‫מינהל עובדים זרים‬

‫אגף חקלאות‬
'‫נספח ב‬

Declaration and Undertaking of an Applicant for Visa and Work Permit (B/1) for
Agricultural Work in Israel

I, the undersigned, hereby request a visa and work permit in Israel for temporary employment in the
field of agriculture, and I undertake and declare as follows:

1) I understand that the State of Israel is in a general state of war at this time, and that the
war is expected to last a long time. I understand that in this war, thousands of missiles have
been and continue to be shot by Israel's enemy at mostly civilian targets all over Israel. I
understand that many but not all of the missiles are being shot down by anti-missile
systems but that some of the missiles hit their targets and that the hits as well as shrapnel
can kill and injure persons. In addition, there is a danger of terror attacks in Israel due to
the war.

2) I declare that despite the information concerning the dangers in Israel at this time, I wish to
arrive to work in the Israel immediately, and I understand that if I receive entry
permission, I may enter no later than 21 days after receiving permission to enter Israel or by
31st January 2024, the earlier of the two, and if I do not do so, permission to enter will no
longer be valid.

3) None of my immediate family members (common law partner/ spouse/parents/children) are

employed in Israel and I am aware that I will not be allowed to remain in Israel if any of my
aforementioned family members are found staying in Israel as well.

4) I hereby declare that I am able, ready and willing to perform excellent, and diligent full time
work in the Agriculture field in Israel and that I will carry out the instructions of my employer
willingly and to the best of my ability.

5) I hereby affirm that it has been explained to me that the State of Israel takes the fingerprints
of foreign workers and also takes their photographs upon their arrival at Ben Gurion
International Airport. It was also explained to me that the fingerprints and the photographs
taken are kept in a database, all in accordance with the authority of the Minister of the
Interior of the State of Israel to set the conditions for issuing an entry visa in accordance with
the Law of Entry into Israel –1952. I therefore affirm that I understand that upon my arrival in
Israel I will be photographed and my fingerprints will be taken as part of the conditions for my
receiving an entry visa into Israel, and I hereby do give my consent to this.

6) I am aware and understand that after arriving in Israel, I will be permitted to work only for a
farmer with a permit to employ foreign agricultural workers, and that I am prohibited from
working for any other person or organization, including during breaks and on weekends and
holidays. I am aware that the maximum period of employment in Israel is 63 months from the
day of entry into Israel and that my work-permit will not be extended beyond that period.

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 ‫מינהל עובדים זרים‬
‫אגף חקלאות‬
'‫נספח ב‬

7) I am aware that if I am not legally registered with a farmer holding a valid permit to employ
foreign workers in Agricultural, for a period of over 90 days, I will be required to leave Israel
immediately, and that if I do not do so, I may be subject to deportation.

8) I am aware that I am permitted to remain in Israel for as long as the work permit in my
passport is valid and that each year my employer will be required to extend my work permit
according to the conditions dictated by law and the Population and Immigration Authority's
procedures up to the maximum permitted period of up to 63 months from the time I enter. I
understand that I am prohibited from working or remaining in Israel without a valid, extended
permit of residence (other than during the 60 days after completing my legal employment
period in which I am entitled to remain in Israel, without working, in order to prepare to leave
the country).

9) I understand that the Israel Recruitment Agency recruiting me must provide me with a link to
the Foreign Workers' Rights Handbook as appears on the website of PIBA. I also understand that
I may call the Foreign Workers' Call Center in Israel if I wish to file a complaint or receive
information: Tel: 1 700 707 889.
In addition, I have been notified of a link for filing written complaints and inquiries in my
language:: https://cimihotline.formtitan.com/homepage#/
I have also received the contact information of the Ombudsman for Foreign Worker Labour
Rights in the Ministry of Labour in Israel as follows: TEL: + 972 -74-7696161, +972-50-6290758
for sending text messages. E-mail: foreignr@labor.gov.il
I also agree that PIBA and PIBA's call center for foreign workers may use my contact information
for sending me information and updates relevant to my legal stay and work, rights and
obligations in Israel etc. as well as to request (but not to require) that I take part in relevant
surveys or questionnaires.

10) I hereby declare that I am mentally and physically healthy, do not suffer and didn't suffer in
the past from chronic diseases or mental illness and am capable of performing strenuous
agricultural work including lifting heavy weight.

11) I am aware and understand that my private health insurance in Israel will not cover pre-
existing medical conditions and the insurance companies will not pay expenses in connection
with the treatment of such conditions. In addition, if due to illness I will not be fit for work for
over 90 days, the medical insurance will no longer cover this illness and I must return to my
country.

12) I am aware that as per existing Israeli procedures, my employer must deposit my salary into a
bank account which he has helped my open on my name only, in Israel, and that after deposit
of the salary, I may transfer the monies as I wish. I hereby agree to open such a bank account
and have my salary deposited in such, as a condition of my visa and work permit.

13) I am aware and understand that I will be invited to Israel to work for a licensed farmer and I
declare that I will make a true and faithful attempt to carry out work for my assigned
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 ‫מינהל עובדים זרים‬
‫אגף חקלאות‬
'‫נספח ב‬

employer. I understand that if I arrive in Israel without true intention to work for the assigned
farmer, as per the employment contract which I shall sign, I may be considered as a worker
who has received his visa and work permit based on false declarations, and therefore shall be
liable for deportation from Israel, after a hearing.

14) I hereby agree to abide by Israeli law and customs and I am aware that if after arriving in
Israel I am found to have violated Israeli laws I may be deported after a hearing. In addition, I
understand that if I am found by PIBA not to have the necessary skills for agricultural work, or
if I become drunk and disorderly, violent, or use illegal drugs, or if I work in any other field
than agriculture , I may be deported by PIBA after a hearing.

15) I am aware and understand that if I violate any of my aforementioned obligations or if these
declarations or any others that I made during the processes of applying for employment in
Israel are proven to be untrue, I will be required to depart from Israel immediately and if I do
not do so, I will be subject to arrest and deportation.

16) I understand and agree that my signing on this document will be videoed along with my
passport and may be shown to the Israeli Recruitment Agency as well as Israeli official bodies
or bodies who have contracted with the Israeli official bodies as necessary concerning my
recruitment and employment.

Applicant's Signature:

Applicants Name _______________________ Passport Number _______________________

I, the undersigned, _______________________ ID number __________________

Holding position of ____________________ in _____________ declare that Mr.

____________________ ID Number_____________________ did sign this statement in my
presence on the day of ______________________.