DESCRIPTION OF CHILD BORN AND PARENTS

( Non – Saudi )

Ministry of Health
Kingdom of Saudi Arabia

No. :
Date :

NAME OF CHILD : SURNAME : SEX :

PLACE OF BIRTH :

DATE OF BIRTH : TIME : DAY : MONTH : YEAR :

( Lunar )

DATE OF BIRTH : TIME : DAY : MONTH : YEAR :

( Gregorian )

NAME OF FATHER : RELIGION : OCCUPATION :

NATIONALITY : RESIDENCE CARD NO. :

DATE OF ISSUE : PLACE OF ISSUE :

NAME OF MOTHER : RELIGION : OCCUPATION :

NATIONALITY : RESIDENCE CARD NO. :

DATE OF ISSUE : PLACE OF ISSUE :

*PLEASE WRITE CLEARLY AND LEGIBLY IN BLOCK LETTERS.