ‬

‫ﻟﻠﻤﻌﺮﻑ ﺍﻟﺜﺎﻧﻲ‬
‫*ﻣﻼﺣﻈﺔ‪ :‬ﻳﺮﺟﻰ ﺇﺭﻓﺎﻕ ﺻﻮﺭﺓ ﻣﻦ ﺑﻄﺎﻗﺔ ﺍﻷﺣﻮﺍﻝ ُ‬

‫ﻟﻠﻤﻌﺮﻑ )ﺟﻬﺔ ﺍﻟﻌﻤﻞ – ﺍﻟﻌﻤﺪﺓ – ﺍﻟﺸﺮﻃﺔ(‬

‫ﺗﻌﺒﺄ ﻣﻦ ﺍﻟﺠﻬﺔ ﺍﻟﻤﺼﺎﺩﻗﺔ ُ‬
‫ﻧﺼﺎﺩﻕ ﻋﻠﻰ ﺻﺤﺔ ﺗﻮﻗﻴﻊ ﺍﻟﻤﺬﻛﻮﺭ ﺃﻋﻼﻩ‬

‫‪Date‬‬ ‫ﺍﻟﺘﺎﺭﻳﺦ‬ ‫‪Signature‬‬ ‫ﺍﻟﺘﻮﻗﻴﻊ‬ ‫‪Name‬‬ ‫ﺍﻻﺳﻢ‬

‫اﻟﺒﻨﻚ اﻷهﻠﻲ اﻟﺴﻌﻮدي ﺷﺮﮐﺔ ﻣﺴﺎهﻤﺔ ﺳﻌﻮدﯾﺔ | رأس اﳌﺎل ‪ 44,780,000,000‬رﯾﺎل ﺳﻌﻮدي ﻣﺪﻓﻮع ﺑﺎﻟﮑﺎﻣﻞ | اﻟﺮﻗﻢ اﻟﻀﺮﯾﺒﻲ ‪ | 300002471110003‬س ‪ .‬ت ‪4030001588‬‬
‫‪18-HR-540‬‬

‫‪10/6‬‬
‫ﺧﺎﺿﻌﺔ ﻹﺷﺮاف ورﻗﺎﺑﺔ اﻟﺒﻨﻚ اﳌﺮﮐﺰي اﻟﺴﻌﻮدي | ﻣﺮﺧﺺ ﻟﻬﺎ ﺑﻤﻮﺟﺐ اﻷﻣﺮ اﻟﺴﺎﻣﻲ رﻗﻢ ‪ 3737‬و ﺗﺎرﯾﺦ ‪ 1373/4/20‬هـ اﳌﻮاﻓﻖ ‪ 1953/12/26‬م‬
‫ﺑﺮج اﻟﺒﻨﻚ اﻷهﻠﻲ اﻟﺴﻌﻮدي ﻣﺮﮐﺰ اﳌﻠﻚ ﻋﺒﺪ اﷲ اﳌﺎﻟﻲ | ﻃﺮﯾﻖ اﳌﻠﻚ ﻓﻬﺪ | ﺣﻲ اﻟﻌﻘﯿﻖ | اﻟﺮﯾﺎض ‪13511‬‬
 (‫ﻧﻤﻮذج ﻓﺘﺢ ﺣﺴﺎب ﻣﻮﻇﻒ )رﺟﺎل‬
Employee Bank account opening Form (Male)

O B Date: :‫ﺍﻟﺘﺎﺭﻳﺦ‬

Conflict of interest ‫ﺗﻀﺎﺭﺏ ﺍﻟﻤﺼﺎﻟﺢ‬

Bank Account Opening Request at SNB Bank ‫ﻃﻠﺐ ﻓﺘﺢ ﺣﺴﺎﺏ ﻓﻲ ﺍﻟﺒﻨﻚ ﺍﻷﻫﻠﻲ ﺍﻟﺴﻌﻮﺩﻱ‬
Dear SNB Branch Network ‫ﺍﻟﺴﺎﺩﺓ ﺷﺒﻜﺔ ﻓﺮﻭﻉ ﺍﻟﺒﻨﻚ ﺍﻻﻫﻠﻲ ﺍﻟﺴﻌﻮﺩﻱ‬

