Applicant’s

2”X2”
Photograph
PHILIPPINE CONSULATE GENERAL (2 pieces)
JEDDAH, KINGDOM OF SAUDI ARABIA

APPLICATION FOR ENDORSEMENT CERTIFICATE FOR SAUDI POLICE CLEARANCE

FOR FILIPINOS IN JEDDAH AND THE WESTERN REGION
(includes Makkah, Madinah, Asir, Abha, Al Baha, Khamis Mushayt, Gizan, Rabigh, Taif and Yanbu)

Date _______________________
Personal Information
Full Name _________________________________________________________________________________
Sex:  Male  Female Civil Status: Single Married Widow/er Legally Separated Annulled
Philippine Address ________________________________________________________________________
Telephone No. ____________________________ Mobile No. _____________________________________
KSA Address ____________________________________________________________________________
Telephone No. ____________________________ Mobile No. _____________________________________
Email Address ____________________________________________________________________________
d
Passport Details
Passport Number __________________________
Place of Issue ______________________________
Date of Issue _______________________________
Valid Until _________________________________

Iqama Details
Iqama Number _____________________________
Place of Issue ______________________________
Date of Issue _______________________________
Valid Until _________________________________

Work Information
Name of Employer _______________________________________________________________________
Address _______________________________________________________________________________
Telephone No. __________________________________ Fax _______________________________________
Purpose of Request
Country of Destination _______________________________________________________________________
Kind of Visa Requested from Country of Destination
 Work  Immigration  Visit  Citizenship Acquisition  Others _________________________

___________________________________
Signature of Applicant
Doc. no. : __________
Service no. : __________
Series of : __________
*Please attach a photocopy of your valid Philippine Passport and Iqama
O.R. no. : __________