‫‪Critical Infrastructure & Coastal Protection Authority‬‬ ‫ﺟﻬﺎﺯ ﺣﻤﺎﻳﺔ ﺍﻟﻤﻨﺸﺂﺕ ﺍﻟﺤﻴﻮﻳﺔ ﻭﺍﻟﺴﻮﺍﺣﻞ‬

‫‪Infrastructure Permt’s Department‬‬ ‫ﺷﻌﺒﺔ ﺗﺼﺎﺭﻳﺢ ﺍﻟﻤﻨﺸﺂﺕ ﺍﻟﺤﻴﻮﻳﺔ‬

‫*‬
‫ﻭﺛـﻴـﻘـــﺔ ﺗــﻌــــﺎﺭﻑ ‪Introduction Form‬‬

‫ﻧﻤــﻮﺫﺝ ﺭﻗـــﻢ )‪(7‬‬

‫‪Applicant’s Details‬‬ ‫ﺑﻴﺎﻧﺎﺕ ﺍﻟﺸﺨﺺ‬
‫‪Full Name‬‬ ‫ﺍﻹﺳـﻢ ﺑـﺎﻟﻜــﺎﻣﻞ‬
‫‪Nickname‬‬ ‫‪//‬‬ ‫‪ Surname‬ﺇﺳـﻢ ﺍﻟـﺸـﻬــﺮﺓ‬ ‫ﺇﺳـــﻢ ﺍﻟـﻌــﺎﺋـﻠـﺔ‬
‫‪Previous Nationality‬‬ ‫‪ Nationality‬ﺍﻟﺠﻨﺴﻴﺔ ﺍﻟﺴﺎﺑﻘﺔ‬ ‫ﺍﻟﺠﻨﺴﻴـﺔ ﺍﻟـﺤﺎﻟﻴﺔ‬
‫‪Place Of Birth‬‬ ‫‪ Religion /Doctrine‬ﻣـﻜـﺎﻥ ﺍﻟـﻤـﻴﻼﺩ‬ ‫ﺍﻟﺪﻳـﺎﻧـﺔ‪/‬ﺍﻟﻤﺬﻫﺐ‬
‫‪Date Of Entry‬‬ ‫‪ Date Of Birth‬ﺗــﺎﺭﻳـﺦ ﺍﻟـﺪﺧﻮﻝ‬ ‫ﺗــــﺎﺭﻳﺦ ﺍﻟـﻤﻴـﻼﺩ‬
‫ﺍﻟﺼــــﻮﺭﺓ ‪Photograph‬‬
‫‪(6 X 4) cm‬‬ ‫‪Port of Entry‬‬ ‫ﻣـﺮﻛــﺰ ﺍﻟـﺪﺧﻮﻝ‬ ‫‪Sponsor’s Name‬‬ ‫‪EURO MECHANICAL & ELECTRICAL CONTRACTING CO. LLC‬‬ ‫ﺍﻟﻜﻔﻴﻞ ﻋﻨﺪ ﺍﻟﺪﺧﻮﻝ‬

‫‪Office Tel.‬‬ ‫‪026781133‬‬ ‫ﻫﺎﺗﻒ ﺍﻟﻌﻤﻞ‬ ‫‪Current Sponsor‬‬ ‫ﺍﻟـﻜﻔﻴـﻞ ﺍﻟﺤــﺎﻟـﻲ ‪EURO MECHANICAL & ELECTRICAL CONTRACTING CO. LLC‬‬
‫‪Occupation‬‬ ‫‪ Work Location‬ﺍﻟـــﻤـﻬــﻨــﺔ‬ ‫‪ABU DHABI‬‬ ‫ﻣـﻜــــﺎﻥ ﺍﻟـﻌـﻤـﻞ‬
‫‪Bank‬‬ ‫‪ Salary‬ﺍﻟﺒــﻨـــــــﻚ‬ ‫ﺍﻟــــﺮﺍﺗـــﺐ‬

