GROUP REQUEST FORM

‫إ ﺳ ﺘ ﻤﺎ ر ة ﺣ ﺠ ﺰ ﻣ ﻮ ﻋ ﺪ ﻟ ﻠ ﻤ ﺠ ﻤ ﻮ ﻋ ﺔ‬

GROUP ID ‫رﻗ ﻢ اﻟ ﻤ ﻮ ﻋﺪ ﻟﻠ ﻤ ﺠ ﻤ ﻮ ﻋ ﺔ‬

Date : 11-Jul-2021 Time : 16:34

Appointment Type
GROUP Agent Name & ID EL YANBOA
‫ﻧ ﻮ ع اﻟ ﻤ ﻮ ﻋﺪ‬ ‫إ ﺳ ﻢ اﻟ ﻮ ﻛﯿ ﻞ و ر ﻗ ﻤ ﻪ‬ ELYANBOA

Appointment Category NORMAL LOUNGE No. of Applicants

‫ﻓﺌ ﺔ اﻟ ﻤ ﻮ ﻋﺪ‬ ‫ﻋ ﺪ د ﻣﻘ ﺪ ﻣ ﻲ ا ﻟ ﻄ ﻠ ﺒﺎ ت‬ 1

Appointment Date
12-Jul-2021 Visa Service Center Address Smouha – 14 May Bridge, next to Al Nasr Club –
‫ﺗﺎ ر ﯾ ﺦ ا ﻟ ﻤ ﻮ ﻋﺪ‬
‫ﻋ ﻨ ﻮ ا ن ﻣ ﺮ ﻛ ﺰ ﺧ ﺪ ﻣ ﺔ ا ﻟ ﺘﺄ ﺷ ﯿ ﺮ ا ت‬ Smouha Grand Tower - Alexandria
Appointment Time
10:30
‫اﻟ ﻮ ﻗ ﺖ اﻟ ﻤ ﺤﺪد ﻟﻠ ﻤ ﻮ ﻋﺪ‬
S.No. AppRef No. Passport Number Name Appointment Time

1 A28447268 ESLAM ELSHEIRY 10:30

The consolidated amount to be paid at the VSC center is displayed below

‫ﯾ ﺘ ﻢ د ﻓ ﻊ ﻣ ﺠ ﻤ ﻮ ع ا ﻟ ﻤ ﺒﺎ ﻟ ﻎ ا ﻟ ﻤﺬ ﻛ ﻮ ر ة أد ﻧﺎ ه ﻓ ﻲ ﻣ ﺮ ﻛ ﺰ ﺧﺪ ﻣ ﺔ ا ﻟ ﺘﺄ ﺷ ﯿ ﺮ ا ت‬
Name Unit Fee(in EGP) No. of Applicants Amount in EGP
‫اﻹﺳﻢ‬ ‫ﻋ ﺪ د ﻣ ﻘ ﺪ ﻣ ﻲ ا ﻟ ﻄ ﻠ ﺒﺎ ت‬

Agent Bio Normal 75.00 1 75.00

GST 14.00 % for Agent Bio Normal 1 10.50

Total 85.50

To Be Paid 85.50
Instructions : ‫اﻟﺘ ﻌﻠﯿ ﻤﺎ ت‬
1. If granted the visa I shall abide by all the laws and regulations of the Kingdom of Saudi Arabia and respect the Islamic customs and traditions of its people.

‫ ﻓ ﻲ ﺣﺎ ل ﺣ ﺼ ﻮ ﻟ ﻲ ﻋ ﻠ ﻰ ا ﻟ ﺘﺄ ﺷ ﯿ ﺮ ة ﻋ ﻠ ﻲ أ ن أ ﻟ ﺘ ﺰ م ﺑ ﺠ ﻤ ﯿ ﻊ ا ﻟ ﻘ ﻮ ا ﻧ ﯿ ﻦ و ا ﻷ ﻧ ﻈ ﻤ ﺔ ا ﻟ ﻤ ﻌ ﻤ ﻮ ل ﺑ ﻬﺎ ﻓ ﻲ ا ﻟ ﻤ ﻤ ﻠ ﻜ ﺔ ا ﻟ ﻌ ﺮ ﺑ ﯿ ﺔ ا ﻟ ﺴ ﻌ ﻮ د ﯾ ﺔ و إ ﺣ ﺘ ﺮ ا م ا ﻟ ﻌﺎ د ا ت و ا ﻟ ﺘ ﻘﺎ ﻟ ﯿ ﺪ ا ﻹ ﺳ ﻼ ﻣ ﯿ ﺔ ﻟ ﺸ ﻌ ﺒ ﻬﺎ‬.

2. I am also fully aware that the crime of smuggling narcotics and other illegal drugs into the Kingdom of Saudi Arabia is punishable by the death penalty.

