نموذج المعاينة

25-Oct-2021 : Date / ‫ﺍﻟﺘﺎ��ﺦ‬ ‫ﺇﺩﺍﺭﺓ ﺗ�ﺍﺧﻴﺺ ﺍﻟﻨﻘﻞ ﺍﻟﺒﺮﻱ‬ Land Transport Licensing Department Inspection Application Form - ‫ﻧﻤﻮﺫﺝ ﻣﻌﺎﻳﻨﺔ‬ :Inspection and Control.Section /‫ﻗﺴﻢ ﺍﻟﺮﻗﺎﺑﺔ ﻭﺍﻟﺘﻔﺘﻴﺶ‬ Car Rental without Driver/‫ﺃﻧﺸﻄﺔ ﺗﺄﺟﻴﺮ ﺍﻟﺴﻴﺎ�ﺍﺕ ﺑﺪﻭﻥ ﺳﺎﺋﻖ‬ Car Rental with Driver/‫ﺗﺄﺟﻴﺮ ﺍﻟﺴﻴﺎ�ﺍﺕ ﺑﺎﻟﺴﺎﺋﻖ‬ Limousine/‫ﺃﻧﺸﻄﺔ ﻟﻴﻤﻮ��ﻦ‬ :Establishment Information/‫�ﻴﺎﻧﺎﺕ ﺍﻟﻤﻨﺸﺄﺓ‬ :Commercial Name/‫ﺍﻻﺳﻢ ﺍﻟﺘﺠﺎﺭﻱ‬ :Commercial Reg. No./‫ﺭﻗﻢ ﺍﻟﺴﺠﻞ ﺍﻟﺘﺠﺎﺭﻱ‬ :Commercial Reg. Expiration Date/‫ﺗﺎ��ﺦ ﺇ�ﺘﻬﺎﺀ ﺍﻟﺴﺠﻞ‬ :Establishment Type/‫ﻧﻮﻉ ﺍﻟﻤﻨﺸﺄﺓ‬ :Commercial Reg. Issuance Date/‫ﺗﺎ��ﺦ ﺇﺻﺪﺍﺭ ﺍﻟﺴﺠﻞ‬ :Email/‫ﺍﻟﺒ��ﺪ ﺍﻹﻟﻜﺘ�ﻭﻧﻲ‬ :P.O. Box/‫ﺻﻨﺪﻭﻕ ﺍﻟﺒ��ﺪ‬ :Bldg. No./‫ﺭﻗﻢ ﺍﻟﻤﺒﻨﻰ‬ :Street No./‫ﺭﻗﻢ ﺍﻟﺸﺎ�ﻉ‬ :Establishment Location/‫ﻣﻮﻗﻊ ﺍﻟﻤﻨﺸﺄﺓ‬ :Establishment HQ/‫ﻣﻘﺮ ﺍﻟﻤﻨﺸﺄﺓ ﺍﻟﺮﺋﻴﺴﻲ‬ :Telephone/‫ﺍﻟﻬﺎ�ﻒ‬ :Telephone/‫ﺍﻟﻬﺎ�ﻒ‬ :Street Name/‫ﺍﺳﻢ ﺍﻟﺸﺎ�ﻉ‬ :Telephone/‫ﺍﻟﻬﺎ�ﻒ‬ :Establishment Contact Details/‫ﻭﺳﻴﻠﺔ ﺍﻻﺗﺼﺎﻝ ﺑﺎﻟﻤﻨﺸﺄﺓ‬ :Owner/‫ﻣﺎﻟﻚ ﺍﻟﻤﻨﺸﺄﺓ‬ :Executive Director/‫ﺍﻟﻤﺪ�ﺮ ﺍﻟﺘﻨﻔﻴﺬﻱ ﻟﻠﻤﻨﺸﺄﺓ‬ :Representative/‫ﻣﻨﺪﻭﺏ ﺍﻟﻤﻨﺸﺄﺓ‬ :General Mgr./Designee Signature/‫ﺗﻮﻗﻴﻊ ﺍﻟﻤﺪ�ﺮ ﺃﻭ ﻣﻦ ﻳﻨﻮﺏ ﻋﻨﻪ‬ :Signature/‫ﺍﻟﺘﻮﻗﻴﻊ‬ : Inspector’s Information/(‫�ﻴﺎﻧﺎﺕ ﺍﻟﻤﻌﺎ�ﻦ )ﺍﻟﻤﻔﺘﺶ‬ :Inspection Time/‫ﻭﻗﺖ ﺍﻟﻤﻌﺎﻳﻨﺔ‬ :Name/‫ﺍﺳﻢ ﺍﻟﻤﻌﺎ�ﻦ‬ :Inspection Date/‫ﺗﺎ��ﺦ ﺍﻟﻤﻌﺎﻳﻨﺔ‬ :Notes/‫ﺍﻟﻤﻼﺣﻈﺎﺕ‬ :Date/‫ﺍﻟﺘﺎ��ﺦ‬ :Approval of Inspection & Control Dept.Section/‫ﻳﻌﺘﻤﺪ ﻗﺴﻢ ﺍﻟﺮﻗﺎﺑﺔ ﻭﺍﻟﺘﻔﺘﻴﺶ‬ :Signature/‫ﺍﻟﺘﻮﻗﻴﻊ‬ :Approval of Land Transport Licensing Director/‫ﻳﻌﺘﻤﺪ ﻣﺪ�ﺮ ﺇﺩﺍﺭﺓ ﺗ�ﺍﺧﻴﺺ ﺍﻟﻨﻘﻞ ﺍﻟﺒﺮﻱ ﺑﺎﻹﻧﺎﺑﺔ‬ :Date/‫ﺍﻟﺘﺎ��ﺦ‬ :Signature/‫ﺍﻟﺘﻮﻗﻴﻊ‬