Greetings ‫ﺑﻌﺪ ﺍﻟﺘﺤﻴﺔ‬

According to the above subject we kindly request you to open an account for ‫ﻭﻓﻘﺎً ﺇﻟﻰ ﺍﻟﻤﻮﺿﻮﻉ ﺃﻋﻼﻩ ﻳﺮﺟﻰ ﺍﻟﺘﻜﺮﻡ ﺑﻔﺘﺢ ﺣﺴﺎﺏ ﻣﺼﺮﻓﻲ‬

Mr ‫ﻟﻠﺴﻴﺪ‬

Please attached the international Bank Account Number (IBAN). Please note that the (IBAN) ‫ﻳﺮﺟﻰ ﺇﺭﻓﺎﻕ ﺭﻗﻢ ﺍﻟﺤﺴﺎﺏ ﺍﻟﻤﺼﺮﻓﻲ ﺍﻟﺪﻭﻟﻲ‬
account will be enclosed as a staff account based on the employee ID badge. ‫ﻋﻠﻤﺎً ﺑﺄﻥ ﻳﺘﻢ ﺗﺮﻣﻴﺰ ﺍﻟﺤﺴﺎﺏ ﻛﺤﺴﺎﺏ ﻣﻮﻇﻒ ﺑﻤﻮﺟﺐ ﺑﻄﺎﻗﺔ ﺍﻟﻌﻤﻞ‬
‫ﻭﻟﻜﻢ ﺗﺤﻴﺎﺗﻨﺎ‬
Best regards,
‫ﺩﺍﺋﺮﺓ ﺍﻟﺘﻮﻇﻴﻒ‬
Recruitment Department

SNB Branch Network Confirmation of the new Bank Account ‫ﺗﺄﻛﻴﺪ ﺷﺒﻜﺔ ﻓﺮﻭﻉ ﺍﻟﺒﻨﻚ ﺍﻷﻫﻠﻲ ﻋﻠﻰ ﺣﺴﺎﺏ ﻣﺼﺮﻓﻲ ﺟﺪﻳﺪ‬
Eear Recruitment Dept. ‫ﺍﻟﺴﺎﺩﺓ ﺩﺍﺋﺮﺓ ﺍﻟﺘﻮﻇﻴﻒ‬

Greetings ‫ﺑﻌﺪ ﺍﻟﺘﺤﻴﺔ‬

We would like to inform you that the bank account of the above mentioned employee is :‫ﻧﻔﻴﺪﻛﻢ ﺑﺄﻧﻪ ﺗﻢ ﻓﺘﺢ ﺣﺴﺎﺏ ﻣﻮﻇﻒ ﻟﻠﻤﺬﻛﻮﺭ ﺃﻋﻼﻩ ﺑﺮﻗﻢ ﺍﻟﺤﺴﺎﺏ ﺍﻟﺘﺎﻟﻲ‬
now open under:

Account number ‫ﺭﻗﻢ ﺍﻟﺤﺴﺎﺏ‬

Bank's stamp ‫ﺧﺘﻢ ﺍﻟﺒﻨﻚ‬

Customer service representative signature ‫ﺗﻮﻗﻴﻊ ﻣﺴﺆﻭﻝ ﺍﻟﺨﺪﻣﺔ‬

Customer service representative name ‫ﺍﺳﻢ ﻣﺴﺆﻭﻝ ﺍﻟﺨﺪﻣﺔ‬

Best regards, ‫ﻭﻟﻜﻢ ﺗﺤﻴﺎﺗﻨﺎ‬

SNB Branch Network: ‫ﺷﺒﻜﺔ ﻓﺮﻭﻉ ﺍﻟﺒﻨﻚ ﺍﻷﻫﻠﻲ ﺍﻟﺴﻌﻮﺩﻱ‬

AlAhliOnline Registration (To be filled by Account Holder) (‫ﺍﻟﺘﺴﺠﻴﻞ ﻓﻲ ﺍﻷﻫﻠﻲ ﺃﻭﻥ ﻻﻳﻦ )ﺗﻌﺒﺄ ﻣﻦ ﻗﺒﻞ ﺻﺎﺣﺐ ﺍﻟﺤﺴﺎﺏ‬
AlAhliOnline Username ‫ﺍﺳﻢ ﺍﻟﻤﺴﺘﺨﺪﻡ ﻓﻲ ﺍﻷﻫﻠﻲ ﺃﻭﻥ ﻻﻳﻦ‬

