(‫ﻧﻤﻮذج )أ‬

Form (A)

‫ﻃﻠﺐ ﺗﺮﺧﻴﺺ ﺷﺮﻛﺔ ﻛﻮﻳﺘﻴﺔ‬

Application for Licensing a Kuwaiti Company

with Incentives ‫ﻣﻊ ﻣﺰاﻳﺎ‬

Application No.: : ‫اﻟﻄﻠﺐ‬ ‫رﻗﻢ‬

Application : ‫اﻟﻄﻠﺐ‬ ‫ﺗﺎرﻳﺦ ﺗﻘﺪﻳﻢ‬

Submission Date:

1 Application A
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Form (A) (‫ﻧﻤﻮذج )أ‬
Application for Licensing a Kuwaiti Company ‫ﻃﻠﺐ ﺗﺮﺧﻴﺺ ﺷﺮﻛﺔ ﻛﻮﻳﺘﻴﺔ‬

Information of the Mother Company / Investor: : ‫ اﻟﻤﺴﺘﺜﻤﺮ‬/ ‫ﺑﻴﺎﻧﺎت اﻟﺸﺮﻛﺔ اﻷم‬

Name ‫اﻻﺳﻢ‬
Nationality ‫اﻟﺠﻨﺴﻴﺔ‬
Address ‫اﻟﻌﻨﻮان اﻟﺮﺋﻴﺴﻲ‬
Postal Address ‫اﻟﻌﻨﻮان اﻟﺒﺮﻳﺪي‬
Telephone ‫اﻟﻬﺎﺗﻒ‬
Fax ‫اﻟﻔﺎﻛﺲ‬
E-mail ‫اﻟﺒﺮﻳﺪ اﻻﻛﺘﺮوﻧﻲ‬

Information of the Investment Entity to be established: : ‫ﺑﻴﺎﻧﺎت اﻟﻜﻴﺎن اﻻﺳﺘﺜﻤﺎري اﻟﻤﺮاد ﺗﺄﺳﻴﺴﻪ‬

