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Embassy of
Riyadh,
CanadaSaudi
Arabia Visa Section

Ambassade Du
Canada
Riyad, Arabie
Saoudite Service des
Visas

Supplementary Form

* Please, use TYPE/PRINT & Gregorian calendar format (Day/Month/ Year)

*Please write N/A if a question does not apply to you.

Consult our website for forms and instructions, including a list of countries whose
nationals require a temporary resident visa: Saudi Arabia.

Type of Application:
( ) Visitor ( ) Worker ( ) Student ( ) Other

'.APP-licant SuR.P-lemen a-==n=fo=-r-m.....a....t.i..o.....n..

------

1.Full Name (Family Name, First Name and Middle Name) as in passport.
2. Current Nationality:

Nationality at birth:
Do you have any other nationalities? If yes, please provide details:
3. Passport Details: Passport Type: ( ) Regular ( ) Special ( ) Diplomatic ( ) Other

Place of issue (City &Country):

Date of your last entry into the Kingdom of Saudi Arabia:
4. Length of Travel: (DD/MM/YYYY)

- Date you will leave Saudi Arabia :

- Estimate date of arrival
to Canada:
- Estimate date of departure from Canada:
- Are you travelling to any other country during this trip: YES
NO
- Please indicate the countries you will be
visiting:

Family & Friends SupplementaryInformation

Relatives/friends in Canada? ( )YES ( )NOIf YES, please provide the requested information
with a copy of the document proving the validity of their status in Canada: Valid Study
Permit
- Work Permit, Permanent Resident Card.....etc
Relationship Family Name First Name

Date of Birth
Citizenship Occupation in Canada
(dd/mm/yyy)

riyadh.visa@international.gc.ca Internet :www.saudiarabia.gc.ca

Riyad, Arabie Saoudite

Service des Visas

Riyadh, Saudi Arabia

Visa Section

Please provide the requested information for other individuals (not family)
travelling with you.
Current country
Family
First
Date of
Relationship
Citizenship Occupation
of residence
Name
Name Birth
(dd/mm/yyy)

il'ravelInformation
Please list all countries visited in the past ten years and year of visit.
separate sheet if necessary.

Use

Year

Country
1

2
3
4
5

6
7
8
9
- Have you ever travelled to Canada during the past 10 years? ( )Yes ( ) No
- f YES,please provide details of your last two visits to Canada (beginning with the
most recent one).
Date of
Entry
(dd/mm/yyy)

Purpose

Duration

Date of
Departure
(dd/mm/ yyyy)

P.O. Box 94321,Riyadh 11693, KSA. Fax: 01-4889657 Email:

riyadh.visa@international.gc.ca Internet :
www.saudiarabia.gc.ca

Visa File
Number (if
applicable)

l+I

Embassy of Canada
Riyadh, Saudi
Arabia Visa Section

Ambassade Du Canada
Riyad, Arabie Saoudite
Service des Visas

Non-Saudi
Nati:o:.:n.:.=als=--1. How long have you resided in Saudi Arabia?
2. What is the expiry date of your residence permit?
3. What is the name of your sponsor for your residence permit?
4. What are the dates of your authorized leave from your sponsor?

For Student Permit Applicants Only ***

Please give the request information in reference to the agent or representative who assisted
you with your admission to the Educational nstitution in Canada and/or with your study
permit in application:
Agent's name: --------------------Phone number:
_
Business
address:
_
- Please detail your education/work experience since the age of 18. Start with the most
recent information. Under Field Activity, write your course of study or details of
employment.In the case where you were not working or studying, please indicate what you
were doing. As an example: unemployed, travelling, etc...
* Use separate sheet if necessary .
From

To

Month &
Year

Month &
Year

School /
EmployerCompany

Field of Study
Activity

Diploma or Certificate/
Position at work

Who will pay for your tuition and fees in Canada?

Complete name:
Relationship:
Phone number(s) where the person can be
contacted:

_
__
_

I declare that I have answered all questions in this form fully and truthfully. I understand
that if the information is found to be untruth or incomplete, my application may be refused.
Name
Signatur e._
Date:

(dd/mm/ yyyy)
P.O. Box 94321,Riyadh 11693, KSA. Fax: 01-4889657 Email:
riyadh.visa@internati onal.gc .ca
Internet :www.saudiarabia.gc.ca