‫اﻟرﻗم اﻟﻣرﺟﻌﻲ‪P220004F042O1M :‬‬ ‫دوﻟﮫ اﻹﻣﺎرات اﻟﻌرﺑﯾﺔ اﻟﻣﺗﺣدة‬

‫ﺗﺎرﯾﺦ اﻹﺻدار‪31/1/2022 :‬‬ ‫ﻣدﯾﻧﮫ اﻟﺷﯾﺦ ﺧﻠﯾﻔﮫ اﻟطﺑﯾﺔ‬

‫ﻣرﻛز اﻟﻔﺣص اﻟطﺑﻲ‬
‫ﺟﮭﺔ اﻹﺻدار‪ :‬ﻋﺟﻣﺎن‬

‫ﺷﮭﺎدة ﺧﻠو ﻣن اﻷﻣراض اﻟﺗﻲ ﺗﺷﻛل ﺧطرا ﻋﻠﻰ اﻟﺻﺣﺔ اﻟﻌﺎﻣﺔ‬

‫‪Free from Diseases That Pose a Threat to Public Health Certificate‬‬

‫ﺟدﯾد‬
‫‪New‬‬
‫‪Examination Applicant Details‬‬ ‫اﻟﺑﯾﺎﻧﺎت اﻟﺧﺎﺻﺔ ﺑطﺎﻟب اﻟﻔﺣص‬

‫)‪Name (in English‬‬ ‫‪UMAIR ALI MAHMOOD ALI‬‬ ‫اﻻﺳم )ﺑﺎﻟﻠﻐﺔ اﻹﻧﺟﻠﯾزﯾﺔ(‬
‫)‪Name (in Arabic‬‬ ‫ﻋﻣﯾر ﻋﻠﻰ ﻣﺣﻣود ﻋﻠﻰ‬ ‫اﻻﺳم )ﺑﺎﻟﻠﻐﺔ اﻟﻌرﺑﯾﺔ(‬
‫‪Date of Birth‬‬ ‫‪5/1/1998‬‬ ‫ﺗﺎرﯾﺦ اﻟﻣﯾﻼد‬
‫‪Gender‬‬ ‫‪Male‬‬ ‫ذﻛر‬ ‫اﻟﺟﻧس‬
‫‪Nationality‬‬ ‫‪Pakistan‬‬ ‫ﺑﺎﻛﺳﺗﺎن‬ ‫اﻟﺟﻧﺳﯾﺔ‬
‫‪Passport Number‬‬ ‫‪SJ1825631‬‬ ‫رﻗم ﺟواز اﻟﺳﻔر‬
‫‪Entry Permit / Residence No‬‬ ‫‪401/2022/2/0002580‬‬ ‫رﻗم إذن اﻟدﺧول ‪ /‬اﻹﻗﺎﻣﺔ‬
‫‪Unified Number‬‬ ‫‪68713144‬‬ ‫اﻟرﻗم اﻟﻣوﺣد‬
‫‪Profession‬‬ ‫‪ELECTRICIAN ASSISTANT‬‬ ‫ﻣﺳﺎﻋد ﻛﮭرﺑﺎﺋﻲ‬ ‫اﻟﻣﮭﻧﺔ‬
‫‪Address‬‬ ‫‪AJMAN‬‬ ‫اﻟﻌﻧوان‬
‫‪City / Emirate‬‬ ‫‪Ajman / Ajman‬‬ ‫ﻋﺟﻣﺎن ‪ /‬ﻋﺟﻣﺎن‬ ‫اﻟﻣدﯾﻧﺔ ‪ /‬اﻹﻣﺎرة‬
‫‪EmailAddress‬‬ ‫‪zajeluae70@gmail.com‬‬ ‫اﻟﺑرﯾد اﻹﻟﻛﺗروﻧﻲ‬
‫‪Phone‬‬ ‫‪0521334462‬‬ ‫ھﺎﺗف‬

