rSCz For Negative and Unable to Verify PSV Reports Only ‘Bid GA A fs Jay Ay a La Slay! Juels Application Details Pr prem ce ve nex cornu ra renin eee Par ema porde ene ee Set en eat are, . Peas Peeve ene eat nee ny eee) Licensing Authority for which PSV has been Coed eee oie Pa een ee ed Sy iss (a ty tt Age) tt yo ti i (14 Jd AD J Sa pe) LI ‘ Personal Details: Please give your name in ful (a per your Passport Natonal ID) and altematves where applicable. Maiden Name (ie. Family Name /Last/ Surname before mamiage) should be provided where appropriate CEN * Family Name (Last / Surname) ood * Given Name (First Name) Perron Sed EWE [emer PRE Ee weer 2 Job | io% Bsr i... re Sg 245k ater onl od 34803302 Identity Card No. Cyrene) eeeHaat al 1g eel a a ail ae pata yal) atl ak oe a Ang pa Bay MA Cote EN ag an Please provide full and clear name and address for the institution attended. Clearly indicate your qualification and the ‘exact name and address of the qualifying body. Do not use abbreviated terms or initials. bs Erajomeyen Tue gi 2b GV op GE SS eal GS) St eee Eewnip worm) peor pens Soe neat pace) Cpon Bom (> iF cy OD ATDNSLEE asker) por ere pee Lapeey irony en TRO Pekar DIPLOMA IN ELECTRICAL oT (eg. Master of Internal Medicine) ee pen mene in eet SCPE Ee nasi Renee 50122 | NO2\ Peete ere a 5 ey ey EH Ot | 19>) Con eee Preset eat coven cerry ac Comex eeee yy ree ee teeSpall BAG Gx fake ge ely Sat Clear uncut copy of degree ceticate Sipe gal CLI yy Mark sheet for sll years Sar gl RD Cia GY ALT a Sa amp / eal ye Letter from the University Institute establishing is acoredttation to a Governing education body in the country Bayt anal 5g J Proof of undated cerification!membership | Taka AGN Se Mp Bg JUS) alg Course completion cerificate from College/University Aaah Sy Lat yan 3 alg ld Functional official contact details ofthe Insitute/Univers (GEG pee GREEN) oe pe apg cata eal) pall Ja all lg? Gye GE | Copy ofthe backside on the degree certificate ( for applicants having Afghanistan, Egyptian & Pakistani | degreesicertficates)* SDE 5 Sf AES TGE GUM TGE) Baes Te A ol tt | cate, applicable (Marclage certificate, afidavit, any legol document, et.) | Date received: a SE | Name & signature : aa |Letter of Authorization I hereby authorize Saudi Council of Engineers, its authorized affiliates, agents and subsidiaries, acting on its behalf to verify information, documentation and background verification presented on my application form including but not limiting to education and employment. I hereby grant the authority for the bearer of this letter, with immediate effect, to release all necessary information to Saudi Council of Engineers, its authorized affiliates, agents and subsidiaries, This information / documentation may contain but is not limited to grades, dates of attendance, grade point average, degree I diploma certification, employment title, employment tenure, and any other information deemed necessary to conduct the verification of the information | documentation provided. hereby release all persons or entities requesting or supplying information from any liability arising from such disclosure. | am willing that a photocopy of this authorization be accepted with the same authority as the original. | further understand and acknowledge that this Information Release Form will remain valid for a period of two years following its completion. Personal Detai (In BLOCK letters) Azave Full Name. RAMAN (Cest/ Sumeme) (Fist Name) (Widele Name) Passport / Identity Card Number: BWOA SESH |22ZqBeBZor hel2 22}os |2022 —_—— Date (dammiyyyy)