‫‪Electronic Work Permit Cancellation‬‬ ‫طﻠب إﻟﻐﺎء ﻋﺎﻣل ﺗﺻرﯾﺢ ﻋﻣل اﻟﻛﺗروﻧﻲ‬

‫‪Transaction No: MB994508333AE‬‬

‫*‪*MB994508333AE‬‬
‫ﺑﯾﺎﻧﺎت اﻟﻣﻧﺷﺄة‬
‫‪21/10/2021 :‬‬ ‫ﺗﺎرﯾﺦ إﻧﺗﮭﺎء اﻟﺗرﺧﯾص‬ ‫‪746769 :‬‬ ‫رﻗم اﻟﺗرﺧﯾص‬ ‫‪A‬‬ ‫‪857886 :‬‬ ‫رﻗم اﻟﻣﻧﺷﺄة‬
‫‪:‬‬ ‫رﻗم ﻣﻣﯾز‬
‫‪ :‬ﺑﻠو ھوراﯾزن ﻟﺧدﻣﺎت اﻟﺗزوﯾد ﺑﻌﺎﻣﻠﯾن ﺗﺣت ا ﻟطﻠب ش‪.‬ذ ‪.‬م ‪.‬م‬ ‫إﺳم اﻟﻣﻧﺷﺄة‬
‫‪ :‬ﻛﺑﯾرة‬ ‫‪ BLUE HORIZON ON DEMAND LABORS SUPPLY SERVICES‬ﺗﺻﻧﯾف اﻟﻣﻧﺷﺎة‬
‫‪L.L.C‬‬
‫‪ :‬دﺑﻰ‬ ‫ﻣﻛﺗب اﻟﻌﻣل‬ ‫‪ :‬دﺑﻲ‬ ‫اﻹﻣﺎرة‬ ‫‪6176 :‬‬ ‫ﺻﻧدوق اﻟﺑرﯾد‬
‫رﻗم اﻟﻣﻧﺷﺎة ﻓﻲ اﻹدارة اﻟﻌﺎﻣﺔ ﻟﻺﻗﺎﻣﺔ و ﺷؤون اﻷﺟﺎﻧب ‪21275714 :‬‬

‫ﺑﯾﺎﻧﺎت اﻟﺷﺧص‬
‫ﺗﺻرﯾﺢ ﻋﻣل اﻟﻛﺗروﻧﻲ‬
‫‪04/08/2023 :‬‬ ‫ﺗﺎرﯾﺦ اﻧﺗﮭﺎء‬ ‫ﺗﺎرﯾﺦ اﻹﺻدار ‪05/08/2021 :‬‬ ‫‪:‬‬ ‫‪ 92621098 :‬ﻧوع اﻟﺑطﺎﻗﺔ‬ ‫رﻗم اﻟﺑطﺎﻗﺔ‬
‫ﺟدﯾد‬
‫‪ :‬ﻛوﻣﺎل ﺑروﯾز ﺑروﯾز ادم‬ ‫اﺳم اﻟﺷﺧص‬

‫‪KOMAL PERVEZ PERVEZ ADAM‬‬

‫‪ :‬ﺑﺎﻛﺳﺗﺎن‬ ‫اﻟﺟﻧﺳﯾﺔ‬ ‫‪ :‬ﻛﺎﺗب اﻷرﺷﯾف‬ ‫اﻟﻣﮭﻧﺔ‬

‫‪26/09/2023 :‬‬ ‫ﺗﺎرﯾﺦ اﻧﺗﮭﺎء اﻟﺟواز‬ ‫‪HR3998362‬‬ ‫‪:‬‬ ‫رﻗم اﻟﺟواز‬

‫ﺗﺎرﯾﺦ اﻧﺗﮭﺎء اﻹﻗﺎﻣﺔ‬
‫‪:‬‬ ‫‪201/2021/2457387‬‬ ‫‪:‬‬ ‫رﻗم اﻹﻗﺎﻣﺔ‬
‫اﻟﮭﺎﺗف اﻟﻣﺗﺣرك‬
‫‪:‬‬ ‫ﻋﺎدي‬ ‫‪:‬‬ ‫ﻧوع اﻹﻟﻐﺎء‬
‫ﺗﺎرﯾﺦ اﻟﻣﻐﺎدرة ‪ /‬وﻓﺎة ‪:‬‬ ‫‪:‬‬ ‫ﺗﺎرﯾﺦ اﻟدﺧول‬
‫‪RESIGNATION :‬‬ ‫ﺳﺑب اﻹﻟﻐﺎء‬ ‫ﺗﺻﻧﯾف اﻟﺷﺧص ‪ :‬ﻣﺣدود اﻟﻣﮭﺎرة‬

