‫ﺍﻻﺩﺍﺭﺓ ﺍﻟﻤﺮﻛﺰﻳﺔ ﻟﻠﻤﻌﺎﻣﻞ ﻭﻓﺮﻭﻋﻬﺎ‬ ‫ﻭﺯﺍﺭﺓ ﺍﻟﺼﺤﺔ ﻭﺍﻟﺴﻜﺎﻥ‬

Central Public Health Laboratories&Branches Ministry of Health and Population

‫ﺷﻬﺎﺩﺓ ﺗﺤﻠﻴﻞ ﻣﺴﺎﻓﺮ‬
Passenger Test Certificate

E.NO.
Date Of Birth 07/04/1974 5257159

‫ﻫﺎﻧﻰ ﻋﺒﺪﺍﻟﻤﻨﻌﻢ ﻣﺤﻤﺪ ﻋﻠﻰ‬ ‫ﺍﻻﺳـﻢ‬

Full Name

‫ﺟﻮﺍﺯ ﺍﻟﺴﻔﺮ‬ 27404072101991 ‫ﺍﻟﺮﻗﻢ ﺍﻟﻘﻮﻣﻰ‬

A34754109
Passport Number ID Number

20/09/2023 ‫ﺗﺎﺭﻳﺦ ﺍﻟﻔﺤﺺ‬ CPHL - ‫ﺍﻷﺩﺍﺭﺓ ﺍﻟﻤﺮﻛﺰﻳﺔ ﻟﻠﻤﻌﺎﻣﻞ‬ ‫ﻣﺮﻛﺰ ﺍﻟﻔﺤﺺ‬

Examination Date Examination Center

Examination Result ‫ﻧﺘﻴﺠﺔ ﺍﻟﻔﺤﺺ‬

Test ‫ﺍﻟﻔﺤﺺ‬ Result ‫ﺍﻟﻨﺘﻴﺠﺔ‬

HBs Ag Negative
HCV Ab Negative
HIV - Ab Negative

Signature ,

Please review the travel requirements of each country in ‫ﺑﺮﺟﺎﺀ ﻣﺮﺍﺟﻌﻪ ﻣﺘﻄﻠﺒﺎﺕ ﺍﻟﺴﻔﺮ ﺍﻟﺨﺎﺻﺔ ﺑﻜﻞ ﺩﻭﻟﺔ ﻣﻦ ﺣﻴﺚ ﻭﺿﻊ‬
terms of infection status , as a positive analysis may be ‫ ( ﻗﺪ ﺗﻜﻮﻥ ﺳﺒﺒﺎ ﻓﻰ‬Positive ) ‫ﺍﻻﺻﺎﺑﺔ ﺣﻴﺚ ﺍﻥ ﺍﻳﺠﺎﺑﻴﺔ ﺍﻟﺘﺤﻠﻴﻞ‬
a reason for preventing you from traveling according to .‫ﻣﻨﻌﻚ ﻣﻦ ﺍﻟﺴﻔﺮ ﻃﺒﻘﺎ ﻟﺘﻌﻠﻴﻤﺎﺕ ﺑﻌﺾ ﺍﻟﺪﻭﻝ‬
regulations of some countries .