‫و ﺛ ﯿﻘ ـ ـ ـ ـ ـ ـ ﺔ ﺗ ﻌ ـ ـ ـ ـ ـ ـ ﺎ ر ف‬

‫‪INTRODUCTORY STATEMENT‬‬

‫‪Personal Information :‬‬ ‫اﻟﺒﯿـــﺎﻧــــﺎت اﻟﺸﺨﺼﯿــــــﺔ‪:‬‬

‫‪Statement No.‬‬ ‫رﻗﻢ اﻟﻮﺛﯿﻘـــﺔ‬

‫‪Relgious Sect‬‬ ‫‪sunni‬‬ ‫اﻟﻤـــــــــــﺬ ھــــــﺐ‬ ‫‪Full Name‬‬ ‫‪Azamat‬‬ ‫اﻻﺳﻢ اﻟﻜﺎﻣﻞ‬
‫اﻟﺠﻨﺴﯿﺔ اﻟﺴﺎﺑﻘﺔ‬
‫‪Previous Nationality‬‬ ‫‪Family Name‬‬ ‫‪Bekbolat‬‬ ‫اﺳﻢ اﻟﻌﺎﺋﻠــﺔ‬
‫‪Alias‬‬
‫‪Present Nationality‬‬ ‫‪Kazakh‬‬ ‫اﻟﺠﻨﺴﯿﺔ اﻟﺤﺎﻟﯿـــﺔ‬ ‫اﺳﻢ اﻟﺸﮭـﺮة‬

‫‪Date of Entry to U.A.E‬‬ ‫ﺗﺎرﯾﺦ دﺧﻮل اﻟﺪوﻟﺔ‬ ‫‪Date of Birth‬‬ ‫‪07.11.2002‬‬ ‫ﺗﺎرﯾــﺦ اﻟﻤﯿــﻼد‬

‫‪Port of Entry‬‬ ‫ﻣﺮﻛــــﺰ اﻟﺪﺧـــــﻮل‬ ‫‪Place of Birth‬‬ ‫‪Pavlodar‬‬ ‫ﻣﻜــــﺎن اﻟﻤﯿﻼد‬

‫‪Sponsor Upon Entry‬‬ ‫اﻟﻜﻔﯿﻞ ﻋﻨﺪ اﻟﺪﺧﻮل‬ ‫‪Religion‬‬ ‫‪Muslim‬‬ ‫اﻟﺪﯾــــﺎﻧــــــــﺔ‬

‫‪Mother's Details‬‬ ‫ﺑﯿـــﺎﻧــﺎت اﻷم‬ ‫‪Father's Details‬‬ ‫ﺑﯿـــﺎﻧــﺎت اﻷب‬

‫‪Mother's Name‬‬ ‫‪Zhanar Sadykova‬‬ ‫اﺳـــــــﻢ اﻷم‬ ‫‪Father's Name‬‬ ‫اﺳـــــــﻢ اﻻب‬

‫‪Nationality‬‬ ‫‪Kazakh‬‬ ‫اﻟﺠﻨﺴﯿــــــــﺔ‬ ‫‪Nationality‬‬ ‫اﻟﺠﻨﺴﯿــــــــﺔ‬

‫‪Date of Birth‬‬ ‫‪04.12.1978‬‬ ‫ﺗﺎرﯾــﺦ اﻟﻤﯿــﻼد‬ ‫‪Date of Birth‬‬ ‫ﺗﺎرﯾــﺦ اﻟﻤﯿــﻼد‬

‫‪Place of Birth‬‬ ‫ﻣﻜــــﺎن اﻟﻤﯿﻼد‬ ‫‪Place of Birth‬‬ ‫ﻣﻜــــﺎن اﻟﻤﯿﻼد‬

‫‪Profession‬‬ ‫‪ICT teacher‬‬ ‫اﻟﻤﮭﻨـــــــــــــﺔ‬ ‫‪Profession‬‬ ‫اﻟﻤﮭﻨـــــــــــــﺔ‬

