‫قــدوم‬

‫ﺗﺴﺠﯿﻞ زاﺋﺮ ﻣﺤﺼﻦ‬ ‫منصة‬

Vaccinated Visitor Registration

Main Data ‫اﻟﺒﯿﺎﻧﺎت اﻟﺮﺋﯿﺴﯿﺔ‬

‫اﻻﺳﻢ‬
MUHAMMAD SHIHABUDIN AHMED Name
‫ﺗﺎرﯾﺦ اﳌﯿﻼد‬ ‫اﻟﺠﻨﺴﯿﺔ‬
20/06/1997 Birthdate INDIAN Nationality
‫رﻗﻢ اﻟﺠﻮاز‬ ‫رﻗﻢ اﻟﺘﺄﺷﯿﺮة‬
U4705336 PassportNumber 6073781085 VisaNumber

Arrival Details ‫ﺑﯿﺎﻧﺎت اﻟﻮﺻﻮل‬

‫ﺑﺤﺮﴽ‬ By Sea ‫ﺑـﺮﴽ‬ Overland ‫ﺟﻮﴽ‬ By Air ‫ﻃﺮﯾﻘﺔ اﻟﻮﺻﻮل‬

Arrival Type
‫رﻗﻢ اﻟﺮﺣﻠﺔ‬ ‫اﻟﺨﻄﻮط اﻟﻨﺎﻗﻠﺔ‬
Flight Number Airlines
‫ﺗﺎرﯾﺦ اﻟﻮﺻﻮل‬ ‫ﻣﺤﻄﺔ اﻟﻮﺻﻮل‬
06/10/2021 Arrival Date GHUWAIFAT Arrival Destination

Doses Details ‫ﺑﺒﯿﺎﻧﺎت اﻟﺠﺮﻋﺎت‬

3 2 1 ‫ﻋﺪد اﻟﺠﺮﻋﺎت‬
Vacination Doses Count
‫ﻧﻮع اﻟﻠﻘﺎح‬
Covishield/Oxford-AstraZeneca Vaccine Type
‫ﺗﺎرﯾﺦ اﻟﺠﺮﻋﺔ‬ ‫اﻟﺠﺮﻋﺔ اﻷوﻟﯽ‬
09/06/2021 Does Date First Dose Details
‫دوﻟﺔ اﻟﺠﺮﻋﺔ‬
INDIA Dose Country

‫ﻧﻮع اﻟﻠﻘﺎح‬
Covishield/Oxford-AstraZeneca Vaccine Type
‫ﺗﺎرﯾﺦ اﻟﺠﺮﻋﺔ‬ ‫اﻟﺠﺮﻋﺔ اﻟﺜﺎﻧﯿﺔ‬
30/07/2021 Does Date Second Dose Details
‫دوﻟﺔ اﻟﺠﺮﻋﺔ‬
INDIA Dose Country

‫ﻧﻮع اﻟﻠﻘﺎح‬
Vaccine Type
‫ﺗﺎرﯾﺦ اﻟﺠﺮﻋﺔ‬ ‫اﻟﺠﺮﻋﺔ اﻟﺜﺎﻟﺜﺔ‬
Does Date Third Dose Details
‫دوﻟﺔ اﻟﺠﺮﻋﺔ‬
Dose Country

For official use ‫ﻟﻼﺳﺘﻌﻤﺎل اﻟﺮﺳﻤﻲ‬

‫ﺗﺼﺪﯾﻖ اﻟﺠﻬﺔ اﻟﻄﺎﻟﺒﺔ @ ﻣﻄﺎﺑﻘﺔ اﻟﺠﺮﻋﺎت اﳌﺴﺠﻠﺔ‬

……………………………………………………………………………………………………….. : ‫اﻟﺠﻬﺔ‬

……………………………………………………………………………………………………….. : ‫اﻻﺳﻢ‬

…………………………………………………………………………………………………….. : ‫اﻟﺘﻮﻗﯿﻊ‬
‫اﻟﺨﺘﻢ‬