Legal Form: : ‫اﻟﺸﻜﻞ اﻟﻘﺎﻧﻮﻧﻲ‬

Limited Liability ‫ذات ﻣﺴﺆوﻟﻴﺔ ﻣﺤﺪودة‬

Single Person ‫اﻟﺸﺨﺺ اﻟﻮاﺣﺪ‬
Shareholding ‫اﻟﻤﺴﺎﻫﻤﺔ‬

Econimic Activity: :‫اﺳﻢ اﻟﻨﺸﺎط اﻻﻗﺘﺼﺎدي‬

Economic Sector Type: : ‫ﻧﻮع اﻟﻘﻄﺎع اﻻﻗﺘﺼﺎدي‬

Services ‫ﺧﺪﻣﻲ‬
Industrial ‫ﺻﻨﺎﻋﻲ‬
Primary ‫أوﻟﻲ‬

Commercial Code: : ‫رﻗﻢ اﻟﺘﺼﻨﻴﻒ اﻟﺘﺠﺎري‬

Objectives: : ‫اﻷﻏﺮاض‬

2 Application A
V2
 Capital structure: : ‫ﻫﻴﻜﻞ رأس اﻟﻤﺎل‬

Cash: : ‫ﻧﻘﺪي‬

In-kind Contribution: : ‫ﻋﻴﻨﻲ‬

Total Capital: : ‫إﺟﻤﺎﻟﻲ رأس اﻟﻤﺎل‬

(KWD) (‫)دﻳﻨﺎر ﻛﻮﻳﺘﻲ‬

Investment Value Breakdown: : ‫ﺣﺠﻢ اﻻﺳﺘﺜﻤﺎر‬

Capital Expenditure (CAPEX): : ‫اﻻﻧﻔﺎق اﻟﺮأﺳﻤﺎﻟﻲ‬

Working Capital: : ‫رأس اﻟﻤﺎل اﻟﻌﺎﻣﻞ‬

Fixed Assets: : ‫اﻷﺻﻮل اﻟﺜﺎﺑﺘﺔ‬

Total Investment Value: : ‫إﺟﻤﺎﻟﻲ ﺣﺠﻢ اﻻﺳﺘﺜﻤﺎر‬

(KWD) (‫)دﻳﻨﺎر ﻛﻮﻳﺘﻲ‬

Shareholders / Partners Information: : ‫ اﻟﺸﺮﻛﺎء‬/ ‫ﺑﻴﺎﻧﺎت اﻟﻤﺴﺎﻫﻤﻴﻦ‬

‫ اﻟﺤﺼﺺ‬/ ‫اﻷﺳﻬﻢ‬ ‫ﻧﻮع اﻟﻤﺴﺎﻫﻤﺔ‬ ‫اﻟﺠﻨﺴﻴﺔ‬ ‫اﻻﺳﻢ‬

Equity / Shares Contribution Type Nationality Name

) ‫اﻟﻘﻴﻤﺔ )دﻳﻨﺎر ﻛﻮﻳﺘﻲ‬ ‫اﻟﻨﺴﺒﺔ‬ ‫اﻟﻌﺪد‬ ‫ﻋﻴﻨﻴﺔ‬ ‫ﻧﻘﺪﻳﺔ‬

Value (KWD) Percentage (%) Number In-kind Cash

3 Application A
V2
 Requested Incentives and Exemptions: ‫ اﻟﻤﺰاﻳﺎ واﻹﻋﻔﺎءات اﻟﻤﻄﻠﻮﺑﺔ‬.٣

1. Exemption from income tax for a period not ‫ اﻹﻋﻔﺎء ﻣﻦ ﺿﺮﻳﺒﺔ اﻟﺪﺧﻞ ﻟﻤﺪة ﻻ ﺗﺰﻳﺪ ﻋﻠﻰ ﻋﺸﺮ‬.١
exceeding ten years from the date of the actual ‫ﺳﻨﻮات ﻣﻦ ﺗﺎرﻳﺦ ﺑﺪء اﻟﺘﺸﻐﻴﻞ اﻟﻔﻌﻠﻲ ﻓﻲ اﻟﻜﻴﺎن‬
commencement of operations of the licensed .‫اﻻﺳﺘﺜﻤﺎري اﻟﻤﺮﺧﺺ ﻓﻴﻪ‬
investment entity.
(In accordance with the mechanism adopted by KDIPA’s Board ً
‫ ﻗﺮار اﻟﻤﺪﻳﺮ اﻟﻌﺎم‬:‫)وﻓﻘﺎ ﻟﻶﻟﻴﺔ اﻟﻤﻌﺘﻤﺪة ﻣﻦ ﻣﺠﻠﺲ إدارة اﻟﻬﻴﺌﺔ‬
of Directors: Director General Decision No. 16 of 2016) (2016 ‫ ﻟﺴﻨﺔ‬16 ‫رﻗﻢ‬

2. Total or partial exemption from customs taxes and ‫ اﻹﻋﻔﺎء اﻟﻜﻠﻲ أو اﻟﺠﺰﺋﻲ ﻣﻦ اﻟﻀﺮاﺋﺐ واﻟﺮﺳﻮم‬.٢
duties or any other fees that might be imposed on ‫اﻟﺠﻤﺮﻛﻴﺔ أو أي رﺳﻮم أﺧﺮى ﻗﺪ ﺗﺴﺘﺤﻖ ﻋﻠﻰ‬
imports for the purposes of direct investment from : ‫اﻟﻮاردات اﻻزﻣﺔ ﻷﻏﺮاض اﻻﺳﺘﺜﻤﺎر اﻟﻤﺒﺎﺷﺮ ﻣﻤﺎ ﻳﻠﻲ‬
the following:

a. Machinery, tools, equipment and means of transport ‫ اﻵﻻت واﻷدوات واﻟﻤﻌﺪات ووﺳﺎﺋﻞ اﻟﻨﻘﻞ وﻏﻴﺮﻫﺎ‬.‫أ‬
and other technological devices. .‫ﻣﻦ اﻷﺟﻬﺰة اﻟﺘﻜﻨﻮﻟﻮﺟﻴﺔ‬