‫‪Pavalodar business‬‬
‫‪Place of Work‬‬ ‫‪college‬‬ ‫ﻣﻜﺎن اﻟﻌﻤــﻞ‬ ‫‪Place of Work‬‬ ‫ﻣﻜﺎن اﻟﻌﻤــﻞ‬

‫‪Present Sponsor:‬‬ ‫اﻟﻜﻔﯿـــﻞ اﻟﺤـــــــﺎﻟﻲ‪:‬‬

‫‪Current Place‬‬
‫ﻣﻜـــــــــﺎن اﻟﻌﻤــــــــــــﻞ‬ ‫‪Profession‬‬ ‫اﻟﻤﮭﻨـــــــــــــﺔ‬
‫‪of‬‬
‫اﻟﺤــــﺎﻟﻲ‬
‫‪Employment‬‬
‫‪Bank‬‬ ‫اﻟﺒﻨــــــــــــــﻚ‬

‫‪Office Tel No.‬‬ ‫ھﺎﺗﻒ اﻟﻌﻤﻞ‬ ‫‪Salary‬‬ ‫اﻟـــــــــــــﺮاﺗﺐ‬

‫‪Passport & Residence Details:‬‬ ‫ﺑﯿﺎﻧﺎت اﻟﺠﻮاز واﻹﻗﺎﻣﺔ‪:‬‬

‫‪Residence V. No.‬‬ ‫رﻗﻢ اﻻﻗﺎﻣﺔ‬ ‫‪Passport/Document No.‬‬ ‫‪13505185‬‬ ‫رﻗـــﻢ اﻟﺠــــﻮاز‬

‫‪Ministry of internal‬‬
‫‪Place of Issue‬‬ ‫ﻣﻜﺎن اﻻﺻﺪار‬ ‫‪Place of Issue‬‬ ‫‪affairs‬‬ ‫ﻣﻜﺎن اﻻﺻﺪار‬

‫‪Date of Issue‬‬ ‫ﺗﺎرﯾﺢ اﻻﺻﺪار‬ ‫‪Date of Issue‬‬ ‫‪11.05.2021‬‬ ‫ﺗﺎرﯾﺢ اﻻﺻﺪار‬

‫‪Date of Expiry‬‬ ‫ﺗﺎرﯾﺦ اﻻﻧﺘﮭﺎء‬ ‫‪Date of Expiry‬‬ ‫‪10.05.2031‬‬ ‫ﺗﺎرﯾﺦ اﻻﻧﺘﮭﺎء‬

‫‪Page 1 of 3‬‬
 Academic Qualifications: :‫اﻟﻤﺆھـــﻼت اﻟﺪراﺳﯿـــــﺔ‬
Please state latest qualifications: HIgh school diploma :‫ﯾﺮﺟﻰ ذﻛﺮ آﺧﺮ ﻣﺆھﻞ اﻟﺪراﺳﻲ‬
Nazarbayev

Languages Spoken Intelellectual

‫اﻟﻠﻐـــﺎت اﻟﺘﻲ ﺗﺠﯿــــــــﺪھﺎ‬ ◌ٍSchool/University schools ‫اﻟﺠﺎﻣﻌﺔ‬/‫اﻟﻤﺪرﺳﺔ‬

Kazakh, russion, english Date of Graduation 2021 ‫ﺗ ﺎ ر ﯾ ﺦ ا ﻟ ﺤ ﺼ ﻮ ل ﻋ ﻠ ﻰ ا ﻟﺸ ﮭ ﺎ د ة‬