‫‪Place of Issue‬‬ ‫‪ Passport No.‬ﻣﻜـﺎﻥ ﺍﻹﺻـﺪﺍﺭ‬ ‫ﺭﻗﻢ ﺍﻟﺠﻮﺍﺯ‪/‬ﺍﻟﻮﺛﻴﻘﺔ‬

‫‪Expiry Date‬‬ ‫‪ Date Of Issue‬ﺗـﺎﺭﻳـﺦ ﺍﻹﻧﺘﻬـﺎﺀ‬ ‫ﺗـــﺎﺭﻳـﺦ ﺍﻹﺻـﺪﺍﺭ‬
‫‪Place Of Issue‬‬ ‫‪ Residence No.‬ﻣـﻜـﺎﻥ ﺍﻹﺻـﺪﺍﺭ‬ ‫ﺭﻗـــــﻢ ﺍﻹﻗـــﺎﻣـﺔ‬
‫‪Expiry Date‬‬ ‫‪ Date Of Issue‬ﺗــﺎﺭﻳـﺦ ﺍﻹﻧﺘﻬﺎﺀ‬ ‫ﺗــﺎﺭﻳـﺦ ﺍﻹﺻــﺪﺍﺭ‬

‫‪Education‬‬ ‫ﺍﻟـﻤﺆﻫﻞ ﺍﻟﺪﺭﺍﺳﻲ‬

‫‪College/University‬‬ ‫‪ Graduation‬ﺍﻟﻤﺪﺭﺳﺔ‪/‬ﺍﻟﺠﺎﻣﻌﺔ‬ ‫ﺗـﺎﺭﻳــﺦ ﺍﻟـﺘـﺨــﺮﺝ‬
‫‪Place Of Issue‬‬ ‫‪//‬‬ ‫‪ Residence No.‬ﻣـﻜـﺎﻥ ﺍﻹﺻــﺪﺍﺭ‬ ‫‪//‬‬ ‫ﺭﻗـــﻢ ﺍﻹﻗــــــﺎﻣﺔ‬
‫‪Country‬‬ ‫‪ Languages‬ﺍﻟــﺪﻭﻟــﺔ‬ ‫ﺍﻟﻠــﻐــــــﺎﺕ‬

‫‪Spouse Name‬‬ ‫‪ Martial Status‬ﺇﺳﻢ ﺍﻟﺰﻭﺝ‪/‬ﺍﻟﺰﻭﺟﺔ‬ ‫ﺍﻟﺤﺎﻟﺔ ﺍﻹﺟﺘﻤﺎﻋﻴﺔ‬

‫‪Place Of Birth‬‬ ‫‪ Nationality‬ﻣـﻜــﺎﻥ ﺍﻟـﻤﻴﻼﺩ‬ ‫ﺍﻟﺠﻨﺴﻴﺔ‬
‫‪Employer‬‬ ‫‪ Occupation‬ﻣﻜﺎﻥ ﺍﻟﻌﻤﻞ‬ ‫ﺍﻟﻤﻬﻨﺔ‬ ‫‪Date Of Birth‬‬ ‫ﺗﺎﺭﻳﺦ ﺍﻟﻤﻴﻼﺩ‬

‫‪Children Names‬‬ ‫ﺃﺳﻤـﺎﺀ ﺍﻷﺑﻨـﺎﺀ‬

‫‪5‬‬ ‫‪1‬‬
‫‪6‬‬ ‫‪2‬‬
‫‪7‬‬ ‫‪3‬‬
‫‪8‬‬ ‫‪4‬‬

‫‪Nationality‬‬ ‫‪ Father’s Name‬ﺍﻟـﺠــﻨـﺴــــــﻴـﺔ‬ ‫ﺇﺳـــــﻢ ﺍﻷﺏ‬

‫‪Date Of Bith‬‬ ‫‪ Place Of Birth‬ﺗـﺎﺭﻳــﺦ ﺍﻟـﻤﻴﻼﺩ‬ ‫ﻣـﻜــﺎﻥ ﺍﻟـﻤـﻴـﻼﺩ‬
‫‪Occupation‬‬ ‫‪ Employer‬ﺍﻟـﻤــﻬــﻨــﺔ‬ ‫ﻣـﻜــﺎﻥ ﺍﻟــﻌـﻤـﻞ‬
‫‪Nationality‬‬ ‫‪ Mother’s Name‬ﺍﻟـﺠـﻨـﺴـﻴﺔ‬ ‫ﺇﺳــــﻢ ﺍﻷﻡ‬