AlAhliOnline Registration Steps: :‫ﻃﺮﻳﻘﺔ ﺍﻟﺘﺴﺠﻴﻞ ﻓﻲ ﺍﻷﻫﻠﻲ ﺃﻭﻥ ﻻﻳﻦ‬

1. Visit www.ahahli.com www.alahli.com ‫ ﻗﻢ ﺑﺰﻳﺎﺭﺓ‬.١
2. Click o «User Login» and click on AlAhloOnline. ‫ ﺍﻧﻘﺮ ﻋﻠﻰ ”ﺩﺧﻮﻝ ﺍﻟﻤﺴﺘﺨﺪﻡ“ ﺛﻢ ﺍﻧﻘﺮ ﻋﻠﻰ ﺍﻷﻫﻠﻲ ﺃﻭﻥ ﻻﻳﻦ‬.٢
3. Click on «Still not Registered?» “‫ ﺍﻧﻘﺮ ﻋﻠﻰ ”ﻏﻴﺮ ﻣﺴﺠﻞ ﺑﻌﺪ‬.٣
“‫ ﻗﻢ ﺑﺈﺩﺧﺎﻝ ﺍﻟﻤﻌﻠﻮﻣﺎﺕ ﺍﻟﻤﻄﻠﻮﺑﺔ ﻋﻠﻰ ﺍﻟﺸﺎﺷﺔ ﺛﻢ ﺍﻧﻘﺮ ﻓﻮﻕ ”ﻣﻮﺍﻓﻖ‬.٤
4. Enter the required information displayed on the screen, then click «OK»
‫ ﻳﺮﺟﻰ ﺍﻻﺗﺼﺎﻝ ﺑﻤﻤﺜﻞ ﺧﺪﻣﺔ ﺍﻟﻌﻤﻼﺀ‬،‫ﻟﻤﺰﻳﺪ ﻣﻦ ﺍﻟﻤﻌﻠﻮﻣﺎﺕ‬
For further information, please contact the Customer Service representative or the toll free
number 9 2000 0895 9 2000 0895 ‫ﺃﻭ ﻋﻠﻰ ﺍﻟﺮﻗﻢ ﺍﻟﻤﺠﺎﻧﻲ‬

Authorization ‫ﺗﻔــــﻮﻳــﺾ‬
I, the undersigned hereby authorize the Human Resources Division of the Saudi National ‫ﺑﻬﺬﺍ ﺃﻓﻮﺽ ﺃﻧﺎ ﺍﻟﻤﻮﻗﻊ ﺍﺳﻤﻲ ﺃﺩﻧﺎﻩ ﺇﺩﺍﺭﺓ ﺍﻟﻤﻮﺍﺭﺩ ﺍﻟﺒﺸﺮﻳﺔ ﺑﺎﻟﺒﻨﻚ ﺍﻷﻫﻠﻲ ﺍﻟﺴﻌﻮﺩﻱ ﺑﻘﻴﺪ ﺻﺎﻓﻲ ﺭﻭﺍﺗﺒﻲ ﻭﻛﺎﻓﺔ‬
Bank to deposit the net salaries and all benefits in my account number ‫ﻣﺴﺘﺤﻘﺎﺗﻲ ﻓﻲ ﺣﺴﺎﺑﻲ ﺭﻗﻢ‬

Please write the account number and sign based on the authorization in the correct place ‫ﻳﺮﺟﻰ ﻛﺘﺎﺑﺔ ﺭﻗﻢ ﺍﻟﺤﺴﺎﺏ ﻭﺍﻟﺘﻮﻗﻴﻊ ﺑﻨﺎﺀ ﻋﻠﻰ ﺍﻟﺘﻔﻮﻳﺾ ﻓﻲ ﺍﻟﻤﻜﺎﻥ ﺍﻟﻤﺨﺼﺺ‬

Account number ‫ﺭﻗﻢ ﺍﻟﺤﺴﺎﺏ‬

Therefore I have signed this authorization ‫ﻭﻋﻠﻰ ﻫﺬﺍ ﺟﺮﻯ ﺍﻟﺘﻮﻗﻴﻊ‬

Date ‫ﺍﻟﺘﺎﺭﻳﺦ‬ Signature ‫ﺍﻟﺘﻮﻗﻴﻊ‬ Name ‫ﺍﻻﺳﻢ‬

4030001588 ‫ ت‬. ‫ | س‬300002471110003 ‫ رﯾﺎل ﺳﻌﻮدي ﻣﺪﻓﻮع ﺑﺎﻟﮑﺎﻣﻞ | اﻟﺮﻗﻢ اﻟﻀﺮﯾﺒﻲ‬44,780,000,000 ‫اﻟﺒﻨﻚ اﻷهﻠﻲ اﻟﺴﻌﻮدي ﺷﺮﮐﺔ ﻣﺴﺎهﻤﺔ ﺳﻌﻮدﯾﺔ | رأس اﳌﺎل‬
18-HR-540

