Date: )Form (4 ﻧﻣوذج )(4 اﻟﺗﺎرﯾﺦ:
Specialty ھﻧدﺳﺔ ﻣﯾﻛﺎﻧﯾﻛﯾﮫ Nationalityاﻟﺗﺧﺻص ﻣﺻر Nameاﻟﺟﻧﺳﯾﺔ ﺣﺳن اﺣﻣد اﺷرف ﻣﺣﻣد اﻻﺳم
Residency exp. date For residents only:sponsorﺗﺎرﯾﺦ ﻧﮭﺎﯾﺔ ﺻﻼﺣﯾﺔ اﻹﻗﺎﻣﺔ 11/10/2024 Current employerﻟﻠﻣﻘﯾﻣﯾن ﻓﻘط:اﺳم اﻟﻛﻔﯾل ﻻﯾﻮﺟﺪ ﺟﮭﺔ اﻟﻌﻣل اﻟﺣﺎﻟﯾﺔ
First : Qualification اوﻻ :اﻟﻣؤھـــﻼت اﻟﻌﻠــﻣﯾﺔ
ﻣﻼﺣظﺎت اﻟﻠﺟﻧﺔ ﻧﺳﺧﺔ ﻣﺻدﻗﺔ ﺳﻧﺔ اﻟﺗﺧرج اﻟدوﻟﺔ اﻟﺟﺎﻣﻌﺔ اﻟﺷﮭﺎدات
Committee's Notarized copy Graduation Country University Qualifications
ﻣﺻدﻗﺔ 2020 ﻣﺻر ﺟﺎﻣﻌﺔ اﻹﺳﻛﻧدرﯾﺔ ﺑﻛﺎﻟورﯾوس
ﻣﺻدﻗﺔ 2020 اﻟﺳوﯾد Kth, Royal Institute ﺑﻛﺎﻟورﯾوس
Second: Training courses ﺛﺎﻧﯾﺎ ً :اﻟدورات اﻟﺗدرﯾﺑﯾـــــــــــــــــــﺔ
Third : Work Experiences ﺛﺎﻟﺛﺎ ً :اﻟﺧﺑـرات اﻟﻌﻣﻠـﯾﺔ
Current working nature طﺑﯾﻌﺔ اﻟﻌﻣل اﻟﺣﺎﻟﯾﺔ
I, the undersigned confirm that the above mentioned data and enclosed documents are
correct and conform to authenticity. I also, officially acknowledged the provisions of
ﻛﻣﺎ أﻗر ﺑﺎﻟﻌﻠم اﻟﺗﺎم اﻟﻧﺎﻓﻲ ﻟﻠﺟﮭﺎﻟﺔ،أﻗر أﻧﺎ اﻟﻣوﻗﻊ أدﻧﺎه ﺑﺄن اﻟﺑﯾﺎﻧﺎت اﻟواردة أﻋﻼه واﻟﻣﺳﺗﻧدات اﻟﻣرﻓﻘﺔ ﺻﺣﯾﺣﺔ وﻣطﺎﺑﻘﺔ ﻟﻠﺣﻘﯾﻘﺔ
Law No. (19) of the year 2005 concerning regulating the practice of engineering
ﻛﻣﺎ أﻗر ﺑﻌدم إﺿﺎﻓﺔ أي ﻣﺳﺗﻧدات، ﺑﺗﻧظﯾم ﻣزاوﻟﺔ اﻟﻣﮭن اﻟﮭﻧدﺳﯾﺔ وﻻﺋﺣﺗﮫ اﻟﺗﻧﻔﯾذﯾﺔ2005 ( ﻟﺳﻧﺔ19) ﺑﺄﺣﻛﺎم اﻟﻘﺎﻧون رﻗم
professions and its implementing regulations. I also, acknowledged that after
. إﻟﺦ( ﺑﻌد ﺗﺳﻠﯾم اﻟطﻠب ﻟﻠﺟﻧﺔ أو ﻋﻧد إﺟراء اﻟﻣﻘﺎﺑﻠﺔ،..... دورات ﺗدرﯾﺑﯾﺔ، ﺷﮭﺎدات ﺧﺑرة،)ﻣؤھﻼت دراﺳﯾﺔ
submitting application to committee or having the interview, I would not provide any
further documents (qualifications or experience certificates, training courses, etc.)
Applicant signature ﺗوﻗﯾﻊ ﻣﻘدم اﻟطﻠب
Auditor signature ﺗوﻗﯾﻊ اﻟﻣدﻗﻖAuditing date ﺗﺎرﯾﺦ اﻟﺗدﻗﯾﻖAuditor name اﺳم اﻟﻣدﻗﻖ
