‫ﺗﺼﺮﻳﺢ ﻋﻮﺩﺓ ﻣﻘﻴﻢ ﺧﺎﺭﺝ ﺍﻟﺪﻭﻟﺔ‬

Return Permit for Resident outside UAE

File No: 20120197242581 :‫ﺭﻗﻢ ﺍﻟﻤﻠﻒ‬

File Expiry Date: 2022-07-13 :‫ﺗﺎﺭﻳﺦ ﺍﻧﺘﻬﺎﺀ ﺍﻟﻤﻠﻒ‬

Return Permit Approval Date: 2020-07-28 :‫ﺗﺎﺭﻳﺦ ﺍﻟﻤﻮﺍﻓﻘﺔ ﻋﻠﻰ ﺗﺼﺮﻳﺢ ﺍﻟﻌﻮﺩﺓ‬

Return Permit Expiry Date: 2020-08-26 :‫ﺗﺎﺭﻳﺦ ﺍﻧﺘﻬﺎﺀ ﺗﺼﺮﻳﺢ ﺍﻟﻌﻮﺩﺓ‬

Personal Information ‫ﺍﻟﺒﻴﺎﻧﺎﺕ ﺍﻟﺸﺨﺼﻴﺔ‬

Name: LLOYD OKWIRI KAMPUNGA ‫ﻟﻮﻳﺪ ﺍﻭﻛﻮﻳﺮﻯ ﻛﺎﻣﺒﺎﻧﺠﺎ‬ :‫ﺍﻻﺳﻢ‬

Nationality: KENYA ‫ﻛﻴﻨﻴﺎ‬ :‫ﺍﻟﺠﻨﺴﻴﺔ‬

Profession: CHAMBERMAN/CHAMBERMAID ‫ﻏﺮﻑ ﺍﻟﻔﻨﺎﺩﻕ‬/‫ﻋﺎﻣﻞ ﺗﻨﻈﻴﻒ‬ :‫ﺍﻟﻤﻬﻨﺔ‬

Passport Number: AK0224483 :‫ﺭﻗﻢ ﺍﻟﺠﻮﺍﺯ‬

Sponsor Information ‫ﺑﻴﺎﻧﺎﺕ ﺍﻟﻜﻔﻴﻞ‬

Sponsor Name: ADDRESS BOULEVARD L.L.C ‫ﻡ‬.‫ﻡ‬.‫ﺫ‬.‫ﺍﻟﻌﻨﻮﺍﻥ ﺑﻮﻟﻴﻔﺎﺭﺩ ﺵ‬ :‫ﺍﺳﻢ ﺍﻟﻜﻔﻴﻞ‬

File No: 21289315 :‫ﺭﻗﻢ ﺍﻟﻤﻠﻒ‬ Sponsor Type: Establishment ‫ﻣﻨﺸﺄﺓ‬ :‫ﺳﻤﺔ ﺍﻟﻜﻔﻴﻞ‬

I, the undersigned, undertake to bear the expenses of quarantine,

‫ﺃﺗﻌﻬﺪ ﺑﺘﺤﻤﻞ ﻣﺼﺎﺭﻳﻒ ﺍﻟﺤﺠﺮ ﺍﻟﺼﺤﻲ ﻭﺍﻟﻌﻼﺝ ﻭﻛﺎﻓﺔ ﺍﻟﻨﻔﻘﺎﺕ ﺍﻟﻤﺘﺮﺗﺒﺔ ﻓﻲ ﺣﺎﻟﺔ‬
treatment and all expenses incurred if I am infected by COVID -19
.‫ ﻳﻮﻡ ﻣﻦ ﺗﺎﺭﻳﺦ ﺍﻟﺪﺧﻮﻝ‬14 ‫ ﺧﻼﻝ ﻓﺘﺮﺓ‬19 ‫ﺍﻹﺻﺎﺑﺔ ﺑﻤﺮﺽ ﻛﻮﻓﻴﺪ‬
disease during the 14-day period from the date of entry.
‫ﺍﻋﺘﻤﺎﺩ ﺍﻹﺩﺍﺭﺓ ﺍﻟﻌﺎﻣﺔ ﻟﻺﻗﺎﻣﺔ ﻭﺷﺆﻭﻥ ﺍﻷﺟﺎﻧﺐ – ﺩﺑﻲ‬