b. Spare parts and needed maintenance supplies ‫ ﻗﻄﻊ اﻟﻐﻴﺎر وﻣﺴﺘﻠﺰﻣﺎت اﻟﺼﻴﺎﻧﺔ اﻟﻼزﻣﺔ ﻟﻤﺎ ورد‬.‫ب‬
described in the previous sub-section. . ‫ﻓﻲ اﻟﺒﻨﺪ اﻟﺴﺎﺑﻖ‬

c. Merchandise, raw materials, partially manufactured ‫ اﻟﺒﻀﺎﺋﻊ‬،‫ اﻟﻤﻮاد اﻷوﻟﻴﺔ‬،‫ اﻟﻤﺴﺘﻠﺰﻣﺎت اﻟﺴﻠﻌﻴﺔ‬.‫ج‬
goods, wrapping and packaging materials. ً
. ‫ وﻣﻮاد اﻟﺘﻐﻠﻴﻒ واﻟﺘﻌﺒﺌﺔ‬،‫ﺟﺰﺋﻴﺎ‬ ‫اﻟﻤﺼﻨﻌﺔ‬

3. The use of land and real estate allocated to ‫ ﻻﻧﺘﻔﺎع ﺑﺎﻷراﺿﻲ واﻟﻌﻘﺎرات اﻟﻤﺨﺼﺼﺔ ﻟﻠﻬﻴﺌﺔ‬.٣
KDIPA or that is subjected to its supervision ً
‫وﻓﻘﺎ‬ ‫ وذﻟﻚ‬،‫أو اﻟﺘﻲ ﺗﺨﻀﻊ ﻹﺷﺮاﻓﻬﺎ أو إدارﺗﻬﺎ‬
or management in accordance with the ‫ﻟﻸﺳﺲ واﻟﻘﻮاﻋﺪ اﻟﺘﻲ ﻳﻀﻌﻬﺎ ﻣﺠﻠﺲ ادارة اﻟﻬﻴﺌﺔ‬
principles .(‫ﻓﻲ ﻫﺬا اﻟﺸﺄن )ﺣﻴﻦ ﺗﻮاﻓﺮﻫﺎ‬
and rules established by KDIPA’s Board of
Directors in this regard (as available).

4. The employment of foreign labor required ‫ اﺳﺘﺨﺪام اﻟﻌﻤﺎﻟﺔ اﻷﺟﻨﺒﻴﺔ اﻟﻼزﻣﺔ ﻟﻼﺳﺘﺜﻤﺎر وذﻟﻚ‬.٤
for the investment, in accordance with ‫وﻓﻘﺎ ﻟﻸﺳﺲ واﻟﻀﻮاﺑﻂ اﻟﺘﻲ ﻳﺼﺪر ﺑﻬﺎ ﻗﺮار‬ً
the principles and conditions established ‫ﻣﺠﻠﺲ اﻟﻮزراء ﺑﺸﺄن اﻟﺤﺪ اﻷدﻧﻰ ﻟﻨﺴﺒﺔ اﻟﻌﻤﺎﻟﺔ‬
by the decision of the Council of Ministers .‫اﻟﻮﻃﻨﻴﺔ اﻟﻮاﺟﺐ ﺗﻮﻓﺮﻫﺎ‬
with respect to the required minimum
percentage of national employment.

4 Application A
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Required Documents (Attachments): : ( ‫اﻟﻮﺛﺎﺋﻖ اﻟﻤﻄﻠﻮﺑﺔ )ﻣﺮﻓﻘﺎت‬

Documents for the Mother company: : ‫وﺛﺎﺋﻖ اﻟﺸﺮﻛﺔ اﻷم‬

- A certified copy of the Mother Company’s ‫ ﻧﺴﺨﺔ ﻣﻌﺘﻤﺪة ﻣﻦ ﻋﻘﺪ ﺗﺄﺳﻴﺲ اﻟﺸﺮﻛﺔ اﻷم‬-
Memorandum and Articles of Association, and a *. ‫ وﻣﺎ ﻳﻔﻴﺪ ﺑﺄﻧﻬﺎ ﻗﺎﺋﻤﺔ‬،‫وﻧﻈﺎﻣﻬﺎ اﻷﺳﺎﺳﻲ‬
certificate evidencing its existence. *

