Name (as in the passport): Bekalu Andargachew Gedebo Known as: Bekalu

Andargachew
Birth Place:(city/country): Hawassa, Ethiopia Birth Date: 18 / 02 / 2004
Current Nationality: Ethiopian Previous Nationality:
Passport No.:EP7710476 Issue Date: 01 / 08 /2023 Expiry Date: 30 / 07/2028
Country of Issue: Ethiopia Religion: Christian Sect: Protestant
Highest Quals: Major: Year:
Institution: Country: Language:
● Applicant’s Spouse:
Name: Nationality: Profession:
Employer: Birth Place: Birth Date: / /
● Applicant’s Parent:
Father’s Name: Andargachew Gedebo Nationality: Ethiopian Profession: Associate professor
Employer: Hawassa University Birth Date: 10 / 07/1968 Birth Place: Omo, Ethiopia
Mother’s Name: Bizunesh Borsamo Nationality: Ethiopian Profession: Business person
Employer: Self employed Birth Date: 27 / 08 /1967 Birth Place: Sidamo, Ethiopia
● Applicant’s Children:
Name: Birth Date: / / Name: Birth Date: / /
Name: Birth Date: / / Name: Birth Date: / /
Name: Birth Date: / / Name: Birth Date: / /
Name: Birth Date: / / Name: Birth Date: / /
● Applicant’s Relatives in UAE:
Name: Nationality: Employer:
Name: Nationality: Employer:
Name: Nationality: Employer:
● Applicant’s Friends in UAE:
Name: Nationality: Employer:
Name: Nationality: Employer:
Name: Nationality: Employer:
● Previous Business/ Employment in UAE (most recent first):
1. 2. 3.

● Countries where previously employed (most recent first):

1. 2. 3. 4.

● Countries you have visited (most recent first):

1. 2. 3. 4.

● Have you ever been in the military service? Yes No (if yes please complete)
Country: Type of Service:
Rank: Duration:
● Sponsorship Details: (if appl icable):
Initial Entry Port: Date: / / Sponsor:
Current Employer: Employment Date: / / Profession:
Address: Salary: Banker:
Residency No.: Issue Place: Issue Date: / / Expiry Date: / /
● Residence Details in UAE (if applicable):
Proprietor: Zone:
Street: House/Building No.: Floor No.: Flat No.:
City: Tel: Mobile: P.O.Box:
● Vehicle Details (if applicable):
Type: Registration Place: Plate No.: Plate Color:
D. License No.: Issue Place: Issue Date: / / Expiry Date: / /
○ I, the undersigned, undertake that details contained in this statement are correct and complete. ○ Enclosure: four passport-size photograph
and copy of a passport with at least six-month validity.

Date: 03 / 08/ 2023 Name __Bekalu Andargachew Signature :

P.O. Box: 25026, Tele + 971 2 6814244, Fax + 971 2 6810993

Web Site: www.hct.ac.ae
Abu Dhabi, United Arab Emirates