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Notice: Kindly fill the form in English ‫ اﻟرﺟﺎء ﺗﻌﺑﺋﺔ اﻟﻧﻣوذج ﺑﺎﻟﻠﻐﮫ اﻹﻧﺟﻠﯾزﯾﺔ‬: ‫ﺗﻧوﯾﺔ‬

(‫اﻟﻘﺳﺎﺋم‬/‫ طﺎﻟب اﻟﺗﺣوﯾل ﻟـ)اﻟﺗذاﻛر‬/ ‫ﻣﻌﻠوﻣﺎت اﻟﻣﺳﺎﻓرﯾن‬


Passengers information / Requester of transference (Tickets / EMDs)
‫رﻗﻢ اﻟﮭﻮﯾﺔ‬ ‫رﻗﻢ اﻟﮭﻮﯾﺔ‬ ‫رﻗم ﻗﺳﯾﻣﺔ اﻟﻣﺑﻠﻎ‬
‫اﻟﻘﺳﯾﻣﺔ اﻟﻣراد‬/‫رﻗم اﻟﺗذﻛرة‬
‫دﻣﺞ‬ ‫أﺳم اﻟﺿﯾف ﻋﻠﻰ اﻟﺗذﻛرة‬ ‫اﻹﻗﺎﻣﺔ‬/‫اﻟﻮطﻨﯿﺔ‬ ‫إﺳم اﻟﺿﯾف اﻟﺟدﯾد‬ ‫اﻹﻗﺎﻣﺔ‬/‫اﻟﻮطﻨﯿﺔ‬ ‫ﺻﻠﺔ اﻟﻘراﺑﺔ‬ ‫رﻗم اﻟﺗذﻛرة اﻟﺟدﯾدة‬
‫اﻟﺠﻮاز ﻟﻄﺎﻟﺐ اﻟﺘﺤﻮﯾﻞ‬/ ‫ﺗﺣوﯾﻠﮭﺎ‬ ‫اﻟﺠﻮاز ﻟﻠﻤﺤﻮل ﻟﮫ‬/ (‫اﻟﻣﺗﺑﻘﻰ )ان وﺟدت‬
transferee Transferee
National ID/ National ID/ Resedual value
Merge Guest name on the ticket Tickets / EMDs no New Guest name Relationship New Ticket no.
Iqamah/ Iqamah/ EMD (if any)
Passport Passport
HASSAN/IBRAHIM N016340643 065-3916622113 HASSAN/MOHAMMAD N016539730 Son-‫إﺑن‬

‫أﺗﻌﮭﺪ أﻧﺎ اﻟﻤﻮﻗﻊ أدﻧﺎه ﺑﺄن ﺟﻤﯿﻊ اﻟﻤﻌﻠﻮﻣﺎت اﻟﻮاردة أﻋﻼه ﺻﺤﯿﺤﺔ وﺗﻘﻊ ﺗﺤﺖ ﻣﺴﺆوﻟﯿﺘﻲ اﻟﺸﺨﺼﯿﺔ إذا اﺗﻀﺢ ﻋﻜﺲ ذﻟﻚ‬

* Ticket/EMD holder Name: HASSAN/IBRAHIM :‫ﻣﻘدم اﻟطﻠب‬


* Authorized by official letter Mobile number: 534984366 :‫رﻗم اﻟﺟوال‬
* ‫ﯾﺟب إرﻓﺎق ﺻورة ﻣن ﺧطﺎب اﻟﺗﻔوﯾض‬ Signature: :‫اﻟﺗوﻗﯾﻊ‬
Attach copy of official authorization letter
‫أﺗﻌﮭﺪ أﻧﺎ اﻟﻤﻮﻗﻊ أدﻧﺎه ﺑﺄﻧﮫ ﺗﻢ ﻣﻄﺎﺑﻘﺔ اﻟﻤﻌﻠﻮﻣﺎت اﻋﻼه ﻣﻊ اﻟﻮﺛﺎﺋﻖ اﻟﺮﺳﻤﯿﺔ واﻗﺮ ﺑﺼﺤﺘﮭﺎ وﺗﻘﻊ ﺗﺤﺖ ﻣﺴﺆوﻟﯿﺘﻲ اﻟﺸﺨﺼﯿﺔ إذا اﺗﻀﺢ ﻋﻜﺲ ذﻟﻚ‬
I, the undersigned, hereby pledge that the above information has been matched with the official documents and I acknowledge its accuracy and it is under my personal responsibility if it turns out to be otherwise
‫اﺳﻢ اﻟﻤﻮظﻒ‬ ‫اﻟﺮﻗﻢ اﻟﻮظﯿﻔﻲ‬ ‫ﺗﻮﻗﯿﻊ اﻟﻤﻮظﻒ‬ ‫رﻣﺰ اﻟﻤﻮظﻒ ﻓﻲ ﻧﻈﺎم اﻟﺤﺠﺰ‬
Employee name Payroll Number Signature Sign Code

‫ ﯾﺟب ﻛﺗﺎﺑﺔ اﺳم اﻟﻣﺎﻟك اﻷﺳﺎﺳﻲ ﻟﻠﺗذﻛرة ﻓﻲ ﺧﺎﻧﺔ اﻟﺗظﮭﯾرات ﻓﻲ ﺣﺎﻟﺔ ﺗﻐﯾﯾر اﻻﺳم ﺗﺟﻧﺑﺎ ﻟﻠﻣﺧﺎﻟﻔﺎت اﻟﻣﺎﻟﯾﺔ‬:‫ﺗﻧوﯾﺔ‬
Notice: The primary ticket owner's name must be written in the endorsements box in case of a name change to avoid ADM

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