- A written approval from the concerned authority ‫ ﻣﻮاﻓﻘـﺔ ﻛﺘﺎﺑﻴـﺔ ﻣـﻦ اﻟﺠﻬﺔ اﻟﻤﺨﺘﺼـﺔ ﺑﺎﻟﺸـﺮﻛﺔ اﻷم‬-
at the Mother Company for establishing the ‫ﻋﻠـﻰ ﺗﺄﺳﻴﺲ اﻟﻜﻴﺎن اﻻﺳﺘﺜﻤﺎري ﻓﻲ دوﻟﺔ اﻟﻜﻮﻳﺖ‬
investment entity in the State of Kuwait, ‫ﻋﻠﻰ أن ﺗﻜـﻮن اﻟﻤﻮاﻓﻘـﺔ ﺻﺮﻳﺤﺔ وﻏﻴﺮ ﻣﻌﻠﻘﺔ ﻋﻠﻰ أﻳﺔ‬
such that this approval shall be explicit and *. ‫ﻣﻮاﻓﻘﺔ أﺧﺮى ﺳﻮاء داﺧﻞ دوﻟﺔ اﻟﻜﻮﻳﺖ أو ﺧﺎرﺟﻬﺎ‬
unconditional to any other approval inside or
outside the State of Kuwait. *

- Copies of certificates and registration numbers ‫ ﻧﺴﺦ ﻣﻦ ﺷﻬﺎدات وأرﻗﺎم ﺗﺴﺠﻴﻞ اﻟﻌﻼﻣﺎت اﻟﺘﺠﺎرﻳﺔ‬-
of trademarks, patents, industrial and ‫وﺑﺮاءات اﻻﺧﺘﺮاع واﻟﺮﺳﻮم واﻟﻨﻤﺎذج اﻟﺼﻨﺎﻋﻴﺔ اﻟﻤﺴﺠﻠﺔ‬
technological designs registered in its name, ‫ﺑﺎﺳﻤﻬﺎ داﺧﻞ ﻣﻮﻃﻦ اﻟﺸﺮﻛﺔ اﻷم وﺧﺎرﺟﻬﺎ ﺑﻤﺎ ﻓﻴﻬﺎ‬
both inside the Mother Company’s country of . ( ‫* )ان وﺟﺪت‬.‫دوﻟﺔ اﻟﻜﻮﻳﺖ‬
origin, and outside it including in the State of
Kuwait. * (As available)

Documents for the Investment Entity to be Established: : ‫وﺛﺎﺋﻖ اﻟﻜﻴﺎن اﻻﺳﺘﺜﻤﺎري اﻟﻤﺮاد ﺗﺄﺳﻴﺴﻪ‬

- A filled copy of the Public Authority for Industry (PAI) ‫ ﻧﺴﺨﺔ ﻣﻌﺒﺌﺔ ﻣﻦ اﻟﻨﻤﻮذج اﻟﺨﺎص ﺑﺎﻟﻬﻴﺌﺔ اﻟﻌﺎﻣﺔ‬-
Application Form (in case of an industrial project). .( ‫ﻟﻠﺼﻨﺎﻋﺔ )ﻓﻲ ﺣﺎل اﻟﻤﺸﺮوع اﻟﺼﻨﺎﻋﻲ‬

- Three hard copies and an electronic copy of the ‫ ﺛﻼث ﻧﺴﺦ ﻣﻦ اﻟﺪراﺳﺔ اﻟﻤﺒﺪﺋﻴﺔ ﻟﻠﻤﺸﺮوع وﻧﺴﺨﺔ‬-
project’s initial study (according to the attached .( ‫اﻟﻜﺘﺮوﻧﻴﺔ )وﻓﻖ اﻟﺪﻟﻴﻞ اﻹرﺷﺎدي اﻟﻤﺮﻓﻖ‬
Introductory Guide).