10/7 ‫ م‬1953/12/26 ‫ هـ اﳌﻮاﻓﻖ‬1373/4/20 ‫ و ﺗﺎرﯾﺦ‬3737 ‫ﺧﺎﺿﻌﺔ ﻹﺷﺮاف ورﻗﺎﺑﺔ اﻟﺒﻨﻚ اﳌﺮﮐﺰي اﻟﺴﻌﻮدي | ﻣﺮﺧﺺ ﻟﻬﺎ ﺑﻤﻮﺟﺐ اﻷﻣﺮ اﻟﺴﺎﻣﻲ رﻗﻢ‬
13511 ‫ﺑﺮج اﻟﺒﻨﻚ اﻷهﻠﻲ اﻟﺴﻌﻮدي ﻣﺮﮐﺰ اﳌﻠﻚ ﻋﺒﺪ اﷲ اﳌﺎﻟﻲ | ﻃﺮﯾﻖ اﳌﻠﻚ ﻓﻬﺪ | ﺣﻲ اﻟﻌﻘﯿﻖ | اﻟﺮﯾﺎض‬
 ‫اﻟﮑﺸﻒ اﻟﻄﺒﻲ ﻟﻠﺘﻮﻇﯿﻒ )رﺟﺎل(‬
‫)‪Medical check up for employment (Male‬‬

‫‪O‬‬ ‫‪B‬‬ ‫‪Date:‬‬ ‫ﺍﻟﺘﺎﺭﻳﺦ‪:‬‬

‫ﻳﺮﺟﻰ ﺇﺭﻓﺎﻕ ﺻﻮﺭﺓ‬ ‫ﻳـــــﺮﺟــــــﻰ ﺍﻟﺘــــﺄﻛــﺪ ﻣﻦ ﺧـــﺘـــﻢ ﺍﻟﻤـﺴـــﺘﺸـــﻔــــﻰ ﻋﻠـــﻰ ﺍﻟﺼـــــﻮﺭﺓ‬ ‫‪Hospital Name‬‬ ‫ﺍﺳﻢ ﺍﻟﻤﺴﺘﺸﻔﻰ‬
‫ﺷﺨﺼﻴﺔ ﻫﻨﺎ‬
‫‪Make sure to get official hospital stamp on the picture‬‬
‫‪Please attach‬‬
‫‪Recent Photo‬‬ ‫‪Sex‬‬ ‫ﻧﻮﻉ ﺍﻟﺠﻨﺲ‬ ‫‪Nationality‬‬ ‫ﺍﻟﺠﻨﺴﻴﺔ‬ ‫‪Name‬‬ ‫ﺍﻻﺳﻢ‬
‫‪Here 33.5cm‬‬

