EMBASSY OF THE REPUBLIC OF THE PHILIPPINES

CONSULAR SECTION
Riyadh, Kingdom of Saudi Arabia

APPLICATION FOR NBI CLEARANCE

PERSONAL INFORMATION:

Name: ____________________________________________________________________
First Name Middle Name Last Name
Passport Details: Passport Number: _________________
Date of Issuance: _________________
Place of Issuance: _________________
Iqama Details: Iqama Number: ____________________
Date of Issuance: __________________
Place of Issuance: _________________
Sex: Male ( ) Female ( ) Civil Status: __________________
Address in Saudi Arabia: _____________________________________________________
P.O. Box No: _________________________________________
Email Address: ____________________ Tel. No: ____________ Mobile No: ____________
Name of Employer/ Company: ________________________________________
Number of Years in Saudi Arabia: _____ Inclusive Dates: From ________ To________

PURPOSE OF THE APPLICATION: ____________________________________________

Required Document/s Submitted:

FOR NEW APPLICANTS:

() Personal Appearance
() NBI Clearance Application Form (NBI Form No. 5) for Finger-Printing
() 2x2 picture in white background, taken within three (3) months prior application
() Photocopy of passport data page
() Other valid identification card/s: ______________________________
() Processing/Notarial Fee: SAR 100.00

Total Number of Documents: ______

_____________________________
Signature
Date: _____________

Verifier: ___________________
Processor: ___________________