- Legal document supporting the designated for ‫ ﺳﻨﺪ ﻗﺎﻧﻮﻧﻲ ﻟﻠﻤﺨﻮل ﺑﺈدارة ﻟﻠﻜﻴﺎن اﻻﺳﺘﺜﻤﺎري‬-
managing the Investment Entity to be established ‫ ﻋﻠﻰ أن ﻳﻜﻮن‬،‫اﻟﻤﺮاد ﺗﺄﺳﻴﺴﻪ ﻓﻲ دوﻟﺔ اﻟﻜﻮﻳﺖ‬
in the State of Kuwait issued by the concerned ً
‫وﻣﺤﺮرا‬ ً
‫ﺻﺎدرا ﻣﻦ اﻟﺠﻬﺔ اﻟﻤﺨﺘﺼﺔ داﺧﻞ اﻟﺸﺮﻛﺔ اﻷم‬
authority in the Mother Company and showing the *. ‫ﺑﻪ ﻧﻄﺎق وﺗﺎرﻳﺦ ﺻﻼﺣﻴﺔ ﺳﺮﻳﺎﻧﻪ‬
scope and date of its validity. *

- Copy of the Civil ID or the Passport of the investment ‫ ﻧﺴﺨﺔ ﻣﻦ اﻟﺒﻄﺎﻗﺔ اﻟﻤﺪﻧﻴﺔ أو ﺟﻮاز ﺳﻔﺮ ﻟﻤﺪﻳﺮ‬-
entity manager. . ‫اﻟﻜﻴﺎن اﻻﺳﺘﺜﻤﺎري‬

5 Application A
V2
Required Documents (Attachments): : ( ‫اﻟﻮﺛﺎﺋﻖ اﻟﻤﻄﻠﻮﺑﺔ )ﻣﺮﻓﻘﺎت‬

Copies of the investment entity requirements: : ‫ﻧﺴﺦ ﻣﻦ اﺣﺘﻴﺎﺟﺎت اﻟﻜﻴﺎن اﻻﺳﺘﺜﻤﺎري‬

a. Lists of imports, costs, sources of origin, and value. . ‫ ﻗﻮاﺋﻢ اﻟﻮاردات وﺗﻜﺎﻟﻴﻔﻬﺎ وﻣﺼﺎدرﻫﺎ وﻗﻴﻤﺘﻬﺎ‬.‫أ‬
(KDIPA´s Form) ( ‫)اﻟﻨﻤﻮذج اﻟﺨﺎص ﺑﺎﻟﻬﻴﺌﺔ‬

b. Total national and foreign labor and the percentage of ‫ إﺟﻤﺎﻟﻲ اﻟﻌﻤﺎﻟﺔ اﻟﻮﻃﻨﻴﺔ واﻷﺟﻨﺒﻴﺔ ﻣﻊ ﺑﻴﺎن ﻧﺴﺒﺔ‬.‫ب‬
each according to the nature of the work, annual costs, .
‫ﻟﻄﺒﻴﻌﺔ اﻟﻌﻤﻞ وﺗﻜﺎﻟﻴﻔﻬﺎ اﻟﺴﻨﻮﻳﺔ‬ ‫ﻛﻞ ﻣﻨﻬﺎ وﻓﻘﺎ‬
and the proposed internal and external training programs. ‫واﻟﺒﺮاﻣﺞ اﻟﺘﺪرﻳﺒﻴﺔ اﻟﻤﻘﺪﻣﺔ ﻟﻬﺎ داﺧﻞ اﻟﺒﻼد وﺧﺎرﺟﻬﺎ‬
(KDIPA´s Form) ( ‫)اﻟﻨﻤﻮذج اﻟﺨﺎص ﺑﺎﻟﻬﻴﺌﺔ‬

Documents for the Applicant: : ‫وﺛﺎﺋﻖ ﻣﻘﺪم اﻟﻄﻠﺐ‬

- A copy of the applicant´s Civil ID or Passport. ‫ ﻧﺴﺨﺔ ﻣﻦ اﻟﺒﻄﺎﻗﺔ اﻟﻤﺪﻧﻴﺔ أو ﺟﻮاز‬-