Country Kazakhstan ‫اﻟﺪوﻟﺔ‬

Marital Status: : ‫اﻟﺤــﺎﻟــﺔ اﻻﺟﺘﻤـــــﺎﻋﯿﺔ‬

Nationality ‫اﻟﺠﻨﺴﯿــــﺔ‬ Name of Spouse ‫اﻟﺰوج‬/‫اﺳﻢ اﻟﺰوﺟﺔ‬

Date of Birth ‫ﺗﺎرﯾﺦ اﻟﻤﯿﻼد‬ Place of Birth ‫ﻣﻜﺎن اﻟﻤﯿﻼد‬

Profession ‫اﻟﻤﮭﻨــــــــﺔ‬ Employer ‫ﻣﻜﺎن اﻟﻌﻤﻞ‬

Names of Children: : ‫أﺳﻤــــﺎء اﻷﺑﻨـــــــــــﺎء‬

1 4 4 1

2 5 5 2

3 6 6 3

Have you ever been in the military service? ‫ ﻻ‬:‫ھﻞ ﺳﺒﻖ ﻟﻚ اﻟﻌﻤﻞ ﻓﻲ اﻟﻤﺠﺎل اﻟﻌﺴﻜﺮي‬
YES NO ‫ﻻ‬ ‫ﻧﻌﻢ‬
x
a- Country c- Rank
x ‫ اﻟﺮﺗﺒــــــﺔ‬-‫ج‬ ‫ اﺳﻢ اﻟﺪوﻟﺔ‬-‫أ‬
x
b- Type of Service d- Duration ‫ ﻣﺪة اﻟﺨﺪﻣﺔ‬-‫د‬ ‫ ﻧﻮع اﻟﺨﺪﻣﺔ‬-‫ب‬

Names of Relatives in UAE (if any): :(‫أﺳﻤــــــﺎء اﻷﻗـــــــــــﺎرب ﺑﺎﻟﺪوﻟﺔ )إن وﺟﺪ‬

Name ‫اﻻﺳــﻢ‬ Nationality ‫اﻟﺠﻨﺴﯿﺔ‬ Employer ‫ﺟﮭﺔ اﻟﻌﻤﻞ‬ Contact No. ‫اﻟﮭﺎﺗﻒ‬

1 1

2 2

3 3

Names of Friends in UAE (if any): :(‫أﺳﻤــــﺎء اﻷﺻﺪﻗــــــﺎء ﺑﺎﻟﺪوﻟﺔ )إن وﺟﺪ‬

Name ‫اﻻﺳــﻢ‬ Nationality ‫اﻟﺠﻨﺴﯿﺔ‬ Employer ‫ﺟﮭﺔ اﻟﻌﻤﻞ‬ Contact No. ‫اﻟﮭﺎﺗﻒ‬

1 1

2 2

3 3

Page 2 of 3
 ‫‪Residence Details:‬‬ ‫ﺑﯿـــﺎﻧــﺎت اﻟﺴﻜــــــﻦ‪:‬‬

‫‪Flat No.‬‬ ‫رﻗـــــــﻢ اﻟﺸﻘــــﺔ‬ ‫‪Zone‬‬ ‫اﻟﻤﻨﻄﻘــــــﺔ‬

‫‪P.O.Box‬‬ ‫رﻗﻢ ﺻﻨﺪوق اﻟﺒﺮﯾﺪ‬ ‫‪Street‬‬ ‫اﻟﺸـــــــﺎرع‬
‫‪Res. Tel. No.‬‬ ‫رﻗﻢ ھﺎﺗﻒ اﻟﻤـــﻨﺰل‬ ‫‪Name of Landlord‬‬ ‫اﺳﻢ اﻟﻤﺎﻟﻚ‬
‫‪Mobile Tel. No.‬‬ ‫رﻗﻢ اﻟﮭﺎﺗﻒ اﻟﻤﺘﺤﺮك‬ ‫‪House/Building No.‬‬ ‫رﻗﻢ اﻟﻤﻨﺰل‪ /‬اﻟﺒﻨﺎﯾﺔ‬
‫‪Pager‬‬ ‫رﻗﻢ اﻟﻨﺪاء اﻟﻌـــﺎم‬ ‫‪Floor No.‬‬ ‫اﻟﻄﺎﺑـــــــﻖ‬

