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Group Request Form

This document is a group visa request form containing information about 3 applicants seeking visas to Saudi Arabia. It includes the date and time of appointment, applicant names and passport numbers, the visa processing center address, and instructions that the applicants must follow Saudi laws and not bring prohibited items such as drugs or pornography into the country. A total amount of 344,998.50 Indonesian Rupiah is to be paid for the group visa processing fees.

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Makhsus Alhanafi
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488 views2 pages

Group Request Form

This document is a group visa request form containing information about 3 applicants seeking visas to Saudi Arabia. It includes the date and time of appointment, applicant names and passport numbers, the visa processing center address, and instructions that the applicants must follow Saudi laws and not bring prohibited items such as drugs or pornography into the country. A total amount of 344,998.50 Indonesian Rupiah is to be paid for the group visa processing fees.

Uploaded by

Makhsus Alhanafi
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as PDF, TXT or read online on Scribd
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GROUP REQUEST FORM

‫إﺳﺘﻤﺎرة ﺣﺠﺰ ﻣﻮﻋﺪ ﻟﻠﻤﺠﻤﻮﻋﺔ‬

GROUP ID ‫رﻗﻢ اﻟﻤ ﻮﻋﺪ ﻟﻠﻤﺠﻤ ﻮﻋﺔ‬

D ate : 19-Mar-2019 Ti m e : 11:06

Appointment Agent Name &


Type GROUP ID PT Albis Nusa Wisata
Albis
‫ﻧﻮع اﻟﻤﻮﻋﺪ‬ ‫إﺳﻢ اﻟﻮﻛﯿﻞ‬
‫ورﻗﻤﻪ‬
Appointment Category NORMAL LOUNGE No. of Applicants
‫ﻓﺌﺔ اﻟﻤﻮﻋﺪ‬ ‫ﻋﺪد ﻣﻘﺪﻣﻲ اﻟﻄﻠﺒﺎت‬ 3

Appointment Date
‫ﺗﺎرﯾﺦ اﻟﻤﻮﻋﺪ‬ 20-Mar-2019 Visa Service Center Kantor Pos Purwokerto Selatan Jalan
Address Sultan Agung No 50 Teluk Kecamatan
Appointment Time
‫اﻟﻮﻗﺖ اﻟﻤﺤﺪد ﻟﻠﻤﻮﻋﺪ‬
10:30 ‫ﻋﻨﻮان ﻣﺮﻛﺰ ﺧﺪﻣﺔ‬ Purwokerto Selatan Kab Banyumas,
‫اﻟﺘﺄﺷﯿﺮات‬
53145

S .No. A p p Ref No. P as s p ort Numb er Name A p p ointment Time

1 C3236646 SARNO SUWARYO 10:30

2 C3237614 SURTINI KAWITANA 10:30

3 C3417133 SOIM NASAWIKARTA 10:30

The consolidated amount to be paid at the VSC center is displayed below


‫ﯾﺘﻢ دﻓﻊ ﻣﺠﻤﻮع اﻟﻤﺒﺎﻟﻎ اﻟﻤﺬﻛﻮر ة أدﻧﺎ ه ﻓﻲ ﻣﺮﻛﺰ ﺧﺪﻣﺔ اﻟﺘﺄ ﺷﯿﺮات‬
Name Unit Fee(in ID R) No. of A p p lic ants A mount in ID R
‫اﻹﺳﻢ‬ ‫ﻋﺪد ﻣﻘﺪﻣ ﻲ اﻟ ﻄﻠﺒﺎت‬

Agent Bio Normal 104545.00 3 313635.00

10.00 % for Agent Bio


VAT 3 31363.50
Normal

Total 344,998.50

To Be Paid 344,998.50
Ins truc tions : ‫ا ﻟﺘﻌ ﻠﯿﻤ ﺎت‬
1. If granted the visa I shall abide by all the laws and regulations of the Kingdom of Saudi Arabia and respect the Islamic customs and traditions of its people.

‫ ﻓﻲ ﺣﺎل ﺣﺼﻮﻟﻲ ﻋﻠﻰ اﻟﺘﺄﺷﯿﺮة ﻋﻠﻲ أن أﻟﺘﺰم ﺑﺠﻤﯿ ﻊ اﻟ ﻘﻮاﻧﯿﻦ واﻷﻧﻈﻤﺔ اﻟﻤﻌﻤﻮل ﺑﻬﺎ ﻓﻲ اﻟﻤﻤﻠﻜﺔ اﻟﻌﺮﺑﯿﺔ اﻟﺴﻌﻮدﯾﺔ وإﺣﺘﺮام اﻟﻌﺎدات واﻟﺘ ﻘﺎﻟﯿﺪ اﻹﺳﻼﻣﯿﺔ ﻟﺸﻌﺒﻬﺎ‬.