. ‫اﻟﺴﻔﺮ ﻟﻤﻘﺪم اﻟﻄﻠﺐ‬

- A Power of Attorney/ Authorization Letter from the ‫اﻟﺸﺮﻛﺎء‬/‫ﻛﺘﺎب ﺗﻔﻮﻳﺾ ﻣﻦ اﻟﻤﺴﺎﻫﻤﻴﻦ‬/ ‫ وﻛﺎﻟﺔ‬-
shareholders/ partners to the applicant.* *. ‫ﻟﻤﻘﺪم اﻟﻄﻠﺐ‬

Note: (*) to be as followed: :‫ )*( ﻋﻠﻰ أن ﺗﻜﻮن ﻋﻠﻰ اﻟﻨﺤﻮ اﻟﺘﺎﻟﻲ‬:‫ﻣﻼﺣﻈﺔ‬

- Original copy in English certified by the ‫ ﻧﺴﺨﺔ أﺻﻠﻴﺔ ﺑﺎﻟﻠﻐﺔ اﻻﻧﺠﻠﻴﺰﻳﺔ ﻣﺼﺪﻗﺔ ﻣﻦ ﺳﻔﺎرة‬-
Embassy of the State of Kuwait in the country ‫دوﻟﺔ اﻟﻜﻮﻳﺖ ﻓﻲ ﺑﻠﺪ اﻟﺸﺮﻛﺔ اﻷم وﻣﺼﺪﻗﺔ ﻣﻦ‬
of origin of the Mother Company and certified . ‫وزارة اﻟﺨﺎرﺟﻴﺔ ﻓﻲ دوﻟﺔ اﻟﻜﻮﻳﺖ‬
by the Ministry of Foreign Affairs in the State
of Kuwait.

- A translated copy in Arabic certified by the ‫ ﻧﺴﺨﺔ ﻣﺘﺮﺟﻤﺔ ﺑﺎﻟﻠﻐﺔ اﻟﻌﺮﺑﻴﺔ وﻣﻌﺘﻤﺪة ﻣﻦ وزارة‬-
Ministry of Justice in the State of Kuwait ‫ إدارة اﻟﺸﺌﻮن اﻹدارﻳﺔ‬،‫اﻟﻌﺪل ﻓﻲ دوﻟﺔ اﻟﻜﻮﻳﺖ‬
(Translation Section). .(‫)ﻗﺴﻢ اﻟﺘﺮﺟﻤﺔ‬

6 Application A
V2
I, the undersigned and the designated signatory :‫أﻗﺮ أﻧﺎ اﻟﻤﻮﻗﻊ أدﻧﺎه واﻟﻤﻔﻮض ﺑﺎﻟﺘﻮﻗﻴﻊ ﻋﻦ‬
on behalf of:

Declare that all the information provided in ‫ﺑﺄن اﻟﻤﻌﻠﻮﻣﺎت اﻟﻮاردة ﻓﻲ ﻫﺬا اﻟﻄﻠﺐ وﻛﺎﻓﺔ اﻷوراق‬
this application and in the attached documents ‫اﻟﻤﺮﻓﻘﺔ ﺑﺸﺄن اﻟﻄﻠﺐ واﻟﺘﻲ ﺗﻢ ﺗﺴﻠﻴﻤﻬﺎ ﻫﻲ ﺳﺎرﻳﺔ‬
submitted is valid and correct. .‫وﺻﺤﻴﺤﺔ‬

Name: :‫اﻻﺳﻢ اﻟﺮﺑﺎﻋﻲ‬

ID No.: :‫رﻗﻢ اﻟﻬﻮﻳﺔ‬

Legal Status: :‫اﻟﺼﻔﺔ اﻟﻘﺎﻧﻮﻧﻴﺔ‬

Telephone: :‫ﻫﺎﺗﻒ‬

E-mail: :‫اﻟﺒﺮﻳﺪ اﻟﻜﺘﺮوﻧﻲ‬

Address: :‫اﻟﻌﻨﻮان‬

Date of ‫ﺗـﺎرﻳـــــﺦ ﺗﻘـــﺪﻳـــﻢ‬

Application :‫اﻟﻄﻠﺐ‬
Submissions:

Signature: :‫اﻟﺘﻮﻗﻴﻊ‬

7 Application A
V2
‫‪For official use:‬‬ ‫ﻻﺳﺘﺨﺪام اﻟﻬﻴﺌﺔ اﻟﺮﺳﻤﻲ‪:‬‬

‫رﻗﻢ اﻟﻤﻠﻒ‪:‬‬ ‫إدارة اﻟﻨﺎﻓﺬة اﻟﻤﻮﺣﺪة‪:‬‬

‫اﻟﻨﻮاﻗﺺ ﻓﻲ اﻟﻄﻠﺐ إن وﺟﺪت‪:‬‬

‫‪-١‬‬

‫‪-٢‬‬

‫‪-٣‬‬

‫‪-٤‬‬

‫اﺳﻢ وﺗﻮﻗﻴﻊ ﻣﺴﺘﻠﻢ اﻟﻄﻠﺐ‪:‬‬

‫ﺗﺎرﻳﺦ إﺑﻼغ ﻣﻘﺪم اﻟﻄﻠﺐ ﺑﺎﻟﻨﻮاﻗﺺ‪:‬‬

‫إﺣﻀﺎر اﻟﻨﻮاﻗﺺ‪:‬‬
‫ﺗﻮﻗﻴﻊ اﻟﻤﺤﻀﺮ‪:‬‬ ‫‪ -١‬ﺗﺎرﻳﺦ اﻹﺣﻀﺎر‪:‬‬
‫ﺗﻮﻗﻴﻊ اﻟﻤﺤﻀﺮ‪:‬‬ ‫‪ -٢‬ﺗﺎرﻳﺦ اﻹﺣﻀﺎر‪:‬‬
‫ﺗﻮﻗﻴﻊ اﻟﻤﺤﻀﺮ‪:‬‬ ‫‪ -٣‬ﺗﺎرﻳﺦ اﻹﺣﻀﺎر‪:‬‬
‫ﺗﻮﻗﻴﻊ اﻟﻤﺤﻀﺮ‪:‬‬ ‫‪ -٤‬ﺗﺎرﻳﺦ اﻹﺣﻀﺎر‪:‬‬

‫ﺗﺎرﻳﺦ إﻛﺘﻤﺎل اﻟﻄﻠﺐ‪:‬‬

‫ﺑﺸﺄن‬ ‫ﺗﻘﺮ اﻟﻬﻴﺌﺔ ﺑﺄن اﻟﻄﻠﺐ ﻗﺪ اﻛﺘﻤﻞ ﺑﺘﺎرﻳﺦ‬

‫اﻟﺼﻔﺔ‪:‬‬ ‫اﻻﺳﻢ‪:‬‬

‫اﻟﺘﻮﻗﻴﻊ‪:‬‬

‫‪8‬‬ ‫‪Application A‬‬

‫‪V2‬‬
 ‫ﻗﺴﻢ ﺗﻘﻴﻴﻢ اﻟﻤﺸﺮوﻋﺎت وﻣﻨﺢ اﻟﻤﺰاﻳﺎ‪:‬‬
‫ﺗﺎرﻳﺦ اﻟﺘﺤﻮﻳﻞ اﻟﻰ ﻗﺴﻢ ﺗﻘﻴﻴﻢ اﻟﻤﺸﺮوﻋﺎت وﻣﻨﺢ اﻟﻤﺰاﻳﺎ‪:‬‬
‫رأي اﻟﻘﺴﻢ وﺗﻘﻴﻴﻤﻪ )اﻟﻄﻠﺐ واﻟﻤﺒﺮرات(‪:‬‬