‫‪Sponsor Details‬‬ ‫ﺑﯾﺎﻧﺎت اﻟﻛﻔﯾل‬

‫)‪Sponsor Name (in English‬‬ ‫‪AL MAJED ELECT REPAIRING‬‬ ‫)اﻻﺳم )ﺑﺎﻟﻠﻐﺔ اﻹﻧﺟﻠﯾزﯾﺔ(‬
‫)‪Sponsor Name (in Arabic‬‬ ‫اﻟﻣﺟد ﻻﺻﻼح اﻟﺗﻣدﯾدات اﻟﻛﮭرﺑﺎﺋﯾﺔ‬ ‫)اﻻﺳم )ﺑﺎﻟﻠﻐﺔ اﻟﻌرﺑﯾﺔ(‬
‫‪Address‬‬ ‫‪AJMAN‬‬ ‫اﻟﻌﻧوان‬
‫‪City / Emirate‬‬ ‫‪Ajman / Ajman‬‬ ‫ﻋﺟﻣﺎن ‪ /‬ﻋﺟﻣﺎن‬ ‫اﻟﻣدﯾﻧﺔ ‪ /‬اﻹﻣﺎرة‬
‫‪EmailAddress‬‬ ‫‪zajeluae70@gmail.com‬‬ ‫اﻟﺑرﯾد اﻹﻟﻛﺗروﻧﻲ‬
‫‪Phone‬‬ ‫‪065290859‬‬ ‫ھﺎﺗف‬

‫‪For the Center Use Only‬‬ ‫ﺧﺎص ﺑﺎﺳﺗﻌﻣﺎل اﻟﻣرﻛز ﻓﻘط‬

‫‪Examination Number‬‬ ‫‪P220004F042O1M‬‬ ‫رﻗم اﻟﻔﺣص‬
‫‪Examination Date‬‬ ‫‪31/1/2022‬‬ ‫ﺗﺎرﯾﺦ إﺟراء اﻟﻔﺣص‬
‫اﺳﺗﻧﺎدا إﻟﻰ اﻟﻘﺎﻧون اﻻﺗﺣﺎدي رﻗم ‪ 27‬ﻟﻌﺎم ‪ 1981‬وﻗرار ﻣﺟﻠس اﻟوزراء رﻗم )‪ (7‬ﻟﺳﻧﺔ ‪ 2008‬ﺑﺷﺄن ﻧظﺎم اﻟﻔﺣص اﻟطﺑﻲ ﻟﻠواﻓدﯾن ﻟﻠدوﻟﺔ ﻟﻠﻌﻣل أو اﻹﻗﺎﻣﺔ وﻛﺎن آﺧر ﺗﻌدﯾل ﻟﮫ ﻓﻲ ‪ ،2016‬ﻓﻘد ﺗم إﺟراء‬
‫اﻟﻔﺣص اﻟطﺑﻲ اﻟﻼزم ﻟﻠﻣذﻛور أﻋﻼه وﻛﺎﻧت اﻟﻧﺗﯾﺟﺔ‬

‫‪Medically Fit‬‬ ‫ﻻﺋﻖ طﺑﯾﺎ‬

‫ﺻﻼﺣﯾﮫ ھذه اﻟﺷﮭﺎدة ﺛﻼﺛﺔ )‪ (3‬أﺷﮭر ﻣن ﺗﺎرﯾﺦ إﺟراء اﻟﻔﺣص اﻟطﺑﻲ‪.‬‬
‫‪..............................................................................................................‬‬ ‫اﺳم اﻟطﺑﯾب اﻟﻣﺧﺗص‬
‫اﻟﺧﺗم اﻟرﺳﻣﻲ‬ ‫‪...............................................‬‬ ‫ﺗوﻗﯾﻊ اﻟطﺑﯾب اﻟﻣﺧﺗص‬
‫ھذه اﻟﺷﮭﺎدة اﻟﻛﺗروﻧﯾﺔ اﻟﺗﺣﻘﻖ ﻣن ﺻﺣﺔ اﻟﺷﮭﺎدة ﻣن ﺧﻼل اﻟﻣوﻗﻊ‬
‫‪http://laiq.ae/FrontOffice/HealthFitness/Inquiry/FitnessInquiry‬‬