‫‪Physical Examination‬‬ ‫ﺍﻟﻔﺤﺺ ﺍﻟﻄﺒﻲ‬

‫‪Examination Type‬‬ ‫‪Signature‬‬ ‫ﺍﻟﺘﻮﻗﻴﻊ‬ ‫‪Result‬‬ ‫ﺍﻟﻨﺘﻴﺠﺔ‬ ‫ﻧﻮﻉ ﺍﻟﻔﺤﺺ‬

‫‪E.N.T Consultation‬‬ ‫ﻓﺤﺺ ﺃﻧﻒ ﻭﺃﺫﻥ ﻭﺣﻨﺠﺮﺓ‬

‫‪Ideogram‬‬ ‫ﺭﺳﻢ ﺍﻟﺴﻤﻊ‬

‫‪Medical Consultation‬‬ ‫ﺍﻟﻔﺤﺺ ﺍﻟﺒﺎﻃﻨﻲ‬

‫‪Surgery Consultation‬‬ ‫ﻓﺤﺺ ﺍﻟﺠﺮﺍﺣﺔ‬

‫‪Vision Acuity External Exam‬‬ ‫‪RT‬‬ ‫‪RT‬‬ ‫ﻓﺤﺺ ﺍﻟﻌﻴﻮﻥ‬

‫‪LT‬‬ ‫‪LT‬‬

‫‪Cardiac Consultation‬‬ ‫ﻓﺤﺺ ﺍﻟﻘﻠﺐ‬

‫‪Investigation‬‬ ‫ﺍﻷﺑﺤﺎﺙ‬
‫‪Investigation Type‬‬ ‫‪Signature‬‬ ‫ﺍﻟﺘﻮﻗﻴﻊ‬ ‫‪Result‬‬ ‫ﺍﻟﻨﺘﻴﺠﺔ‬ ‫ﻧﻮﻉ ﺍﻟﺒﺤﺚ‬

‫‪Urine‬‬ ‫ﻓﺤﺺ ﺍﻟﺒﻮﻝ‬

‫‪ABO RH‬‬ ‫ﻓﺤﺺ ﺍﻟﺪﻡ‬

‫‪H.I.V‬‬ ‫ﺍﺧﺘﺒﺎﺭ ﺍﻻﻳﺪﺯ‬

‫‪HBS - AG‬‬ ‫ﺍﻟﻔﻴﺮﻭﺱ ﺍﻟﻜﺒﺪﻱ ‪ -‬ﺏ‬

‫‪HCV –AB‬‬ ‫ﺍﻟﻔﻴﺮﻭﺱ ﺍﻟﻜﺒﺪﻱ – ﺳﻲ‬

‫‪X-ray -Chest‬‬ ‫ﺃﺷﻌﺔ ﻋﻠﻰ ﺍﻟﺼﺪﺭ‬

‫‪Conclusion‬‬ ‫ﺍﻟﻨﺘﻴﺠﺔ‬
‫‪Fit to work‬‬ ‫ﻻﺋﻖ ﻟﻠﻌﻤﻞ‬

‫‪Unfit to work – Reason‬‬ ‫ﻏﻴﺮ ﻻﺋﻖ ﻟﻠﻌﻤﻞ – ﺍﻟﺴﺒﺐ‬

‫‪Recommendations‬‬ ‫ﺍﻟﺘﻮﺻﻴﺎﺕ‬

‫‪SNB Medical Clinic‬‬ ‫ﺍﻟﻌﻴﺎﺩﺓ ﺍﻟﻄﺒﻴﺔ ﺑﺎﻟﺒﻨﻚ‬ ‫‪Signed by medical director of the hospital‬‬ ‫ﺗﻮﻗﻴﻊ ﺍﻟﻤﺪﻳﺮ ﺍﻟﻄﺒﻲ ﺑﺎﻟﻤﺴﺘﺸﻔﻰ‬

‫اﻟﺒﻨﻚ اﻷهﻠﻲ اﻟﺴﻌﻮدي ﺷﺮﮐﺔ ﻣﺴﺎهﻤﺔ ﺳﻌﻮدﯾﺔ | رأس اﳌﺎل ‪ 44,780,000,000‬رﯾﺎل ﺳﻌﻮدي ﻣﺪﻓﻮع ﺑﺎﻟﮑﺎﻣﻞ | اﻟﺮﻗﻢ اﻟﻀﺮﯾﺒﻲ ‪ | 300002471110003‬س ‪ .‬ت ‪4030001588‬‬
‫‪18-HR-540‬‬

‫ﺧﺎﺿﻌﺔ ﻹﺷﺮاف ورﻗﺎﺑﺔ اﻟﺒﻨﻚ اﳌﺮﮐﺰي اﻟﺴﻌﻮدي | ﻣﺮﺧﺺ ﻟﻬﺎ ﺑﻤﻮﺟﺐ اﻷﻣﺮ اﻟﺴﺎﻣﻲ رﻗﻢ ‪ 3737‬و ﺗﺎرﯾﺦ ‪ 1373/4/20‬هـ اﳌﻮاﻓﻖ ‪ 1953/12/26‬م‬
‫‪10/8‬‬
‫ﺑﺮج اﻟﺒﻨﻚ اﻷهﻠﻲ اﻟﺴﻌﻮدي ﻣﺮﮐﺰ اﳌﻠﻚ ﻋﺒﺪ اﷲ اﳌﺎﻟﻲ | ﻃﺮﯾﻖ اﳌﻠﻚ ﻓﻬﺪ | ﺣﻲ اﻟﻌﻘﯿﻖ | اﻟﺮﯾﺎض ‪13511‬‬
 SNB Pre-employment & IQAMA Test Authorization Form

To be completed by SNB

Staff ID Identity ID Name

Type of Referral (please check)

Pre-employment IQAMA

Instruction for Pre-employment test Instruction for IQAMA

Please provide Pre-employment medical check-up for the above mentioned name Please provide IQAMA test for the above mentioned name from the Saudi National
from the Saudi National Bank. Bank.