‫اﻟﺘﻮﻗﻴﻊ‪:‬‬

‫‪ -١‬إﻋﻔﺎءات ﺿﺮﻳﺒﺔ اﻟﺪﺧﻞ‪:‬‬

‫رأي ﻗﺴﻢ ﺗﻘﻴﻴﻢ اﻟﻤﺸﺮوﻋﺎت وﻣﻨﺢ اﻟﻤﺰاﻳﺎ ﻟﻺﻋﻔﺎء‪:‬‬

‫ﻗﺮار اﻹﻋﻔﺎء‪:‬‬

‫ﺗﺎرﻳﺦ ﻗﺮار اﻹﻋﻔﺎء‪:‬‬

‫‪ -٢‬اﻹﻋﻔﺎءات اﻟﺠﻤﺮﻛﻴﺔ‪:‬‬

‫ﻗﺮار اﻹﻋﻔﺎء‪:‬‬

‫ﺗﺎرﻳﺦ اﻟﻘﺮار‪:‬‬
‫ﻣﻮاﻓﻘﺔ ﺟﻬﺔ اﻻﺧﺘﺼﺎص‪:‬‬

‫ﺗﺎرﻳﺦ اﻟﺘﺤﻮﻳﻞ إﻟﻰ ﺟﻬﺔ اﻻﺧﺘﺼﺎص‪:‬‬

‫رد اﻟﺠﻬﺔ‪:‬‬

‫ﺗﺎرﻳﺦ اﻟﺮد‪:‬‬

‫اﻟﻤﺪﻳﺮ اﻟﻌﺎم‪:‬‬
‫ﺗﺎرﻳﺦ اﻟﻌﺮض ﻋﻠﻰ اﻟﻤﺪﻳﺮ اﻟﻌﺎم‪:‬‬
‫ﻗﺮار اﻟﻤﺪﻳﺮ اﻟﻌﺎم‪:‬‬

‫ﺗﺎرﻳﺦ إﺻﺪار اﻟﻘﺮار‪:‬‬

‫‪9‬‬ ‫‪Application A‬‬

‫‪V2‬‬
 ‫ﺗﺎرﻳﺦ ﺗﺤﻮﻳﻞ اﻟﻘﺮار إﻟﻰ إدارة اﻟﻨﺎﻓﺬة اﻟﻤﻮﺣﺪة ‪ -‬ﻗﺴﻢ ﺧﺪﻣﺔ اﻟﻤﺴﺘﺜﻤﺮﻳﻦ‪:‬‬

‫ﺗﺎرﻳﺦ ﺗﺒﻠﻴﻎ اﻟﻤﺴﺘﺜﻤﺮ ﺑﺎﻟﻘﺮار‪:‬‬

‫اﻻﻋﺘﺮاﺿﺎت‪:‬‬

‫ﺗﺎرﻳﺦ ﺗﻘﺪﻳﻢ اﻻﻋﺘﺮاﺿﺎت‪:‬‬

‫ﺳﺒﺐ اﻻﻋﺘﺮاض‪:‬‬
‫‪-١‬‬

‫‪-٢‬‬

‫ﻗﺮار اﻟﺮد ﻋﻠﻰ اﻻﻋﺘﺮاض‪:‬‬

‫‪For official use:‬‬ ‫ﻻﺳﺘﺨﺪام اﻟﻬﻴﺌﺔ اﻟﺮﺳﻤﻲ‪:‬‬

‫اﻟﻮﺿﻊ اﻟﺤﺎﻟﻲ ﻟﻠﻤﺸﺮوع‪:‬‬

‫ﺗﺎرﻳﺦ اﻟﺘﻮﻗﻒ ﻋﻦ اﻟﻌﻤﻞ‪:‬‬ ‫ﻓﻲ ﺣﺎل ﺗﻮﻗﻒ اﻟﻤﺸﺮوع‪:‬‬

‫ﺳﺒﺐ اﻟﺘﻮﻗﻒ‪:‬‬

‫ﻣﻼﺣﻈﺎت ﺧﺎﺻﺔ ﻋﻦ اﻟﻤﺸﺮوع‪:‬‬

‫‪10‬‬ ‫‪Application A‬‬

‫‪V2‬‬