Order No.

: E782680957

Order date: 12/24/2024

a job Visa type Dhaka Representation in

. Name of the Single trip - 90 days Number of visits

the name

MD HASHEM ALI Name

normal Passport type A08522672 Passport number

12/01/2002 date of birth 01/01/2034 Expiry date

Bangladesh Current Nationality SIRAJGANJ place of birth

Offices and facilities Cleaning worker Profession male Sex

WORK Purpose

I, the undersigned, hereby consent to the taking of fingerprints and iris scans as a procedure for applying for an entry
:visa to the Kingdom of Saudi Arabia and I hereby declare with full awareness and freedom that

I acknowledge that I am aware of the prohibition of entering the city of Makkah Al-
Mukarramah during the period from the beginning of the (fifteenth) day of the month
of Dhul-Qi'dah until the end of the (fifteenth) day of the month of Dhul-Hijjah, and I
acknowledge not to remain in the city of Makkah Al-Mukarramah during that period, and
that this visa does not constitute a permit for me to perform the Hajj pilgrimage, and I
understand that in the event of violating this, I will be subject to the application of
penalties against me in accordance with the regulations and instructions applied in the
.Kingdom of Saudi Arabia

All the information I have entered is correct, and I pledge that during my stay in the Kingdom .2
of Saudi Arabia I will abide by all its laws and regulations and respect the Islamic customs and
traditions of its people, and I acknowledge my knowledge that the competent authorities in
the Kingdom have the right to not allow me to enter and return me from where I came in the
event that I violate the laws and regulations or if the data on the basis of which I obtained
.the entry visa is proven to be incorrect
I am fully aware that all intoxicating substances, narcotic drugs, materials and publications .3
that violate public morals, and all publications that affect any religious beliefs or any political
.trends and conflict with the Islamic religion are prohibited from entering the Kingdom
I am fully aware of the procedures and controls for clearing medicines containing narcotic or .4
psychotropic substances in the possession of patients arriving in or departing from the
:Kingdom for personal use, as recorded in the following link
http://www.sfda.gov.sa/ar/drug/drug_reg/pages/drug_reg.aspx , and that my violation of this
will expose me to the penalty and application of the penalties stipulated in the Anti-Narcotics
.and Psychotropic Substances System and its executive regulations
I have never been deported from the Kingdom of Saudi Arabia or any GCC country, or violated .5
.the applicable regulations
I pledge to abide by the type of visa granted to me, its conditions and duration, and to leave .6
the Kingdom before the expiry of the period of residence specified in the entry visa. I am also
fully aware that my violation of the regulations in force in the Kingdom or my commission of
any of the prohibitions mentioned above or those recorded on the entry visa will expose me
to punishment and the application of the penalties stipulated in the Regulation of the
Treatment of Those Coming to the Kingdom with Entry Visas for Hajj, Umrah, and Others
issued by Royal Decree No. (M/42) dated 10/18/1404 AH, as well as the penalties for violators
of the residence and work regulations issued by virtue of Cabinet Resolution No. (140) dated
.5/6/1434 AH
I acknowledge the right of the Saudi authorities to return me from the port of entry at my .7
own expense or to deport me from the Kingdom’s territory after my entry therein and to
apply the penalties stipulated by the system against me if it is proven at any time after
obtaining the visa or residence permit that I have submitted incorrect papers or documents
or made false statements to any competent Saudi authority inside or outside the country
with the intention of obtaining for myself or another person an entry visa, residence permit
or any official visa or if I was a contributor or partner in submitting this information or
.documents contrary to the truth and reality
I hereby acknowledge that the penalty for smuggling drugs into or promoting them within .8
.the Kingdom is death
I pledge to declare cash, precious metals and the like, the value of which reaches (60,000) .9
sixty thousand riyals or more, or the equivalent in foreign currencies, upon my arrival to or
departure from the Kingdom. I also pledge to declare any valuable luggage with me upon my
arrival to the Kingdom and my readiness to pay the customs duties and taxes due on it. In the
event of my violation of this, I will be subject to legal accountability and the application of
.what the Kingdom’s regulations stipulate against me
I acknowledge that the Kingdom’s regulations criminalize the payment of any bribe, .10
regardless of its amount, and consider it a criminal case that exposes the perpetrator to
.imprisonment, a fine, or both
 I hereby acknowledge and pledge once again that all the information I have entered is .11
correct and I bear full responsibility for it. If it is proven otherwise - or it becomes clear that I
am on the banned list - my application will be rejected, or the visa will be automatically
cancelled if I obtain it, or I will not be allowed to enter the Kingdom of Saudi Arabia if I have a
valid visa. I acknowledge the right of the Saudi authorities to return me from the port of
.entry at my own expense and I have no right to claim compensation

:Name

: the signature

: the date