‫‪884303359127‬‬

‫ﻃﻠﺐ ﺗﻘﺮﻳﺮ ﻣﻘﻴﻢ‬

‫‪Passport Number‬‬ ‫‪EP3485846‬‬ ‫ﺭﻗﻢ ﺍﻟﺠﻮﺍﺯ‬ ‫ﺍﻻﺳﻢ ﺑﺎﻟﻌﺮﺑﻴﺔ‬

‫‪Passport Issuance Place‬‬ ‫‪113‬‬ ‫ﻣﻜﺎﻥ ﺇﺻﺪﺍﺭ ﺍﻟﺠﻮﺍﺯ‬ ‫ﺳﻤﻴﺮﺓ ﺍﺑﺎﺯﻳﻨﺐ ﺣﺎﺟﻲ‬
‫‪Passport Issuance Date‬‬ ‫‪1436/05/12‬‬ ‫ﺗﺎﺭﻳﺦ ﺇﺻﺪﺍﺭ ﺍﻟﺠﻮﺍﺯ‬ ‫‪Name in English‬‬
‫‪Passport Expiry Date‬‬ ‫‪1441/06/16‬‬ ‫ﺗﺎﺭﻳﺦ ﺍﻧﺘﻬﺎﺀ ﺍﻟﺠﻮﺍﺯ‬ ‫‪SEMIRA ABAZINAB HAJI‬‬
‫‪Passport Status‬‬ ‫ﺍﺳﺘﺒﺪﺍﻝ‬ ‫ﺣﺎﻟﺔ ﺍﻟﺠﻮﺍﺯ‬
‫‪Iqama Number‬‬ ‫‪2338703743‬‬ ‫ﺭﻗﻢ ﺍﻹﻗﺎﻣﺔ‬
‫‪Visa Expiry Date‬‬ ‫‪1441/03/27‬‬ ‫ﺗﺎﺭﻳﺦ ﺍﻧﺘﻬﺎﺀ ﺍﻟﺘﺄﺷﻴﺮﺓ‬
‫‪Iqama Version‬‬ ‫‪4‬‬ ‫ﻧﺴﺨﺔ ﺍﻹﻗﺎﻣﺔ‬
‫‪Visa Issuance Place‬‬ ‫ﺑﻮﺍﺑﺔ ﺍﻟﻮﺯﺍﺭﺓ‬ ‫ﻣﻜﺎﻥ ﺇﺻﺪﺍﺭ ﺍﻟﺘﺄﺷﻴﺮﺓ‬
‫‪Iqama Expiry Date‬‬ ‫‪1442/06/29‬‬ ‫ﺗﺎﺭﻳﺦ ﺍﻧﺘﻬﺎﺀ ﺍﻹﻗﺎﻣﺔ‬
‫‪Date of Last Exit‬‬ ‫‪28/05/2019‬‬ ‫ﺗﺎﺭﻳﺦ ﺁﺧﺮ ﺧﺮﻭﺝ‬
‫‪Iqama Issuance Date‬‬ ‫‪1434/04/02‬‬ ‫ﺗﺎﺭﻳﺦ ﺇﺻﺪﺍﺭ ﺍﻹﻗﺎﻣﺔ‬
‫‪Health Insurance Information‬‬
‫‪Occupation‬‬ ‫ﻋﺎﻣﻠﺔ ﻣﻨﺰﻟﻴﺔ‬ ‫ﺍﻟﻤﻬﻨﺔ‬
‫‪Health Insurance‬‬ ‫‪-‬‬ ‫ﺗﺎﺭﻳﺦ ﺍﻧﺘﻬﺎﺀ‬
‫‪Marital Status‬‬ ‫ﻣﺘﺰﻭﺟﺔ‬ ‫ﺍﻟﺤﺎﻟﺔ ﺍﻻﺟﺘﻤﺎﻋﻴﺔ‬
‫‪Expiry Date‬‬ ‫ﺍﻟﺘﺄﻣﻴﻦ ﺍﻟﺼﺤﻲ‬
‫‪Nationality‬‬ ‫ﺍﺛﻴﻮﺑﻴﺎ‬ ‫ﺍﻟﺠﻨﺴﻴﺔ‬
‫‪Vehicles Information‬‬
‫‪Blood Type‬‬ ‫‪-‬‬ ‫ﻓﺼﻴﻠﺔ ﺍﻟﺪﻡ‬
‫‪Number of Vehicles‬‬ ‫‪0‬‬ ‫ﻋﺪﺩ ﺍﻟﻤﺮﻛﺒﺎﺕ‬
‫‪Traffic Violations Number‬‬ ‫‪0‬‬ ‫ﻋﺪﺩ ﺍﻟﻤﺨﺎﻟﻔﺎﺕ ﺍﻟﻤﺮﻭﺭﻳﺔ‬ ‫‪Place of Birth‬‬ ‫ﺍﺛﻴﻮﺑﻴﺎ‬ ‫ﻣﻜﺎﻥ ﺍﻟﻤﻴﻼﺩ‬
‫‪Number of Licenses‬‬ ‫‪0‬‬ ‫ﻋﺪﺩ ﺭﺧﺺ ﺍﻟﻘﻴﺎﺩﺓ‬ ‫‪Date of Birth‬‬ ‫‪11/09/1988‬‬ ‫ﺗﺎﺭﻳﺦ ﺍﻟﻤﻴﻼﺩ‬

‫‪Hajj Information‬‬
‫‪Iqama Issuance Place‬‬ ‫ﺝ ﺍﻟﺼﻴﺮﻓﻲ ﺑﺠﺪﺓ‬ ‫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 ‫‪1053483960‬‬ ‫ﺭﻗﻢ ﻫﻮﻳﺔ ﺍﻟﻜﻔﻴﻞ‬ ‫?‪Is there a finger print‬‬ ‫✘‬ ‫‪Yes‬‬ ‫ال ‪No‬‬ ‫ﻧﻌﻢ‬ ‫✘‬ ‫ﻫﻞ ﺗﻮﺟﺪ ﺑﺼﻤﺔ؟‬

‫‪Sponsor Name‬‬ ‫ﺍﺳﻢ ﺍﻟﻜﻔﻴﻞ‬ ‫‪No. of Sponsorship Transfers‬‬ ‫‪0‬‬ ‫ﻋﺪﺩ ﻣﺮﺍﺕ ﻧﻘﻞ ﺍﻟﻜﻔﺎﻟﺔ‬

‫ﺣﺴﻦ ﻋﺒﺪﻩ ﻋﻠﻲ ﺻﻌﺐ‬

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

‫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

‫‪Family Members‬‬

‫‪Number of Family Members‬‬ ‫‪0‬‬ ‫ﻋﺪﺩ ﺃﻓﺮﺍﺩ ﺍﻷﺳﺮﺓ‬

‫‪Family Members Inside‬‬ ‫‪0‬‬ ‫ﻋﺪﺩ ﺃﻓﺮﺍﺩ ﺍﻷﺳﺮﺓ ﺩﺍﺧﻞ ﺍﻟﻤﻤﻠﻜﺔ‬

‫‪Family Members Outside‬‬ ‫‪0‬‬ ‫ﻋﺪﺩ ﺃﻓﺮﺍﺩ ﺍﻷﺳﺮﺓ ﺧﺎﺭﺝ ﺍﻟﻤﻤﻠﻜﺔ‬

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

‫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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