‫ ﺧﺪﻣﺔ‬/‫إﺳﺘﻤﺎرة ﻃﻠﺐ ﺗﺼﺮﻳﺢ‬

Permit/ Service Application Form

Establishment Details ‫ﺑﻴﺎﻧﺎت اﻟﻤﻨﺸﺄة‬

Establishment Type ‫ﻧﻮع اﻟﻤﻨﺸﺄة‬ CR No. ‫رﻗﻢ اﻟﺴﺠﻞ اﻟﺘﺠﺎري‬
‫ﻏﻴﺮ ﺗﺠﺎرﻳﺔ ﻏﻴﺮ ﺣﻜﻮﻣﻴﺔ‬ ‫ﺣﻜﻮﻣﻴﺔ‬ ‫ﺗﺠﺎرﻳﺔ‬
Non-Commercial Non-Governmental (NCNG) Government Commercial
Establishment Name (In English or Arabic) (‫اﺳﻢ اﻟﻤﻨﺸﺄة )ﺑﺎﻟﻠﻐﺔ اﻟﻌﺮﺑﻴﺔ أو ا«ﻧﺠﻠﻴﺰﻳﺔ‬

‫إﻟﺘﺤﺎق ﻟﻌﻤﻞ‬ ‫ﻣﺆﻗﺘﺔ‬ ‫ﻣﺴﺘﺜﻤﺮ‬ ‫ﻣﻠﺘﺤﻖ‬ ‫اﻧﺘﻘﺎل‬ ‫ﺗﺼﺮﻳﺢ ﻋﻤﻞ ﺟﺪﻳﺪ‬

House Wife to Work Temporary Investor Dependant Transfer New Work Pemit
‫اﻟﺘﺼﺮﻳﺢ اﻟﻤﻄﻠﻮب‬
Selected Permit Period ‫ﻓﺘﺮة اﻟﺘﺼﺮﻳﺢ اﻟﻤﺨﺘﺎر‬ Required Permit
‫ ﺷﻬﺮ‬24 ‫ ﺷﻬﺮ‬12
24 Months 12 Months
‫ﻣﻮاﻓﻘﺔ إﻧﺘﻘﺎل ﻟﻠﻌﺎﻣﻞ اﺟﻨﺒﻲ‬ ‫ﺗﻐﻴﻴﺮ ﻋﻨﻮان ﻣﺮاﺳﻼت اﻟﻌﺎﻣﻞ اﺟﻨﺒﻲ‬ ‫إﻟﻐﺎء‬ ‫ﺗﻐﻴﻴﺮ ﻣﻬﻨﺔ‬
Approval for Employee Transfer Change Expatriate Employee Addess Cancellation Change Occupation
‫اﻟﺨﺪﻣﺔ اﻟﻤﻄﻠﻮﺑﺔ‬
‫ﻧﻮع اﻟﻤﻌﺎﻣﻠﺔ‬ ‫إﻟﻐﺎء ﻣﻌﺎﻣﻠﺔ ﻗﻴﺪ ا«ﺟﺮاء‬ Required Service
Transaction Type In progress transaction cancellation
‫أﺳﺒﺎب إﻟﻐﺎء اﻟﻄﻠﺐ‬
Application Cancellation Reason

Expatriate Employee Details ‫ﺑﻴﺎﻧﺎت اﻟﻌﺎﻣﻞ اﺟﻨﺒﻲ‬

Current Passport No. ‫رﻗﻢ ﺟﻮاز اﻟﺴﻔﺮ اﻟﺤﺎﻟﻲ‬ Old Passport No. ‫رﻗﻢ ﺟﻮاز اﻟﺴﻔﺮ اﻟﻘﺪﻳﻢ‬ Personal No. ‫اﻟﺮﻗﻢ اﻟﺸﺨﺼﻲ‬

Name (in English / Arabic) First Name - Second Name - Third Name - Family Name ‫ اﻟﻌﺎﺋﻠﺔ أو اﻟﻠﻘﺐ‬- ‫ اﻻﺳﻢ اﻟﺜﺎﻟﺚ‬-‫ اﻻﺳﻢ اﻟﺜﺎﻧﻲ‬- ‫اﻻﺳﻢ اول‬ (‫ ا’ﻧﺠﻠﻴﺰﻳﺔ‬/‫اﻻﺳﻢ )ﺑﺎﻟﻠﻐﺔ اﻟﻌﺮﺑﻴﺔ‬