‫‪Date Of Bith‬‬ ‫‪ Place Of Birth‬ﺗـﺎﺭﻳــﺦ ﺍﻟـﻤﻴﻼﺩ‬ ‫ﻣـﻜـﺎﻥ ﺍﻟــﻤﻴــﻼﺩ‬

‫‪Occupation‬‬ ‫‪ Employer‬ﺍﻟـﻤــﻬــﻨــﺔ‬ ‫ﻣـﻜـﺎﻥ ﺍﻟـــﻌــﻤـﻞ‬

‫‪* The document should be hand written in Arabic for Arabs‬‬ ‫* ﻛـﺘــﺎﺑﺔ ﺍﻟـﻮﺛﻴـﻘـﺔ ﺑــﺨـﻂ ﺍﻟـﻴـﺪ ﺑـﺎﻟﻨﺴﺒﺔ ﻟﻠــﻌــﺮﺏ ﺃﻭ ﻣــﻦ ﺃﺻــﻞ‬
‫‪nationals & English typing for other nationalities.‬‬ ‫ﻋـﺮﺑـﻲ ﺃﻣـﺎ ﺑـﺎﻟﻨﺴﺒﺔ ﻟﻸﺟـﺎﻧـﺐ ﻃﺒـﺎﻋـﺔ ﺍﻟﻮﺛﻴﻘﺔ ﺑﺎﻟﻠﻐﺔ ﺍﻹﻧﺠﻠﻴﺰﻳﺔ‪.‬‬
 Relatives ‫ﺍﻷﻗﺎﺭﺏ‬
Employer ‫ﺟﻬﺔ ﺍﻟﻌﻤﻞ‬ Nationality ‫ﺍﻟﺠﻨﺴﻴﺔ‬ Name ‫ﺍﻹﺳــﻢ‬ #
1
// // // 2
/ // // 3

Friends ‫ﺍﻷﺻﺪﻗﺎﺀ‬
Employer ‫ﺟﻬﺔ ﺍﻟﻌﻤﻞ‬ Nationality ‫ﺍﻟﺠﻨﺴﻴﺔ‬ Name ‫ﺍﻹﺳــﻢ‬ #
1
// // // 2
// // // 3

Residence Address ‫ﺑﻴﺎﻧﺎﺕ ﺍﻟﺴﻜﻦ‬

Street 10TH STREET ‫ ﺍﻟــﺸــــﺎﺭﻉ‬Location AL ZAHIYA ‫ﺍﻟﻤﻨـﻄــﻘــﺔ‬
Bldg. No. 7121 ‫ﺍﻟﺒﻨﺎﻳﺔ‬/‫ ﺭﻗﻢ ﺍﻟﻤﻨﺰﻝ‬Landlord AL HURR AL SUWAIDI ‫ﺇﺳﻢ ﺍﻟﻤﺎﻟﻚ‬
Flat No. 102 ‫ ﺭﻗﻢ ﺍﻟﺸﻘﺔ‬Floor FIRST ‫ﺍﻟـﻄـــﺎﺑــﻖ‬
Mobile No. ‫ ﺍﻟﻬﺎﺗﻒ ﺍﻟﻤﺘﺤﺮﻙ‬Telephone 026781133 ‫ﺭﻗﻢ ﺍﻟﻬﺎﺗﻒ‬