‫‪Employment History in U.A.E:‬‬ ‫اﻻﻋﻤﺎل اﻟﺘﻲ ﻣﺎرﺳﺘﮭﺎ داﺧﻞ اﻟﺪوﻟﺔ‪:‬‬

‫‪1‬‬ ‫‪4‬‬ ‫‪4‬‬ ‫‪1‬‬

‫‪2‬‬ ‫‪5‬‬ ‫‪5‬‬ ‫‪2‬‬
‫‪3‬‬ ‫‪6‬‬ ‫‪6‬‬ ‫‪3‬‬

‫‪Countries visited:‬‬ ‫اﻟﺪول اﻟﺘﻲ ﺳﺒﻖ ﻟﻚ زﯾﺎرﺗﮭــــــــــــﺎ‪:‬‬

‫‪1‬‬ ‫‪United Arab Emirated‬‬ ‫‪4‬‬ ‫‪4‬‬ ‫‪1‬‬

‫‪2‬‬ ‫‪5‬‬ ‫‪5‬‬ ‫‪2‬‬
‫‪3‬‬ ‫‪6‬‬ ‫‪6‬‬ ‫‪3‬‬

‫‪Countries of previous work:‬‬ ‫اﻟــﺪول اﻟﺘﻲ ﺳﺒﻖ ﻟﻚ اﻟﻌﻤــﻞ ﺑﮭﺎ‪:‬‬

‫‪1‬‬ ‫‪Kazakhstan‬‬ ‫‪4‬‬ ‫‪4‬‬ ‫‪1‬‬
‫‪2‬‬ ‫‪5‬‬ ‫‪5‬‬ ‫‪2‬‬
‫‪3‬‬ ‫‪6‬‬ ‫‪6‬‬ ‫‪3‬‬

‫‪Vehicle Details:‬‬ ‫ﺑﯿـــﺎﻧـــــﺎت اﻟﻤﺮﻛﺒــــــــــــﺔ‪:‬‬

‫‪Driving Licence No.‬‬ ‫رﻗﻢ رﺧﺼﺔ اﻟﻘﯿﺎدة‬ ‫‪Type‬‬ ‫ﻧﻮع اﻟﻤﺮﻛﺒﺔ‬

‫‪Place of Issue‬‬ ‫ﻣﻜﺎن اﻻﺻﺪار‬ ‫‪Plate No.‬‬ ‫رﻗﻢ اﻟﻠﻮﺣﺔ‬

‫‪Date of Issue‬‬ ‫ﺗﺎرﯾﺢ اﻻﺻﺪار‬ ‫‪Color of Plate‬‬ ‫ﻟﻮن اﻟﻠﻮﺣﺔ‬

‫‪Date of Expiry‬‬ ‫ﺗﺎرﯾﺦ اﻻﻧﺘﮭﺎء‬ ‫‪Place of registration‬‬ ‫ﺟﮭﺔ اﻟﺘﺮﺧﯿﺺ‬

‫أﺗﻌﮭـــــﺪ أﻧــــــﺎ اﻟﻤﻮﻗـــــــﻊ أدﻧـــــــــﺎه ﺑــــــﺄن اﻟﺒﯿـــــــﺎﻧﺎت اﻟــــــﻮاردة ﺑﮭــــــﺬه اﻟﻮﺛﯿﻘــــﺔ ﺻﺤﯿﺤـــــﺔ وﻛﺎﻣﻠــــــﺔ‪.‬‬
‫اﻟﻤﺮﻓﻘـﺎت اﻟﻤﻄﻠﻮﺑﺔ‪ :‬ﺻــﻮرة ﺷــﺨﺼﯿﺔ ‪ -‬ﺻـﻮرة ﺟـﻮاز ﺳــﻔﺮ‬

‫‪I, the undersigned, declare that the details contained in this statement are accurate and complete.‬‬
‫‪Please attach / enclose: 4 passport size photos & one passport photocopy.‬‬

‫‪Name‬‬ ‫‪:‬‬ ‫‪Azamat‬‬ ‫‪:‬‬ ‫اﻻﺳـــــــﻢ‬

‫‪Date‬‬ ‫‪:‬‬ ‫‪26.05.2022‬‬ ‫‪:‬‬ ‫اﻟﺘــــــﺎرﯾﺦ‬

‫‪Signature‬‬ ‫‪:‬‬ ‫‪:‬‬ ‫اﻟﺘﻮﻗﯿـــــﻊ‬

‫‪Page 3 of 3‬‬