Scribd
Upload
464 views1 page

Qib Form DW

1) This document is a service agreement for a domestic worker card between an account holder and a bank. It contains information about the account holder, domestic worker card holder, delivery details for the card and PIN, account holder declaration, and sections for bank use. 2) The account holder authorizes the bank to debit fees from their account as outlined in the domestic worker card tariff of charges. 3) If there is any conflict between the Arabic and English versions, the Arabic version will prevail as the binding version.

Uploaded by

HARISH
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
464 views1 page

Qib Form DW

1) This document is a service agreement for a domestic worker card between an account holder and a bank. It contains information about the account holder, domestic worker card holder, delivery details for the card and PIN, account holder declaration, and sections for bank use. 2) The account holder authorizes the bank to debit fees from their account as outlined in the domestic worker card tariff of charges. 3) If there is any conflict between the Arabic and English versions, the Arabic version will prevail as the binding version.

Uploaded by

HARISH
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
You are on page 1/ 1

‫ اﺗﻔﺎﻗﯾﺔ اﻟﺧدﻣﺔ‬- ‫ﺑطﺎﻗﺔ اﻟﻌﻣﺎﻟﺔ اﻟﻣﻧزﻟﯾﺔ‬

Domestic Worker Card – Service Agreement


19-May-2020 12:29

Account Holder Information ‫ﻣﻌﻠﻮﻣﺎت ﺻﺎﺣﺐ اﻟﺤﺴﺎب‬


Customer Name ‫اﺳﻢ اﻟﻌﻤﯿﻞ‬
QID ‫رﻗم اﻟﺑطﺎﻗﺔ اﻟﺷﺧﺻﯾﺔ‬ Building Name ‫اﺳﻢ اﻟﻤﺒﻨﻰ‬
Account Number ‫رﻗﻢ ﺣﺴﺎب اﻟﺸﺮﻛﺔ‬ Building No. ‫رﻗﻢ اﻟﻤﺒﻨﻰ‬
0RELOH1XPEHU ϝ΍ϮΠϟ΍Ϣϗέ Street Name & No. ‫اﺳﻢ و رﻗﻢ اﻟﺸﺎرع‬
Email Address ‫ﺑﺮﯾﺪ اﻹﻟﻜﺘﺮوﻧﻲ‬ Zone Name & No. ‫اﺳﻢ و رﻗﻢ اﻟﻤﻨﻄﻘﺔ‬
P.O. Box ‫ﺻﻨﺪوق اﻟﺒﺮﯾﺪ‬ City ‫اﻟﻤﺪﯾﻨﺔ‬

Domestic Work Card Holder Information ‫ﺑﯿﺎﻧﺎت ﺣﺎﻣﻞ ﺑﻄﺎﻗﺔ اﻟﻌﻤﺎﻟﺔ اﻟﻤﻨﺰﻟﯿﺔ‬
Card Holder Name ‫اﺳﻢ ﺣﺎﻣﻞ اﻟﺒﻄﺎﻗﺔ‬
QID ‫رﻗﻢ اﻟﺒﻄﺎﻗﺔ اﻟﺸﺨﺼﯿﺔ‬
Passport Number ‫رﻗﻢ ﺟﻮاز اﻟﺴﻔﺮ‬
Nationality ‫اﻟﺠﻨﺴﯿﺔ‬
Date of Birth ‫ﺗﺎرﯾﺦ اﻟﻣﯿﻼد‬
Mobile Number ‫رﻗﻢ اﻟﺠﻮال‬
Name in English to be embossed on the Card. ‫اﻻﺳﻢ ﺑﺎﻹﻧﺠﻠﯿﺰﯾﺔ ﻛﻤﺎ ﺗﻮد أن ﯾﻈﮭﺮ ﻋﻠﻰ اﻟﺒﻄﺎﻗﺔ‬
Leave spaces between each name (up to 20 characters including spaces) (‫ ﺣﺮﻓﺎ ً ﺿﻤﻨﮭﺎ اﻟﻔﺮاﻏﺎت‬20 ‫اﺗﺮك ﻓﺮاﻏﺎت ﺑﯿﻦ ﻛﻞ اﺳﻢ )ﺣﺘﻰ‬

Domestic Worker Card & PIN Delivery ‫ﺗﺴﻠﯿﻢ ﺑﻄﺎﻗﺔ اﻟﻌﺎﻣﻞ اﻟﻤﻨﺰﻟﻲ ورﻗﻢ اﻟﺘﻌﺮﯾﻒ اﻟﺸﺨﺼﻲ‬
Branch Collection / ‫اﺳﺘﻼم ﻣﻦ اﻟﻔﺮع‬ QPost / ‫ﺑﺮﯾﺪ ﻗﻄﺮ‬ Courier / ‫ﺗﻮﺻﯿﻞ‬

