‫‪754914579353‬‬

‫ﻃﻠﺐ ﺗﻘﺮﻳﺮ ﻣﻘﻴﻢ‬

‫‪Passport Number‬‬ ‫‪P7661121‬‬ ‫ﺭﻗﻢ ﺍﻟﺠﻮﺍﺯ‬ ‫ﺍﻻﺳﻢ ﺑﺎﻟﻌﺮﺑﻴﺔ‬

‫‪Passport Issuance Place‬‬ ‫ﻛﻮﺗﺸﻴﻦ‬ ‫ﻣﻜﺎﻥ ﺇﺻﺪﺍﺭ ﺍﻟﺠﻮﺍﺯ‬ ‫ﻣﺤﻤﺪ ﺳﺠﺎﺩ ﺑﺘﻐﺎﺭ‬
‫‪Passport Issuance Date‬‬ ‫‪09/5/1438‬‬ ‫ﺗﺎﺭﻳﺦ ﺇﺻﺪﺍﺭ ﺍﻟﺠﻮﺍﺯ‬ ‫‪Name in English‬‬
‫‪Passport Expiry Date‬‬ ‫‪27/8/1448‬‬ ‫ﺗﺎﺭﻳﺦ ﺍﻧﺘﻬﺎﺀ ﺍﻟﺠﻮﺍﺯ‬ ‫‪MOHAMMED SAJJAD PATGAR‬‬
‫‪Passport Status‬‬ ‫ﺍﺻﻠﻲ‬ ‫ﺣﺎﻟﺔ ﺍﻟﺠﻮﺍﺯ‬
‫‪Iqama Number‬‬ ‫‪2529397784‬‬ ‫ﺭﻗﻢ ﺍﻹﻗﺎﻣﺔ‬
‫‪Visa Expiry Date‬‬ ‫‪-‬‬ ‫ﺗﺎﺭﻳﺦ ﺍﻧﺘﻬﺎﺀ ﺍﻟﺘﺄﺷﻴﺮﺓ‬
‫‪Iqama Version‬‬ ‫‪2‬‬ ‫ﻧﺴﺨﺔ ﺍﻹﻗﺎﻣﺔ‬
‫‪Visa Issuance Place‬‬ ‫‪-‬‬ ‫ﻣﻜﺎﻥ ﺇﺻﺪﺍﺭ ﺍﻟﺘﺄﺷﻴﺮﺓ‬
‫‪Iqama Status‬‬ ‫ﺻﺎﻟﺤﺔ‬ ‫ﺣﺎﻟﺔ ﺍﻹﻗﺎﻣﺔ‬
‫‪Date of Last Exit‬‬ ‫ﺗﺎﺭﻳﺦ ﺁﺧﺮ ﺧﺮﻭﺝ‬
‫‪Iqama Expiry Date‬‬ ‫‪28/2/1445‬‬ ‫ﺗﺎﺭﻳﺦ ﺍﻧﺘﻬﺎﺀ ﺍﻹﻗﺎﻣﺔ‬
‫‪Health Insurance Information‬‬
‫‪Iqama Issuance Date‬‬ ‫‪28/2/1444‬‬ ‫ﺗﺎﺭﻳﺦ ﺇﺻﺪﺍﺭ ﺍﻹﻗﺎﻣﺔ‬
‫‪Health Insurance‬‬ ‫‪26/9/1444‬‬ ‫ﺗﺎﺭﻳﺦ ﺍﻧﺘﻬﺎﺀ‬
‫‪Expiry Date‬‬ ‫ﺍﻟﺘﺄﻣﻴﻦ ﺍﻟﺼﺤﻲ‬ ‫‪Occupation‬‬ ‫ﻣﺸﺮﻑ ﺻﺤﺔ ﻭﺳﻼﻣﺔ ﻣﻬﻨﻴﺔ‬ ‫ﺍﻟﻤﻬﻨﺔ‬

