You are on page 1of 1

‫ﺳﻠﻄـــﺔ ﻣﺪﻳﻨـــــﺔ دﺑــــﻲ اﻟﻄﺒﻴـــــﺔ‬

Dubai Healthcare City Authority

GOVERNMENT SERVICES OPERATIONS

Withdrawal of Absconder:

Company Name:
Employee’s Name:
Job Title:
License No.: Nationality:
Employee’s ID Card No.: Passport No.:

Employee’s Contact Mobile.: Phone No.:

Employee’s Email:

Manager’s Contact Mobile.: Phone No.:

Manager’s Email:

Reason of withdrawal for absconder declaration:

Authorized Signatory & Company Seal:

Date: Signature:

Government services operation office use only:

Checked by: Signature:

Please provide a copy of the passport with visa page.

Dubai Healthcare City Authority, P.O. Box: 505001, Dubai, UAE ‫ اﻣﺎرات اﻟﻌﺮﺑﻴﺔ اﻟﻤﺘﺤﺪة‬،‫ دﺑﻲ‬،505001 :‫ب‬.‫ ص‬،‫ﺳﻠﻄﺔ ﻣﺪﻳﻨـﺔ دﺑـﻲ اﻟﻄﺒﻴـﺔ‬
T +971 4 383 8300 F +971 4 383 8359 www.dhcr.gov.ae +971 4 3٨٣ ٨٣٥٩ ‫ف‬ +971 4 3٨٣ ٨٣٠٠ ‫ﻫـ‬

You might also like