‫ﺑﯾﺎﻧﺎت ﻣﻘدم اﻟطﻠب‬

‫‪HUSAIAN AL HINDI‬‬ ‫ﺣﺳﯾن اﻟﮭﻧدي‬ ‫‪:‬‬ ‫اﺳم ﻣﻘدم اﻟطﻠب‬

‫‪00000‬‬ ‫‪:‬‬ ‫رﻗم اﻟﮭوﯾﺔ‬ ‫‪0504455451‬‬ ‫‪:‬‬ ‫اﻟﮭﺎﺗف اﻟﻣﺗﺣرك‬

‫ﺟواز اﻟﺳﻔر‬ ‫‪:‬‬ ‫ﻧوع اﻟﮭوﯾﺔ‬

‫أﻗﺮ ﺑﺄﻧﻨﻲ ﺗﺴﻠﻤﺖ ﻛﺎﻓﺔ ﻣﺴﺘﺤﻘﺎﺗﻲ‬

‫ھﺬه اﻟﻤﻌﺎﻣﻠﺔ ﻣﻮﻗﻌﺔ إﻟﻜﺘﺮوﻧﯿﺎ‬
‫‪I certify that i have received all my dues up todate‬‬ ‫‪This transaction is signed electronically‬‬

‫‪Employee Signature‬‬ ‫ﺗﻮﻗﯿﻊ اﻟﻌﺎﻣﻞ‬

‫‪ -1‬ﻧﺘﻘﺪم ﺑﻤﻮﺟﺐ ھﺬا اﻟﻄﻠﺐ ﻹﺧﻄﺎرﻛﻢ ﺑﺎﻧﺘﮫﺎء ﻋﻼﻗﺔ اﻟﻌﻤﻞ ﻣﻊ اﻟﻌﺎﻣﻞ اﻟﻤﻮﺿﺤﺔ ﺑﯿﺎﻧﺎﺗﻪ‪ ،‬و اﻟﻤﺬﻳﻞ ﺗﻮﻗﯿﻌﻪ أﻋﻼه ﺑﺎﺳﺘﻼﻣﻪ ﺟﻤﯿﻊ ﻣﺴﺘﺤﻘﺎﺗﻪ‬
‫ﻣﻊ ﺗﺄﻛﯿﺪﻧﺎ ﻋﻠﻰ ﺻﺤﺔ ﻣﺎ ورد ﻓﯿﻪ ﻣﻦ ﺑﯿﺎﻧﺎت و ﺗﻮﻗﯿﻌﺎت و ﻋﻠﻰ ﻣﺴﺆوﻟﯿﺘﻨﺎ اﻟﻘﺎﻧﻮﻧﯿﺔ‪ - 2 .‬ﻛﻤﺎ‬
‫ﻧﺘﻌﮫﺪ ﺑﺎﺳﺘﻜﻤﺎل اﺟﺮاءات إﻟﻐﺎء اﻹﻗﺎﻣﺔ و ﻣﻐﺎدرة اﻟﻌﺎﻣﻞ ﺧﻼل ‪ 30‬ﻳﻮﻣﺎ ﻣﻦ ﺗﺎرﻳﺦ إﻟﻐﺎء ﺑﻄﺎﻗﺔ اﻟﻌﻤﻞ و ﺗﺤﻤﻞ اﻟﻤﺴﺆوﻟﯿﺔ‬
‫اﻟﻘﺎﻧﻮﻧﯿﺔ ﻓﻲ ﺣﺎﻟﺔ ﻣﺨﺎﻟﻔﺔ ذﻟﻚ ‪.‬‬

‫‪Company Stamp and Signature‬‬

‫ﺗﻮﻗﯿﻊ و ﺧﺘﻢ اﻟﻤﻨﺸﺄة‬

‫‪07/10/2021 10:02AM‬‬ ‫)‪SYED WALI HASAN SYED HASAN ASKARI - MS2020308773 - AL ANSARI EXCHANGE SOLE PROPRIETORSHIP (L L C‬‬
‫)‪(DUBAI BRANCH‬‬

‫‪10/7/2021‬‬