‫ﺗﺴﺠﻴﻞ ﺍﻟﻘﺪﻭﻡ‬

Arrival Registration

Name SITI KARTIKA PUTRI ‫ﺍﻻﺳﻢ‬

Passport Number C6336788 ‫ﺭﻗﻢ ﺍﻟﺠﻮﺍﺯ‬

Birthdate 1990-04-06 ‫ﺗﺎﺭﻳﺦ ﺍﻟﻤﻴﻼﺩ‬

Visa Number 6076588571 ‫ﺭﻗﻢ ﺍﻟﺘﺄﺷﻴﺮﺓ‬

Nationality Indonesia ‫ﺍﻧﺪﻭﻧﻴﺴﻴﺎ‬ ‫ﺍﻟﺠﻨﺴﻴﺔ‬

Departure Country Indonesia ‫ﺍﻧﺪﻭﻧﻴﺴﻴﺎ‬ ‫ﺑﻠﺪ ﺍﻟﻤﻐﺎﺩﺭﺓ‬

Registration Number GDP2559682783 ‫ﺭﻗﻢ ﺍﻟﺘﺴﺠﻴﻞ‬

Registration Date 2022-05-25 ‫ﺗﺎﺭﻳﺦ ﺍﻟﺘﺴﺠﻴﻞ‬

Vaccine Country Saudi Arabia ‫ﺍﻟﻌﺮﺑﻴﺔ ﺍﻟﺴﻌﻮﺩﻳﺔ‬ ‫ﺩﻭﻟﺔ ﺍﻟﺘﺤﺼﻴﻦ‬

‫ﺃﺳﺘﺮﺍﺯﻳﻨﻴﻜﺎ ﻭﺟﺮﻋﺔ ﻭﺍﺣﺪﺓ ﻣﻦ ﻟﻘﺎﺡ ﻣﻮﺩﻳﺮﻧﺎ‬-‫ﺟﺮﻋﺔ ﻭﺍﺣﺪﺓ ﻣﻦ ﻟﻘﺎﺡ ﺃﻭﻛﺴﻔﻮﺭﺩ‬

Vaccine Type ‫ﻧﻮﻉ ﺍﻟﺘﺤﺼﻴﻦ‬
One dose of Oxford–AstraZeneca Vaccine and one dose of
Moderna Vaccine

First Dose Date 2021-10-07 ‫ﺗﺎﺭﻳﺦ ﺍﻟﺠﺮﻋﺔ ﺍﻷﻭﻟﻰ‬

Second Dose Date 2021-11-02 ‫ﺗﺎﺭﻳﺦ ﺍﻟﺠﺮﻋﺔ ﺍﻟﺜﺎﻧﻴﺔ‬

Valid Until Date 2022-06-01 ‫ﺻﺎﻟﺢ ﺣﺘﻰ ﺗﺎﺭﻳﺦ‬

‫ ﺃﻗﺮ ﺑﺼﺤﺔ ﺍﻟﻤﻌﻠﻮﻣﺎﺕ ﺍﻟﻤﺪﺧﻠﺔ ﻭﺃﻧﻪ ﺳﻴﺘﻢ ﺍﻟﺘﺤﻘﻖ ﻣﻦ ﺻﺤﺔ ﺍﻟﻤﻌﻠﻮﻣﺎﺕ ﻋﻨﺪ ﺍﺻﺪﺍﺭ ﻛﺮﺕ ﺻﻌﻮﺩ ﺍﻟﻄﺎﺋﺮﺓ ﻭﻓﻲ ﻣﻨﺎﻓﺬ ﺍﻟﺪﺧﻮﻝ ﻭﻋﺪﻡ ﺍﻻﻟﺘﺰﺍﻡ ﺑﻬﺬﻩ ﺍﻻﺷﺘﺮﺍﻃﺎﺕ ﺗﺠﻌﻠﻨﻲ ﻋﺮﺿﻪ‬-
.‫ﻟﻤﻨﻊ ﺍﻟﺪﺧﻮﻝ ﺍﻟﻰ ﺍﻟﻤﻤﻠﻜﺔ ﺍﻟﻌﺮﺑﻴﺔ ﺍﻟﺴﻌﻮﺩﻳﺔ ﻭﺍﻟﺘﺒﻌﺎﺕ ﺍﻟﻘﺎﻧﻮﻧﻴﺔ‬

.(‫ ﻳﺸﺘﺮﻁ ﺣﻤﻞ ﺷﻬﺎﺩﺓ ﻭﺭﻗﻴﺔ ﻣﻌﺘﻤﺪﺓ ﻹﺛﺒﺎﺕ ﺃﺧﺬ ﺍﻟﻠﻘﺎﺡ ﻣﺼﺪﻗﺔ ﻣﻦ ﺍﻟﺠﻬﺎﺕ ﺍﻟﺼﺤﻴﺔ ﺍﻟﺮﺳﻤﻴﺔ ﻓﻲ ﺑﻼﺩ ﺍﻟﻤﺴﺎﻓﺮﻳﻦ ﺍﻟﻘﺎﺩﻣﻴﻦ )ﻭﺯﺍﺭﺓ ﺍﻟﺼﺤﺔ ﺍﻭ ﺟﻬﺔ ﺻﺤﻴﺔ ﻣﺨﻮﻟﺔ‬-

- I acknowledge that the entered information is correct and that the information will be verified when the boarding pass is issued and at the ports
of entry, and the failure to comply with these requirements makes me open to preventing entry to the Kingdom of Saudi Arabia and the legal

- It is required to carry an approved paper certificate to prove the vaccination, certified by the official health authorities in the countries of arriving
travelers (the Ministry of Health or an authorized health authority).