‫ﺳﻔﺎﺭﺓ ﺍﳌﻤﻠﻜﺔ ﺍﻟﻌﺮﺑﻴﺔ ﺍﻟﺴﻌﻮﺩﻳﺔ ﻛﻮﺍﻻﳌﺒﻮﺭ‬

‫ﺻﻮرة‬ ‫ﺍﻟﻘﺴﻢ ﺍﻟﻘﻨﺼﻠﻲ‬

ROYAL EMBASSY OF SAUDI ARABIA
Photo KUALA LUMPUR
CONSULAR SECTION
Application Form
MOFA Visa No.:__________________
Website: www.saudiembassy.org.my E No.: ________________________

Full Name: :‫اﻻﺳ اﻟ ﺎﻣﻞ‬

Date of birth: :‫ ﺗﺎر ﺦ اﻟ ﻼد‬Place of birth: :‫ﻣ ﻞ اﻟ ﻼد‬
Previous Nationality: :‫ﺔ اﻟ ﺎ ﻘﺔ‬ ‫ اﻟ‬Present Nationality: :‫ﺔ اﻟ ﺎﻟ ﺔ‬ ‫اﻟ‬

Sex: Female ‫أﻧ ﻰ‬ Male ‫ذ‬ : ‫ اﻟ‬Marital Status: :‫اﻟ ﺎﻟﺔ اﻻﺟ ﺎﻋ ﺔ‬
Profession: : ‫ اﻟ ﻬ ﺔ‬Religion: :‫اﻟ ﺎﻧﺔ‬
Place of Issue: :‫رﻩ‬ ‫ ﻣ‬Qualification: :‫اﻟ ﻫﻞ اﻟﻌﻠ ﻲ‬
Home Address and Telephone No: :‫ل ورﻗ اﻟﻬﺎﺗﻒ‬ ‫ﻋ ان اﻟ‬

Business address and telephone No: :‫ﺔ ورﻗ اﻟﻬﺎﺗﻒ‬ ‫ﻋ ان اﻟ‬

Purpose of Travel: : ‫اﻟﻐﺎ ﺔ ﻣ اﻟ ﻔ‬

‫ﺣﺞ‬ ‫ﻋ ﻩ‬ ‫ﻣ ور‬ ‫دراﺳ ﺔ‬ ‫ﺗ ﯾ اﻟ وج واﻟﻌ دة‬ ‫ﺧﺎﺻﺔ‬ ‫دﺑﻠ ﻣﺎﺳ ﺔ‬ ‫ز ﺎرة‬ ‫إﻗﺎﻣﺔ‬ ‫ﻋ ﻞ‬
Hajj Umrah Transit Study Exit & Re-Entry Official Diplomatic Visit Residence Work

Place of Issue: :‫ﻣ ﻞ اﻹﺻ ار‬ Passport No: :‫رﻗ اﻟ از‬

Date of Expiry: :‫ﺗﺎر ﺦ اﻧ ﻬﺎء اﻟ از‬ Date of Issue: :‫ﺗﺎر ﺦ اﻹﺻ ار‬
Date of departure: :‫ﺗﺎر ﺦ اﻟ ﻐﺎدرة‬ Date of arrival: :‫ﺗﺎر ﺦ اﻟ ﺻ ل‬
Duration of stay in the Kingdom: :‫ﻣ ة اﻹﻗﺎﻣﺔ ﺎﻟ ﻠ ﺔ‬

:‫ﺗﺎر ﺦ‬ : ‫ﺎل رﻗ‬ ‫إ‬ :‫ﺗﺎر ﺦ‬ : ‫رﻗ‬ ‫ﻧﻘ ًا‬ ‫ﻣ ﺎﻣﻠﺔ‬ :‫ﻘﺔ اﻟ ﻓﻊ‬

Mode of payment: Free Cash Cheque No: Date: Draft No: Date:

Name of Mahram: :‫م‬ ‫اﺳ اﻟ‬

Relationship: :‫ﺻﻠﺔ اﻟﻘ ا ﺔ‬
Destination: :‫ﺟﻬﺔ اﻟ ﺻ ل ﺎﻟ ﻠ ﺔ‬ Carrier's Name: :‫ﺔ اﻟ ﺎﻗﻠﺔ‬ ‫اﺳ اﻟ‬
Dependents traveling in the same passport: :(‫اﻟ از‬ ‫ﻋﻠﻰ ﻧﻔ‬ ‫ﺎﻓ‬ ‫أﻓ اد اﻟﻌﺎﺋﻠﺔ )اﻟ‬ ‫ﺎﺣﺎت ﺗ‬ ‫إ‬
Relationship / ‫ﺻﻠﺔ اﻟﻘ ا ﺔ‬ Date of Birth / ‫ﺗﺎر ﺦ اﻟ ﻼد‬ Sex / ‫اﻟ‬ Full Name / ‫اﻻﺳ ﺎﻟ ﺎﻣﻞ‬

Name and address of company or individual in the Kingdom: :‫وﻋ اﻧﻪ ﺎﻟ ﻠ ﺔ‬ ‫ﺔ أو اﺳ اﻟ‬ ‫اﺳ وﻋ ان اﻟ‬

The undersigned hereby certify that all the information ً‫ﺔ وﺳﺄﻛ ن ﻣﻠ ﻣﺎ‬ ‫ﺄن ﻞ اﻟ ﻌﻠ ﻣﺎت اﻟ ﻲ دوﻧ ﻬﺎ ﺻ‬ ‫أﻧﺎ اﻟ ﻗﻊ أدﻧﺎﻩ أﻗ‬
I have provided are correct. Will abide by the kingdom during .‫اﻟ ﻠ ﺔ أﺛ ﺎء ﻓ ة وﺟ د ﺑﻬﺎ‬ ‫ﻘ اﻧ‬
the period of my residence in it.
(DEATH SENTENCE FOR DRUG TRAFFICKING) (‫رات اﻟﻘ ﻞ ﺗﻌ ًا‬ ‫اﻟ‬ ‫)ﻋﻘ ﺔ ﺗﻬ‬

Date: :‫اﻟ ﺎر ﺦ‬ Signature: :‫اﻟ ﻗ ﻊ‬ Name: : ‫اﻻﺳ‬

FOR OFFICIAL USE ONLY / ‫ﻟﻼﺳ ﻌ ﺎل اﻟ ﺳ ﻲ ﻓﻘ‬

Date: :‫ﺗﺎر ﻪ‬ Authorization: :‫ﻋﻠ ﻪ ﻓﻲ إﺻ ار اﻟ ﺄﺷ ة‬ ‫رﻗ اﻷﻣ اﻟ ﻌ‬
Visit / Work for: : ‫ اﻟﻌ ﻞ ﻟ‬/ ‫ﻟ ﺎرة‬
Date: :‫ﺗﺎر ﺦ‬ Visa No: : ‫أﺷ ﻟﻪ ﺑ ﻗ‬
Amount collected: :‫ﻞ‬ ‫اﻟ ﻠﻎ اﻟ‬ Type: :‫ﻧ ﻋﻬﺎ‬ Duration: :‫ﻣ ﺗﻬﺎ‬
:Head of consular section / ‫ﻠﻲ‬ ‫اﻟﻘ‬ ‫اﻟﻘ‬ ‫رﺋ‬ : Checked by / ‫ﻣ ﻗ اﻟ ﺎﻧﺎت‬