Arrival Date ‫ﻓﻲ ﺣﺎﻟﺔ ﺗﺎرﻳﺦ اﻟﺪﺧﻮل‬ ‫ﻫﻞ اﻟﻌﺎﻣﻞ اﺟﻨﺒﻲ ﻣﻮﺟﻮد ﺣﺎﻟﻴ ﻓﻲ‬
‫ﻣﻤﻠﻜﺔ اﻟﺒﺤﺮﻳﻦ‬
Nationality ‫اﻟﺠﻨﺴﻴﺔ‬
:(‫)ﻧﻌﻢ‬
No ‫ﻻ‬ Yes ‫ ﻧﻌﻢ‬Is the expatriate employee
If (Yes): currently in the Kingdom of Bahain
Description of Speciality ‫وﺻﻒ اﻟﺘﺨﺼﺺ‬ Occupation Title ‫اﻟﻤﺴﻤﻰ اﻟﻮﻇﻴﻔﻲ‬ Job Code ‫رﻣﺰ اﻟﻮﻇﻴﻔﺔ‬

Monthly Salary ‫اﻟﺮاﺗﺐ اﻟﺸﻬﺮي‬ Highest Academic Qualification ‫أﻋﻠﻰ ﻣﺆﻫﻞ دراﺳﻲ‬

‫ﻣﻄﻠﻖ‬ ‫أرﻣﻞ‬ ‫ﻣﺘﺰوج‬ ‫أﻋﺰب‬ ‫اﻟﺤﺎﻟﺔ اﻻﺟﺘﻤﺎﻋﻴﺔ‬ ‫أﺧﺮى‬ ‫ﻳﻬﻮدي‬ ‫ﻣﺴﻴﺤﻲ‬ ‫ﻣﺴﻠﻢ‬ ‫اﻟﺪﻳﺎﻧﺔ‬
Divorced Widowed Married Single Martial Status Others Jewish Christian Muslim Religion
Address in Bahrain (Expatriate Employee address in the Kingdom of Bahrain) (‫اﻟﻌﻨﻮان ﻓﻲ ﻣﻤﻠﻜﺔ اﻟﺒﺤﺮﻳﻦ )ﻋﻨﻮان ﺳﻜﻦ اﻟﻌﺎﻣﻞ اﺟﻨﺒﻲ ﻓﻲ ﻣﻤﻠﻜﺔ اﻟﺒﺤﺮﻳﻦ‬
‫اﻟﻤﻨﻄﻘﺔ‬ ‫ﻣﺠﻤﻊ رﻗﻢ‬ ‫ﻃﺮﻳﻖ رﻗﻢ‬ ‫ﻣﺒﻨﻰ رﻗﻢ‬ ‫ﺷﻘﺔ رﻗﻢ‬
Area Block No. Road No. Building No. Flat No.
E-mail ‫اﻟﺒﺮﻳﺪ ا’ﻟﻜﺘﺮوﻧﻲ‬ Phone No. ‫رﻗﻢ اﻟﻬﺎﺗﻒ‬

Declaration ‫إﻗﺮار‬
.‫ ﻛﻤﺎ أﻗﺮ ﺑﺼﺤﺔ اﻟﻤﻌﻠﻮﻣﺎت اﻟﻮاردة ﻓﻴﻬﺎ‬،‫أﻗﺮ أﻧﺎ اﻟﻤﻮﻗﻊ أدﻧﺎه ﺑﺎﻃﻼﻋﻲ ﻋﻠﻰ ﻛﺎﻓﺔ اﻟﺸﺮوط واﺣﻜﺎم اﻟﻮاردة ﻓﻲ ﻫﺬه اﻻﺳﺘﻤﺎرة وﺑﻤﻮاﻓﻘﺘﻲ ﻋﻠﻴﻬﺎ‬
I, the undersigned, declare that I have read and consented to all the terms and conditions stated in this form and that all data above are correct.
‫اﻟﺸﺨﺺ اﻟﻤﺨﻮل‬ ‫اﻟﺸﺨﺺ اﻟﻤﺴﺆول‬
Authorised Person Responsible Person
Signature ‫ اﻟﺘﻮﻗﻴﻊ‬Personal No. ‫ اﻟﺮﻗﻢ اﻟﺸﺨﺼﻲ‬Name ‫اﻻﺳﻢ‬

Date ‫اﻟﺘﺎرﻳﺦ‬ Mobile No. ‫رﻗﻢ اﻟﻬﺎﺗﻒ اﻟﻨﻘﺎل‬ Phone No. ‫رﻗﻢ اﻟﻬﺎﺗﻒ‬
LMRA-QFM-009-02-01 v.4