‫‪Marital Status‬‬ ‫ﻣﺘﺰﻭﺝ‬ ‫ﺍﻟﺤﺎﻟﺔ ﺍﻻﺟﺘﻤﺎﻋﻴﺔ‬

‫‪Vehicles Information‬‬
‫‪Nationality‬‬ ‫ﺍﻟﻬﻨﺪ‬ ‫ﺍﻟﺠﻨﺴﻴﺔ‬
‫‪Number of Vehicles‬‬ ‫‪0‬‬ ‫ﻋﺪﺩ ﺍﻟﻤﺮﻛﺒﺎﺕ‬
‫‪Traffic Violations Number‬‬ ‫‪0‬‬ ‫ﻋﺪﺩ ﺍﻟﻤﺨﺎﻟﻔﺎﺕ ﺍﻟﻤﺮﻭﺭﻳﺔ‬ ‫‪Blood Type‬‬ ‫‪-‬‬ ‫ﻓﺼﻴﻠﺔ ﺍﻟﺪﻡ‬
‫‪Number of Licenses‬‬ ‫ﻋﺪﺩ ﺭﺧﺺ ﺍﻟﻘﻴﺎﺩﺓ‬ ‫‪Place of Birth‬‬ ‫ﺍﻟﻬﻨﺪ‬ ‫ﻣﻜﺎﻥ ﺍﻟﻤﻴﻼﺩ‬

‫‪Hajj Information‬‬ ‫‪Date of Birth‬‬ ‫‪21/04/1997‬‬ ‫ﺗﺎﺭﻳﺦ ﺍﻟﻤﻴﻼﺩ‬

‫‪Hajj Eligibility‬‬ ‫✘‬ ‫‪Yes‬‬ ‫‪No‬‬ ‫ال‬ ‫ﻧﻌﻢ‬ ‫✘‬ ‫ﺃﺣﻘﻴﺔ ﺍﻟﺤﺞ‬ ‫ﻣﻜﺎﻥ ﺇﺻﺪﺍﺭ ﺍﻹﻗﺎﻣﺔﺷﺮﻛﺔ ﺍﻟﻌﻠﻢ ﻻﻣﻦ ﺍﻟﻤﻌﻠﻮﻣﺎﺕ‪Iqama Issuance Place‬‬
‫‪Last Year of Hajj‬‬ ‫‪-‬‬ ‫ﺃﺧﺮ ﺳﻨﺔ ﺣﺞ‬ ‫‪Gender‬‬ ‫✘‬ ‫‪Male‬‬ ‫‪Female‬‬ ‫ﺃﻧﺜﻰ‬ ‫ﺫﻛﺮ‬ ‫✘‬ ‫ﺍﻟﺠﻨﺲ‬

‫‪Sponsor Information‬‬ ‫‪Inside Kingdom‬‬ ‫✘‬ ‫‪Yes‬‬ ‫‪No‬‬ ‫ال‬ ‫ﻧﻌﻢ‬ ‫✘‬ ‫ﺩﺍﺧﻞ ﺍﻟﻤﻤﻠﻜﺔ‬

‫‪Sponsor ID Number‬‬ ‫‪7024017027‬‬ ‫ﺭﻗﻢ ﻫﻮﻳﺔ ﺍﻟﻜﻔﻴﻞ‬ ‫‪Religion‬‬ ‫ﺍﻻﺳﻼﻡ‬ ‫ﺍﻟﺪﻳﺎﻧﺔ‬

‫‪Sponsor Name‬‬ ‫ﺍﺳﻢ ﺍﻟﻜﻔﻴﻞ‬ ‫?‪Is there a finger print‬‬ ‫✘‬ ‫‪Yes‬‬ ‫ال ‪No‬‬ ‫ﻧﻌﻢ‬ ‫✘‬ ‫ﻫﻞ ﺗﻮﺟﺪ ﺑﺼﻤﺔ؟‬
‫ﻣﺆﺳﺴﺔ ﻭﺭﻭﺩ ﺍﻟﻤﺴﺘﻘﺒﻞ ﻟﻠﻤﻘﺎﻭﻻﺕ ﺍﻟﻌﺎﻣﺔ‬ ‫‪No. of Sponsorship Transfers‬‬ ‫‪1‬‬ ‫ﻋﺪﺩ ﻣﺮﺍﺕ ﻧﻘﻞ ﺍﻟﻜﻔﺎﻟﺔ‬