The hospital should verify the candidates identity, the attached form should be filled The hospital should verify the candidates identity, the attached form should be filled
by the hospital, both the form and candidate's photo should be stamped, placed in a by the hospital, both the form and candidate's photo should be stamped, placed in a
sealed and stamped envelope, and to be handed to the candidate. sealed and stamped envelope, and to be forwarded to the following designated HR
representative

Provider Name Region Practice Province City District Address Trunkline ‫ﺍﻟﻌﻨﻮﺍﻥ‬ ‫ﺍﻟﻤﺪﻳﻨﺔ‬ ‫ﺍﻟﻤﻨﻄﻘﺔ‬ ‫ﺍﺳﻢ ﻣﻘﺪﻡ ﺍﻟﺨﺪﻣﺔ‬
Type

Al Mohamadyyeh Prince sultan

My Clinic West Polyclinic Makkah Jeddah 920022811 ‫ﺷﺎﺭﻉ ﺍﻻﻣﻴﺮ ﺳﻠﻄﺎﻥ‬ ‫ﺍﻟﻤﺤﻤﺪﻳﺔ‬ ‫ﺟﺪﺓ‬ ‫ﻋﻴﺎﺩﺗﻲ‬
Dist road

Al Mana Eastern Ar Rakah Al Janubiyah, Ar Rakah Al Janubiyah, ،‫ﺍﻟﺮﺍﻛﺔ ﺍﻟﺠﻨﻮﺑﻴﺔ‬ ‫ﺍﻟﺨﺒﺮ‬

East Hospital Khobar 920033440 ‫ﺍﻟﺨﺒﺮ‬ ‫ﻣﺴﺘﺸﻔﻰ ﺍﻟﻤﺎﻧﻊ ﺍﻟﻌﺎﻡ‬
General Hospital Province Al Khobar 34226 Al Khobar 34226 34226 ‫ﺍﻟﺨﺒﺮ‬ ‫ﺍﻟﺸﻤﺎﻟﻴﺔ‬
‫ﻣﻴﺪﺍﻥ ﺍﻟﻘﺎﻫﺮﺓ ﺗﻘﺎﻃﻊ‬
Specialized Medica Central King fahad ‫ﺍﻟﻌﻠﻴﺎ‬ ‫ﺍﻟﺮﻳﺎﺽ‬ ‫ﻣﺴﺘﺸﻔﻰ ﺍﻟﻤﺮﻛﺰ‬
Hospital Riyadh Riyadh Al Warood 114164000 ‫ﻃﺮﻳﻖ ﺍﻟﻤﻠﻚ ﻓﻬﺪ‬
Center & Hospital branch road ‫ﺍﻟﺘﺨﺼﺼﻲ ﺍﻟﻄﺒﻲ‬
‫ﻣﻊ ﻃﺮﻳﻖ ﻣﻜﺔ‬

Billing
A copy of this letter and result of the Pre-Employment/ IQAMA Test Should be attached to the invoice and forwarded to Bupa as part of your monthly claims submission.

Contacts
If you require further clarification please contact our call center at 920009612

920009612 www.bupa.com.sa

4030001588 ‫ ت‬. ‫ | س‬300002471110003 ‫ رﯾﺎل ﺳﻌﻮدي ﻣﺪﻓﻮع ﺑﺎﻟﮑﺎﻣﻞ | اﻟﺮﻗﻢ اﻟﻀﺮﯾﺒﻲ‬44,780,000,000 ‫اﻟﺒﻨﻚ اﻷهﻠﻲ اﻟﺴﻌﻮدي ﺷﺮﮐﺔ ﻣﺴﺎهﻤﺔ ﺳﻌﻮدﯾﺔ | رأس اﳌﺎل‬
18-HR-540