‫ ﻣﺘﻌﻬﺪ¶ ﺑﺎﻻﻟﺘﺰام ﺑﺠﻤﻴﻊ اﻧﻈﻤﺔ واﻟﻠﻮاﺋﺢ اﻟﺨﺎﺻﺔ ﺑﻬﺎ واﻣﻮر ا«دارﻳﺔ واﻟﻤﺎﻟﻴﺔ واﻟﻤﺘﺮﺗﺒﺔ ﻋﻠﻰ اﻟﺘﻌﺎﻣﻞ‬،“‫أﻗﺮ أﻧﺎ اﻟﻤﻮﻗﻊ أدﻧﺎه ﺑﻤﻮاﻓﻘﺘﻲ ﻋﻠﻰ اﻟﺘﻌﺎﻣﻞ ﺑﻨﻈﺎم ”اﻟﺒﺤﺮﻧﺔ اﻟﻤﻮازﻳﺔ‬
.‫ﺑﻬﺬا اﻟﻨﻈﺎم‬
I, the undersigned, declare that I agree to deal with the system “Parallel Bahranization” , pledging to abide all the rules and regulations related to it and the
administrative and financial matters that are required to deal with this system.
Date ‫ اﻟﺘﺎرﻳﺦ‬Signature ‫ اﻟﺘﻮﻗﻴﻊ‬Name ‫اﻻﺳﻢ‬
 Terms and Conditions ‫اﻟﺸﺮوط واﺣﻜﺎم‬
.‫ﻻ ًﻋﻨﻬﺎ‬
ً ‫ وﻳﻜﻮن ﻣﻘﺪم اﻟﻄﻠﺐ ﻣﺴﺆو‬،‫ ﻳﺠﺐ أن ﺗﻜﻮن ﺟﻤﻴﻊ اﻟﻤﺴﺘﻨﺪات واﻟﻤﻌﻠﻮﻣﺎت اﻟﻤﺪوﻧﺔ ﻓﻲ اﺳﺘﻤﺎرة اﻟﻄﻠﺐ ﺻﺤﻴﺢ‬.١
‫ وﻟﻬﺎ ﺗﺰوﻳﺪ اﻟﻘﻀﺎء أو أﻳﺔ ﺟﻬﺔ ﺣﻜﻮﻣﻴﺔ ﺑﺎﻟﻤﻌﻠﻮﻣﺎت ﺑﻨﺎء ﻋﻠﻰ ﻃﻠﺐ‬،‫ ﺗﺤﺎﻓﻆ اﻟﻬﻴﺌﺔ ﻋﻠﻰ ﺳﺮﻳﺔ اﻟﻤﻌﻠﻮﻣﺎت اﻟﺨﺎﺻﺔ ﺑﺼﺎﺣﺐ اﻟﻌﻤﻞ واﻟﻌﺎﻣﻞ اšﺟﻨﺒﻲ‬.٢
.‫ﻛﺘﺎﺑﻲ ﻣﻨﻬﺎ ﺑﺬﻟﻚ‬
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.‫ أو أﻛﺜﺮ ﻣﻦ ﺷﺮوط اﻟﺘﺼﺮﻳﺢ‬ª‫ﻓﻘﺪ اﻟﻌﺎﻣﻞ اšﺟﻨﺒﻲ ﺷﺮﻃ‬

.‫ﺻﺪور ﺣﻜﻢ ﺟﻨﺎﺋﻲ ﻧﻬﺎﺋﻲ ﺿﺪ اﻟﻌﺎﻣﻞ اšﺟﻨﺒﻲ ﺑﻌﻘﻮﺑﺔ ﺟﻨﺎﻳﺔ أو ﻓﻲ ﺟﺮﻳﻤﺔ ﻣﺨﻠﺔ ﺑﺎﻟﺸﺮف أو اšﻣﺎﻧﺔ‬
.‫ﻣﺨﺎﻟﻔﺔ اﻟﻌﺎﻣﻞ اšﺟﻨﺒﻲ ﺷﺮوط اﻟﺘﺼﺮﻳﺢ اﻟﺼﺎدر ﺑﺸﺄﻧﻪ‬