‫ﻣﺪﺓ ﺻﻼﺣﻴﺔ ﺍﻟﺴﺠﻞ ‪ 30‬ﻳﻮﻣﺎً ﺍﻋﺘﺒﺎﺭﺍً ﻣﻦ ﺗﺎﺭﻳﺦ ﺍﻹﺻﺪﺍﺭ ‪ 17/07/2023‬ﻡ‬

‫ﻳﻤﻜﻦ ﺍﻟﺘﺤﻘﻖ ﻣﻦ ﺻﺤﺔ ﺍﻟﺴﺠﻞ ﻣﻦ ﺧﻼﻝ ﺧﺪﻣﺔ ﺍﻻﺳﺘﻌﻼﻡ ﻋﺒﺮ ﺃﺑﺸﺮ ﻭﺫﻟﻚ ﺑﺎﺳﺘﺨﺪﺍﻡ ﺍﻟﺮﻗﻢ ﺍﻟﻤﺮﺟﻌﻲ‬
‫ﻋﻠﻰ ﺍﻟﺮﺍﺑﻂ )‪ ،(www.absher.sa‬ﺍﻟﺒﻴﺎﻧﺎﺕ ﺍﻟﻤﻌﺮﻭﺿﺔ ﺗﺸﻤﻞ ﺍﻟﺒﻴﺎﻧﺎﺕ ﺍﻟﻤﺴﺠﻠﺔ ﺃﺛﻨﺎﺀ ﻋﻤﻠﻴﺔ ﺍﻹﺻﺪﺍﺭ‬
‫ﻭﺍﻟﻄﺒﺎﻋﺔ‪ ،‬ﻋﻠﻤﺎً ﺃﻧﻪ ﺳﻴﺘﻢ ﻋﺮﺽ ﺍﻟﺒﻴﺎﻧﺎﺕ ﺍﻟﻤﺴﺠﻠﺔ ﺑﺎﻟﻨﻈﺎﻡ ﻋﻨﺪ ﺍﻻﺳﺘﻔﺴﺎﺭ‪.‬‬

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‫ﻃﻠﺐ ﺗﻘﺮﻳﺮ ﻣﻘﻴﻢ‬

‫‪Family Members‬‬ ‫ﺃﻓﺭﺍﺩ ﺍﻷﺳﺭﺓ‬

‫‪Number of Family Members‬‬ ‫‪0‬‬ ‫ﻋﺪﺩ ﺃﻓﺮﺍﺩ ﺍﻷﺳﺮﺓ‬

‫‪Family Members Inside‬‬ ‫‪0‬‬ ‫ﻋﺪﺩ ﺃﻓﺮﺍﺩ ﺍﻷﺳﺮﺓ ﺩﺍﺧﻞ ﺍﻟﻤﻤﻠﻜﺔ‬

‫‪Family Members Outside‬‬ ‫‪0‬‬ ‫ﻋﺪﺩ ﺃﻓﺮﺍﺩ ﺍﻷﺳﺮﺓ ﺧﺎﺭﺝ ﺍﻟﻤﻤﻠﻜﺔ‬

‫ﻣﺪﺓ ﺻﻼﺣﻴﺔ ﺍﻟﺴﺠﻞ ‪ 30‬ﻳﻮﻣﺎً ﺍﻋﺘﺒﺎﺭﺍً ﻣﻦ ﺗﺎﺭﻳﺦ ﺍﻹﺻﺪﺍﺭ ‪ 17/07/2023‬ﻡ‬

‫ﻳﻤﻜﻦ ﺍﻟﺘﺤﻘﻖ ﻣﻦ ﺻﺤﺔ ﺍﻟﺴﺠﻞ ﻣﻦ ﺧﻼﻝ ﺧﺪﻣﺔ ﺍﻻﺳﺘﻌﻼﻡ ﻋﺒﺮ ﺃﺑﺸﺮ ﻭﺫﻟﻚ ﺑﺎﺳﺘﺨﺪﺍﻡ ﺍﻟﺮﻗﻢ ﺍﻟﻤﺮﺟﻌﻲ‬
‫ﻋﻠﻰ ﺍﻟﺮﺍﺑﻂ )‪ ،(www.absher.sa‬ﺍﻟﺒﻴﺎﻧﺎﺕ ﺍﻟﻤﻌﺮﻭﺿﺔ ﺗﺸﻤﻞ ﺍﻟﺒﻴﺎﻧﺎﺕ ﺍﻟﻤﺴﺠﻠﺔ ﺃﺛﻨﺎﺀ ﻋﻤﻠﻴﺔ ﺍﻹﺻﺪﺍﺭ‬
‫ﻭﺍﻟﻄﺒﺎﻋﺔ‪ ،‬ﻋﻠﻤﺎً ﺃﻧﻪ ﺳﻴﺘﻢ ﻋﺮﺽ ﺍﻟﺒﻴﺎﻧﺎﺕ ﺍﻟﻤﺴﺠﻠﺔ ﺑﺎﻟﻨﻈﺎﻡ ﻋﻨﺪ ﺍﻻﺳﺘﻔﺴﺎﺭ‪.‬‬

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