Account Holder Declaration ‫ﺗﺼﺮﯾﺢ ﺻﺎﺣﺐ اﻟﺤﺴﺎب‬


I/We, the undersigned, declare that the information mentioned in this form is true ‫ﻧﻌﻠﻦ أن اﻟﻤﻌﻠﻮﻣﺎت اﻟﻤﺬﻛﻮرة ﻓﻲ ھﺬا اﻟﻨﻤﻮذج‬/‫ أﻋﻠﻦ‬،‫اﻟﻤﻮﻗﻌﯿﻦ أدﻧﺎه‬/‫ﻧﺤﻦ اﻟﻤﻮﻗﻊ‬/‫أﻧﺎ‬
and correct. I/We undertake to notify the Bank in writing of any changes in details ‫ﻧﺘﻌﮭﺪ ﺑﺈﺧﻄﺎر اﻟﺒﻨﻚ ﻛﺘﺎﺑﯿﺎ ً ﺑﺄي ﺗﻐﯿﯿﺮ ﻓﻲ اﻟﺘﻔﺎﺻﯿﻞ اﻟﻮاردة ﻓﻲ‬/‫ﻧﺤﻦ أﺗﻌﮭﺪ‬/‫ أﻧﺎ‬.‫ﺻﺤﯿﺤﺔ‬
contained in this form. I/We authorize the Bank to debit my account with the ‫ﺣﺴﺎﺑﺎﺗﻨﺎ ﻟﺪى اﻟﺒﻨﻚ ﻋﻦ‬/‫ﻧﻔﻮض اﻟﺒﻨﻚ ﺑﺎﻟﺨﺼﻢ ﻣﻦ ﺣﺴﺎﺑﻲ‬/‫أﻓﻮض‬ ّ ‫ﻧﺤﻦ‬/‫ أﻧﺎ‬.‫ھﺬا اﻟﻨﻤﻮذج‬
Bank for any fees as outlined in the Domestic Worker Card Tariff of Charges. ‫اااااااااااااااااااااااا‬.‫أﯾﺔ رﺳﻮم ﻛﻤﺎ ھﻮ ﻣﻮﺿﺢ ﻓﻲ ﺗﻌﺮﻓﺔ رﺳﻮم ﺑﻄﺎﻗﺔ اﻟﻌﺎﻣﻞ اﻟﻤﻨﺰﻟﻲ‬

I/We acknowledge that the above selected method of delivery will be to the ‫ﻧﻘﺮ ﺑﺄن طﺮﯾﻘﺔ اﻟﺘﺴﻠﯿﻢ اﻟﻤﺨﺘﺎرة أﻋﻼه ﺳﺘﻜﻮن ﻟﻠﻌﻨﻮان اﻟﻤﺬﻛﻮر ﻋﻠﻰ اﻟﻨﻈﺎم‬/‫أﻗﺮ‬ ّ ‫ﻧﺤﻦ‬/‫أﻧﺎ‬
address stated on the Banks Banking system with no liability on the Bank. ‫اااااااااااااااااااااااااااااااااااااااااااااااااااااااااا‬.‫اﻟﻤﺼﺮﻓﻲ ﻟﻠﺒﻨﻮك دون أي ﻣﺴﺆوﻟﯿﺔ ﻋﻠﻰ اﻟﺒﻨﻚ‬
In case of conflict, discrepancies or difference between the Arabic Version and ‫ وﻓﻲ ﺣﺎﻟﺔ وﺟود ﺗﻌﺎرض أو اﺧﺗﻼف ﺑﯾن‬،‫أﻋد ھﺬا اﻟﻧﻣوذج ﺑﺎﻟﻐﺗﯾن اﻟﻌرﺑﯾﺔ واﻹﻧﺟﻠﯾزﯾﺔ‬
the English Version, the Arabic Version will prevail and will therefore be the ‫ ﺳوف ﺗﻌﺗﻣد اﻟﻧﺳﺧﺔ اﻟﻌرﺑﯾﺔ وﺑﺎﻟﺗﺎﻟﻲ ﺳﺗﻛون‬،‫اﻟﻧﺳﺧﺔ اﻟﻌرﺑﯾﺔ واﻟﻧﺳﺧﺔ اﻹﻧﺟﻠﯾزﯾﺔ‬
binding version. .‫اﻟﻧﺳﺧﺔ اﻟﻣﻠزﻣﺔ‬

‫اﻟﺘﺎرﯾﺦ‬ ‫ﺗﻮﻗﯿﻊ ﺻﺎﺣﺐ اﻟﺤﺴﺎب‬ ‫اﺳﻢ ﺻﺎﺣﺐ اﻟﺤﺴﺎب‬


Date Account Holder Signature Account Holder Name

Receiving Branch SV ‫ﻣﻄﺎﺑﻘﺔ اﻟﺘﻮاﻗﯿﻊ ﻣﻦ ﺧﻼل اﻟﻔﺮع اﻟﻤﺴﺘﻠﻢ‬

For Bank Use Only ‫ﻹﺳﺘﺨﺪام اﻟﺒﻨﻚ ﻓﻘﻂ‬


I have checked the details and documents given by the Authorized signatories ‫ وﻗد ﻗﻣت ﺑﺎﻟﺗﺣﻘﻖ ﻣن ﺗوﻗﯾﻌﮭم‬، ‫ﻟﻘد راﺟﻌت اﻟﺗﻔﺎﺻﯾل واﻟوﺛﺎﺋﻖ اﻟﺗﻲ ﻗدﻣﮭﺎ اﻟﻣوﻗﻌون اﻟﻣﻌﺗﻣدون‬
and I have verified their signature(s). I have processed the request as per the .‫)ﺗوﻗﯾﻌﺎﺗﮭم( و ﻧﻔذت اﻟطﻠب ﺣﺳب ﻣﺎ ورد أﻋﻼه‬
above.
Signature ‫اﻟﺘﻮﻗﯿﻊ‬ Staff Name ‫اﺳم اﻟﻣوظف‬

Date ‫اﻟﺘﺎرﯾﺦ‬ Staff No. ‫اﻟرﻗم اﻟوظﯾﻔﻲ‬

Signature ‫اﻟﺘﻮﻗﯿﻊ‬ Manager Name ‫اﺳم اﻟﻣدﯾر‬

Date ‫اﻟﺘﺎرﯾﺦ‬ Staff No. ‫اﻟرﻗم اﻟوظﯾﻔﻲ‬

You might also like