2. I am also fully aware that the crime of smuggling narcotics and other illegal drugs into the Kingdom of Saudi Arabia is punishable by the death penalty.
‫‪.‬إﻧﻨﻲ أدرك ﺗﻤﺎﻣﺎ أن ﺟﺮﯾﻤﺔ ﺗﻬﺮﯾﺐ اﻟﻌ ﻘﺎ ﻗﯿﺮ اﻟﻤﺨﺪرة واﻟﻤﺨﺪرات ﻏﯿﺮ اﻟﻤﺸﺮوﻋﺔ اﻷﺧﺮى إﻟﻰ اﻟﻤﻤﻠﻜﺔ اﻟﻌﺮﺑﯿﺔ اﻟﺴﻌﻮدﯾﺔ ﻣﻌﺎ ﻗﺐ ﻋﻠﯿﻬﺎ ﺑﺎﻹﻋﺪام‬

‫‪3. I have never been removed, excluded or deported from the Kingdom of Saudi Arabia or from any other G ulf Cooperation Council member state or‬‬
‫‪charged with violation of any law or regulation thereof.‬‬

‫‪.‬ﻟﻢ ﯾﺴﺒﻖ أن ﺗﻢ إﺳﺘﺒﻌﺎدي أو ﺗﺮﺣﯿﻠﻲ ﻣﻦ اﻟﻤﻤﻠﻜﺔ اﻟﻌﺮﺑﯿﺔ اﻟﺴﻌﻮدﯾﺔ أو ﻣﻦ أي دوﻟﺔ ﻋﻀﻮ ﻓﻲ ﻣﺠﻠﺲ اﻟﺘﻌﺎون ﻟﺪول اﻟﺨﻠﯿﺞ اﻟﻌﺮﺑﯿﺔ أو ﺗﻢ إﺗﻬﺎﻣﻲ ﺑﻤﺨﺎﻟ ﻔﺔ أي ﻣﻦ ﻗﻮاﻧﯿﻨﻬﺎ أو أﻧﻈﻤﺘﻬﺎ‬

‫‪4. I am aware that all alcoholic everages, narcotics and other illegal drugs, pornographic materials or publications, which violate the social norms of decency‬‬
‫‪and all other publications, which are disrespectful of any religious belief or political orientation, are prohibited and shall not be brought into the Kingdom of‬‬
‫‪Saudi Arabia‬‬

‫أﻧﺎ أدرك ﺗﻤﺎﻣﺎ أن ﺟﻤﯿ ﻊ اﻟﻤﺸﺮوﺑﺎت اﻟﻜﺤﻮﻟﯿﺔ‪ ،‬اﻟﻤﺨﺪرات واﻟﻌ ﻘﺎ ﻗﯿﺮ اﻟﻐﯿﺮ ﻗﺎﻧﻮﻧﯿﺔ اﻷﺧﺮى‪ ،‬اﻟﻤﻮاد اﻹﺑﺎﺣﯿﺔ ﻣﻦ رﺳﻮﻣﺎت أو أﻋﻤﺎل ﻋﺎﻣﺔ‪ ،‬واﻟﺘﻲ ﺗﻨﺘﻬﻚ اﻷﻋﺮاف اﻻﺟﺘﻤﺎﻋﯿﺔ ﻣﻦ اﻟﺤﺸﻤﺔ وﺟﻤﯿ ﻊ اﻹﺟﺮاءات اﻟﻌﺎﻣﺔ اﻷﺧﺮى وﻋﺪم‬
‫‪.‬إﺣﺘﺮام أي ﻣﻌﺘ ﻘﺪ دﯾﻨﻲ أو ﺗﻮﺟﻪ ﺳﯿﺎﺳﻲ‪ ،‬أﻣﻮر ﻣﺤﻈﻮرة ﻻ ﯾﺠﻮز إدﺧﺎﻟﻬﺎ اﻟﻰ اﻟﻤﻤﻠﻜﺔ اﻟﻌﺮﺑﯿﺔ اﻟﺴﻌﻮدﯾﺔ‬

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