.‫ ﻟﻘﺮار وزﻳﺮ اﻟﺼﺤﺔ ﻣﻤﺎ ﻳﺴﺘﻮﺟﺐ ﺗﺮﺣﻠﻴﻪ‬ª‫إﺻﺎﺑﺔ اﻟﻌﺎﻣﻞ اšﺟﻨﺒﻲ ﺑﺄﺣﺪ اšﻣﺮاض اﻟﻤﻌﺪﻳﺔ ﻃﺒﻘ‬
.‫ ﻻ ﺗﺘﺤﻤﻞ اﻟﻬﻴﺌﺔ ﻣﺴﺆوﻟﻴﺔ ﺗﺄﺧﺮ وﺻﻮل اﻟﻌﺎﻣﻞ اšﺟﻨﺒﻲ ﻛﻤﺎ ﻻ ﺗﺘﺤﻤﻞ ﻣﺴﺆوﻟﻴﺔ ﻋﺪم اﺟﺘﻴﺎزه اﻟﻔﺤﺺ اﻟﻄﺒﻲ‬.٩
.‫ ﻳﻠﺘﺰم ﺻﺎﺣﺐ اﻟﻌﻤﻞ ﺑﺈﺧﻄﺎر اﻟﻬﻴﺌﺔ ﻓﻮر ﺗﺮك اﻟﻌﺎﻣﻞ اšﺟﻨﺒﻲ اﻟﻌﻤﻞ ﻟﺪﻳﻪ‬.١٠
.‫ﻳﻠﺘﺰم ﺻﺎﺣﺐ اﻟﻌﻤﻞ ﺑﺘﻮﻓﻴﺮ ﺑﻴﺌﺔ ﻋﻤﻞ وﺳﻜﻦ ﻣﻨﺎﺳﺒﺔ ﻟﻠﻌﺎﻣﻞ اšﺟﻨﺒﻲ‬ .١١
.‫ ﻳﺠﺐ ﺗﻮﻓﺮ ﺗﺄﻣﻴﻦ ﺻﺤﻲ ﻋﻨﺪ ﻃﻠﺐ ﺗﺠﺪﻳﺪ ﺗﺼﺮﻳﺢ ﻋﻤﻞ اﻟﻌﺎﻣﻞ اšﺟﻨﺒﻲ اﻟﺬي ﺗﺠﺎوز اﻟﺴﺘﻴﻦ ﺳﻨﺔ‬.١٢
.‫ ﻓﻴﻠﺰم ﻣﻐﺎدرﺗﻪ اﻟﻤﻤﻠﻜﺔ أو ﺗﻐﻴﻴﺮ ﻣﻬﻨﺘﻪ‬،‫ ﻋﻨﺪ ﻃﻠﺐ ﺗﻐﻴﻴﺮ اﻟﻤﻬﻨﺔ وﻋﺪم اﺟﺘﻴﺎز اﻟﻌﺎﻣﻞ اšﺟﻨﺒﻲ اﻟﻔﺤﺺ اﻟﻄﺒﻲ اﻟﻼزم‬.١٣
All documents and data should be corredt. The applicant shall be held reponsible.
LMRA shall keep secrecy and confidentiality all information about the employer and the expatriate employee unless required to
revealed by a court order or a written request from a governmental authority.
The application is subject to the laws and regulations of the Kingdom of Bahrain.
The terms and conditions are enforced as from the date of the applicant signature.
The employer shall infrom LMRA of any changes or updates of data.
The representative of the employer is responsible within the limits of the authorization.
The employer shall settle the prescribed fees within a period not exceeding 30 days as from the date of consent to the issuance
of the work permit.
The work permit shall be immediately cancelled in any of the following:
If the work permit is obtained on the basis of wrong information or false document.
If the expatriate employee ceased to have one or more of the conditions of the work permit.
If a final criminal judgment relating to honor or honesty is passed against the expatriate employee.
Violation of the expatriate eployee to the conditions of the work permit.
Death of the employer unless one of his heirs applied for renewal within six months.
If the employer requested in writing the cancellation of the work permit.
If the employer failed to settle LMRA fees relating to the work permit for a period exceeding three months without
reasonable excuse.
If the expatriate employee is infected with one of the contagious diseases in accordance to the decision of the Minister of
Health.
LMRA is not responsible for the delay of arrival of the expatriate employee or his failure to pass the medical test.
The employer shall immediately infrom LMRA in case the expatriate employee abandoned work.
The employer shall secure reasonable accomodation and work environment for the expatriate employee.
To obtain health insurance for the expatriate employees above 60 years old.
In case of change of profession, the expatriate employee shall immediately leave the Kingdom, if he did not pass the medical
LMRA-QFM-009-02-01 v.4

test.

For Official Use Only

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