10/9 ‫ م‬1953/12/26 ‫ هـ اﳌﻮاﻓﻖ‬1373/4/20 ‫ و ﺗﺎرﯾﺦ‬3737 ‫ﺧﺎﺿﻌﺔ ﻹﺷﺮاف ورﻗﺎﺑﺔ اﻟﺒﻨﻚ اﳌﺮﮐﺰي اﻟﺴﻌﻮدي | ﻣﺮﺧﺺ ﻟﻬﺎ ﺑﻤﻮﺟﺐ اﻷﻣﺮ اﻟﺴﺎﻣﻲ رﻗﻢ‬
13511 ‫ﺑﺮج اﻟﺒﻨﻚ اﻷهﻠﻲ اﻟﺴﻌﻮدي ﻣﺮﮐﺰ اﳌﻠﻚ ﻋﺒﺪ اﷲ اﳌﺎﻟﻲ | ﻃﺮﯾﻖ اﳌﻠﻚ ﻓﻬﺪ | ﺣﻲ اﻟﻌﻘﯿﻖ | اﻟﺮﯾﺎض‬
 ‫ﻧﻤﻮذج اﻟﺘﺤﻘﻖ اﻟﻮﻇﯿﻔﻲ‬
Job Verification Form

‫ﺑﻨﺎ ًﺀ ﻋﻠﻰ ﺗﻌﻠﻴﻤﺎﺕ ﻭﺃﻧﻈﻤﺔ ﺍﻟﺒﻨﻚ ﺍﻟﻤﺮﻛﺰﻱ ﺍﻟﺴﻌﻮﺩﻱ ﻳﺮﺟﻰ ﻣﻨﻜﻢ ﺗﻌﺒﺌﺔ ﺍﻟﻨﻤﻮﺫﺝ‬
On the instructions and regulations of the Saudi Central Bank, please ll out the form

Employee Data

Employee Name

Nationality

Mobile number

ID Number

Previous Employer Data

Name of previous employer before

The Saudi National Bank ‫ﺍﻟﺴﻌﻮﺩﻱ‬

Job title previously before The

Saudi National Bank ‫ﺍﻟﺴﻌﻮﺩﻱ‬

Reasons for leaving the previous job

before The Saudi National Bank ‫ﺍﻟﺴﻌﻮﺩﻱ‬

Name of your direct manager before

The Saudi National Bank ‫ﺍﻟﺴﻌﻮﺩﻱ‬

Job title of the direct manager before

The Saudi National Bank ‫ﺍﻟﺴﻌﻮﺩﻱ‬

Mobile for manager before The

Saudi National Bank ‫ﺍﻟﺴﻌﻮﺩﻱ‬

Employee signature on data

‫ﺍﻟﺴﻌﻮﺩﻱ‬
Use of Recruitment and Development Management at The Saudi National Bank

Name

Notes

Action

Signature

All elds are mandatory

4030001588 ‫ ت‬. ‫ | س‬300002471110003 ‫ رﯾﺎل ﺳﻌﻮدي ﻣﺪﻓﻮع ﺑﺎﻟﮑﺎﻣﻞ | اﻟﺮﻗﻢ اﻟﻀﺮﯾﺒﻲ‬44,780,000,000 ‫اﻟﺒﻨﻚ اﻷهﻠﻲ اﻟﺴﻌﻮدي ﺷﺮﮐﺔ ﻣﺴﺎهﻤﺔ ﺳﻌﻮدﯾﺔ | رأس اﳌﺎل‬
18-HR-540

10/10 ‫ م‬1953/12/26 ‫ هـ اﳌﻮاﻓﻖ‬1373/4/20 ‫ و ﺗﺎرﯾﺦ‬3737 ‫ﺧﺎﺿﻌﺔ ﻹﺷﺮاف ورﻗﺎﺑﺔ اﻟﺒﻨﻚ اﳌﺮﮐﺰي اﻟﺴﻌﻮدي | ﻣﺮﺧﺺ ﻟﻬﺎ ﺑﻤﻮﺟﺐ اﻷﻣﺮ اﻟﺴﺎﻣﻲ رﻗﻢ‬
13511 ‫ﺑﺮج اﻟﺒﻨﻚ اﻷهﻠﻲ اﻟﺴﻌﻮدي ﻣﺮﮐﺰ اﳌﻠﻚ ﻋﺒﺪ اﷲ اﳌﺎﻟﻲ | ﻃﺮﯾﻖ اﳌﻠﻚ ﻓﻬﺪ | ﺣﻲ اﻟﻌﻘﯿﻖ | اﻟﺮﯾﺎض‬