MIN

NISTRY OF HIGHE
ER EDUCATION

KIN
NG FAHD UNIV
VERSITY OF PETROLEUM
P
& MINERALS

STUDENT AF
FFAIRS

)

Exit Re-Entry Appllication Form (Studen
)nts Only

PHOTOGRAPH
H OF
PASSPORT HOLLDER

Single Exxit / Re-Entry Visa

V
Final Exit Visa

Date
__________ e:
___

___
___________
_:

To:
FACULTY & PERSONNEL SERVICES DEPA
ARTMENT
m: STUDENT AFFFAIRS
From

.

:
.
:

RESIDENT PERMIT
P
(IQAMA
A) #

Please Issue the vvisa to the follo

owing studentt.

NATIONALITY

STUDENT NAM
ME

RESIDENTT PERMIT
Version
)( )Exxpiry Date (Hijri

R
RETURN DATE

STUDENTT ID #

DEPARTURE
E DATE

) (
CONTA
ACT DETAILS A
ABROAD

PURPOSE OF TRAVEL

) (
CONTACTT DETAILS (SAU
)UDI ARABIA

Telepphone:

Mobiile:

:
:

MOBILE:
Addreess at KFUPM:

Room
m No:____________________________________:

Addrress:

Building No:__________________________________:

Emaiil:

Tel:______________________________________________:

Sulim
man M. S. Al-Ngaamshi

Direcctor, Study Grantss & Scholarship Dept.

Deanship of Student Affairs
A

-
.1

.2
.3

.4
.5
.6
.7
.8

IMPO
ORTANT INSTRU
UCTIONS:

180 ..

90
21 (613
)
. 10000

. . 90 .
.

.

5 60 )( .

1. Filll this form and geet it signed by Dirrector General Student Affairs, annd submit it
to the office of Faculty & Personnell Services along with a recent paassport size
phootograph of the ppassport holder.
2. Validity of Exit Re--Entry visa to staay outside the Kingdom is subjecct to Iqama
Expiry (Maximum 180days form the day of departuree).
3. If the Single or Multiple Exit Re-Enttry visa is not ussed within 90 dayys from the
issue date, it must bbe returned to the Faculty & Perssonnel Services D
Department
(Buuilding. 21 Rooom: 613) for FR
REE cancellation at least a weekk before its
exppiry date. A Penaalty of SR1000 will
w be charged foor its late cancelllation after
thee expiration of 90 days period
4. Noo visa fee will be ccharged from stuudents.
5. Hijri calendar should be used for callculating the visa validity.
6. Uppon receiving thee passport along with Exit Re-Entry visa, the Residence
Permit (Original Iqaama) should be returned back to
t the Faculty & Personnel
Services Department.
7. The Passport muust be returnedd to the Faculty & Personneel Services
Deepartment after reeturning from vaccation.
8. Submit the form 5-660 working days before your depaarture date.
I haave read and understand the instruuctions written abbove.

Sttudents Signatuure