P.O.Box 46153 ‫ ﺻﻨـﺪﻭﻕ ﺍﻟـﺒـﺮﻳﺪ‬Pager NIL ‫ﺭﻗﻢ ﺍﻟﻨﺪﺍﺀ ﺍﻟﻌﺎﻡ‬

Previous Occupation in UAE ‫ﺍﻷﻋﻤﺎﻝ ﺍﻟﺘﻲ ﻣﺎﺭﺳﺘﻬﺎ ﺩﺍﺧﻞ ﺍﻟﺪﻭﻟﺔ‬

// 3 // 1
// 4 // 2

Countries you visited ‫ﺍﻟﺪﻭﻝ ﺍﻟﺘﻲ ﺳﺒﻖ ﻟﻚ ﺯﻳﺎﺭﺗﻬﺎ‬

// 4 1
// 5 2
// 6 // 3

Countries you worked with ‫ﺍﻟﺪﻭﻝ ﺍﻟﺘﻲ ﺳﺒﻖ ﻟﻚ ﺍﻟﻌﻤﻞ ﺑﻬﺎ‬

// 4 1
// 5 2
// 6 // 3

Car Information ‫ﺑﻴﺎﻧﺎﺕ ﺍﻟﻤﺮﻛﺒﺔ‬

Place Of Regis. // ‫ ﺟﻬﺔ ﺍﻟﺘﺮﺧﻴﺺ‬Car Brand // ‫ﻧﻮﻉ ﺍﻟﻤﺮﻛﺒﺔ‬
Plate Color // ‫ ﻟــــﻮﻥ ﺍﻟﻠﻮﺣﺔ‬Plate No. // ‫ﺭﻗﻢ ﺍﻟﻠﻮﺣﺔ‬
Place Of Issue // ‫ ﻣﻜﺎﻥ ﺍﻹﺻﺪﺍﺭ‬License No. // ‫ﺭﻗﻢ ﺭﺧﺼﺔ ﺍﻟﻘﻴﺎﺩﺓ‬
Expiry Date // ‫ ﺍﻟﻬﺎﺗﻒ ﺍﻟﻤﺘﺤﺮﻙ‬Date Of Issue // ‫ﺗﺎﺭﻳﺦ ﺍﻹﺻﺪﺍﺭ‬

Have you served in the Military Service: Yes No ‫ﻻ‬ ‫ﻧﻌﻢ‬ :‫ﻫﻞ ﺳﺒﻖ ﻟﻚ ﺍﻟﻌﻤﻞ ﻓﻲ ﺍﻟﻤﺠﺎﻝ ﺍﻟﻌﺴﻜﺮﻱ‬
Level Of Service ‫ ﻧــــﻮﻉ ﺍﻟﺨﺪﻣﺔ‬Country ‫ﺇﺳﻢ ﺍﻟﺪﻭﻟﺔ‬
Date Of Service ‫ ﻣــــﺪﺓ ﺍﻟﺨﺪﻣﺔ‬Rank ‫ﺍﻟﺮﺗﺒﺔ‬

I, Undersigned certify that all the above statement are ‫ﺃﺗﻌﻬﺪ ﺃﻧﺎ ﺍﻟﻤﻮﻗﻊ ﺃﺩﻧﺎﻩ ﺑﺄﻥ ﺍﻟﺒﻴﺎﻧﺎﺕ ﺍﻟﻮﺍﺭﺩﺓ ﺑﻬﺬﻩ ﺍﻟﻮﺛﻴﻘﺔ‬
correct & complete. .‫ﺻﺤﻴﺤﺔ ﻭﻛﺎﻣﻠﺔ‬

Date ‫ﺍﻟﺘﺎﺭﻳﺦ‬ Signature ‫ﺍﻟﺘﻮﻗﻴﻊ‬ Name AL ‫ﺍﻹﺳـــﻢ‬

Include the following with this statement: :‫ﺍﻟﻤﺮﻓﻘﺎﺕ ﺍﻟﻤﻄﻠﻮﺑﺔ‬

Photographs & Passport Copy. .‫ﺻﻮﺭ ﺷﻤﺴﻴﺔ ﻭ ﺻﻮﺭﺓ ﺟﻮﺍﺯ ﺍﻟﺴﻔﺮ‬