‫إﻧﻨﻲ أدرك ﺗﻤﺎﻣﺎ أن ﺟﺮﯾﻤﺔ ﺗﻬﺮﯾﺐ اﻟﻌﻘﺎﻗﯿﺮ اﻟﻤﺨﺪرة واﻟﻤﺨﺪرات ﻏﯿﺮ اﻟﻤﺸﺮوﻋﺔ اﻷﺧﺮى إﻟﻰ اﻟﻤﻤﻠﻜﺔ اﻟﻌﺮﺑﯿﺔ اﻟﺴﻌﻮدﯾﺔ ﻣﻌﺎﻗﺐ ﻋﻠﯿﻬﺎ ﺑﺎﻹﻋﺪام‬.

3. I have never been removed, excluded or deported from the Kingdom of Saudi Arabia or from any other Gulf Cooperation Council member state or charged with violation of any law or regulation
thereof.

‫ ﻟ ﻢ ﯾ ﺴ ﺒ ﻖ أ ن ﺗ ﻢ إ ﺳ ﺘ ﺒ ﻌﺎ د ي أ و ﺗ ﺮ ﺣ ﯿ ﻠ ﻲ ﻣ ﻦ ا ﻟ ﻤ ﻤ ﻠ ﻜ ﺔ ا ﻟ ﻌ ﺮ ﺑ ﯿ ﺔ ا ﻟ ﺴ ﻌ ﻮ د ﯾ ﺔ أ و ﻣ ﻦ أ ي د و ﻟ ﺔ ﻋ ﻀ ﻮ ﻓ ﻲ ﻣ ﺠ ﻠ ﺲ ا ﻟ ﺘ ﻌﺎ و ن ﻟ ﺪ و ل ا ﻟ ﺨ ﻠ ﯿ ﺞ ا ﻟ ﻌ ﺮ ﺑ ﯿ ﺔ أ و ﺗ ﻢ إ ﺗ ﻬﺎ ﻣ ﻲ ﺑ ﻤ ﺨﺎ ﻟ ﻔ ﺔ أ ي ﻣ ﻦ ﻗ ﻮ ا ﻧ ﯿ ﻨ ﻬﺎ أ و أ ﻧ ﻈ ﻤ ﺘ ﻬﺎ‬.

4. I am aware that all alcoholic everages, narcotics and other illegal drugs, pornographic materials or publications, which violate the social norms of decency and all other publications, which are
disrespectful of any religious belief or political orientation, are prohibited and shall not be brought into the Kingdom of Saudi Arabia

‫ أ ﻣ ﻮ ر ﻣ ﺤ ﻈ ﻮ ر ة ﻻ‬، ‫ و ا ﻟ ﺘ ﻲ ﺗ ﻨ ﺘ ﻬ ﻚ ا ﻷ ﻋ ﺮ ا ف ا ﻻ ﺟ ﺘ ﻤﺎ ﻋ ﯿ ﺔ ﻣ ﻦ ا ﻟ ﺤ ﺸ ﻤ ﺔ و ﺟ ﻤ ﯿ ﻊ ا ﻹ ﺟ ﺮ ا ء ا ت ا ﻟ ﻌﺎ ﻣ ﺔ ا ﻷ ﺧ ﺮ ى و ﻋ ﺪ م إ ﺣ ﺘ ﺮ ا م أ ي ﻣ ﻌ ﺘ ﻘ ﺪ د ﯾ ﻨ ﻲ أ و ﺗ ﻮ ﺟ ﻪ ﺳ ﯿﺎ ﺳ ﻲ‬، ‫ ا ﻟ ﻤ ﻮ ا د ا ﻹ ﺑﺎ ﺣ ﯿ ﺔ ﻣ ﻦ ر ﺳ ﻮ ﻣﺎ ت أ و أ ﻋ ﻤﺎ ل ﻋﺎ ﻣ ﺔ‬، ‫ ا ﻟ ﻤ ﺨ ﺪ ر ا ت و ا ﻟ ﻌ ﻘﺎ ﻗ ﯿ ﺮ ا ﻟ ﻐ ﯿ ﺮ ﻗﺎ ﻧ ﻮ ﻧ ﯿ ﺔ ا ﻷ ﺧ ﺮ ى‬، ‫أ ﻧﺎ أ د ر ك ﺗ ﻤﺎ ﻣﺎ أ ن ﺟ ﻤ ﯿ ﻊ ا ﻟ ﻤ ﺸ ﺮ و ﺑﺎ ت ا ﻟ ﻜ ﺤ ﻮ ﻟ ﯿ ﺔ‬

‫ ﯾ ﺠ ﻮ ز إ د ﺧﺎ ﻟ ﻬﺎ ا ﻟ ﻰ ا ﻟ ﻤ ﻤ ﻠ ﻜ ﺔ ا ﻟ ﻌ ﺮ ﺑ ﯿ ﺔ ا ﻟ ﺴ ﻌ ﻮ د ﯾ ﺔ‬.