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Lawsuit

This document contains a form for filing a labor case in Saudi Arabia. The summary includes: 1. The form provides information about the plaintiff worker, including their name, ID number, nationality, date of birth, address and job details. 2. It also includes information about the defendant company, such as the name, commercial registration number, address, activity and manager's name. 3. The case topics are listed, including a request to change the termination reason, request for travel tickets, request for compensation and request for a service certificate. 4. An affidavit is included to confirm the case is being filed in good faith and is not malicious prosecution.

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asem adel
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473 views2 pages

Lawsuit

This document contains a form for filing a labor case in Saudi Arabia. The summary includes: 1. The form provides information about the plaintiff worker, including their name, ID number, nationality, date of birth, address and job details. 2. It also includes information about the defendant company, such as the name, commercial registration number, address, activity and manager's name. 3. The case topics are listed, including a request to change the termination reason, request for travel tickets, request for compensation and request for a service certificate. 4. An affidavit is included to confirm the case is being filed in good faith and is not malicious prosecution.

Uploaded by

asem adel
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as PDF, TXT or read online on Scribd
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‫ﻧﻤﻮﺫﺝ ﺭﻓﻊ ﺩﻋﻮﻯ‬

‫ﺭﻗﻢ ﺍﻟﺪﻋﻮﻯ‪CS-1781474/‬‬
‫ﺗﺎﺭﻳﺦ ﺍﻟﺪﻋﻮﻯ‪30/08/2022/‬‬
‫ﻋﺎﻣﻞ‬
‫ﺻﺎﺣﺐ ﺍﻟﻌﻤﻞ‬
‫‪ ‬‬
‫ﺍﻟﻤﻮﻋﺪ‬
‫‪08/09/2022‬‬ ‫ﺍﻟﺘﺎﺭﻳﺦ‬ ‫‪ 12:30‬ﻡ ‪ 12:55‬ﻡ‬ ‫ﺍﻟﻮﻗﺖ‬
‫ﺗﺘﻢ ﺗﻌﺒﺌﺔ ﺍﻟﺤﻘﻮﻝ ﺃﺩﻧﺎﻩ ﻣﻦ ﻗﺒﻞ ﺍﻟﻤﺘﻘﺪﻡ ﻟﺮﻓﻊ ﺍﻟﺪﻋﻮﻯ )ﻋﺎﻣﻞ ‪/‬ﺍﻟﻤﻨﺸﺄﺓ‬
‫ﺗﻔﺎﺻﻴﻞ ﺍﻟﻤﻨﺸﺄﺓ‬ ‫ﻣﻌﻠﻮﻣﺎﺕ ﺍﻟﻌﺎﻣﻞ‬
‫ﺷﺮﻛﻪ ﻣﻌﺎﺭﻑ ﻟﻠﺘﻌﻠﻴﻢ ﻭﺍﻟﺘﺪﺭﻳﺐ ﺍﻟﻤﺤﺪﻭﺩﺓ‬ ‫ﺍﺳﻢ ﺍﻟﻤﻨﺸﺎﺓ‬ ‫ﻋﺎﺻﻢ ﻋﺎﺩﻝ ﻋﺒﺪﻩ ﻣﺤﻤﺪ ﺍﻟﻨﻤﻜﻰ‬ ‫ﺍﻻﺳﻢ ﺍﻟﻜﺎﻣﻞ‬
‫‪2475598161‬‬ ‫ﺭﻗﻢ ﺍﻟﻬﻮﻳﺔ ‪ /‬ﺍﻻﻗﺎﻣﺔ‬
‫ﻣﺼﺮ‬ ‫ﺍﻟﺠﻨﺴﻴﺔ‬
‫‪1010199880‬‬ ‫ﺭﻗﻢ ﺍﻟﺴﺠﻞ ﺍﻟﺘﺠﺎﺭﻱ‬ ‫‪22/05/1987‬‬ ‫ﺗﺎﺭﻳﺦ ﺍﻟﻤﻴﻼﺩ)ﻣﻴﻼﺩﻱ(‬
‫‪,,‬ﺍﻟﻤﻨﻄﻘﺔ ﺍﻟﺸﺮﻗﻴﺔ‪,‬ﺍﻟﺜﻘﺒﺔ‪,‬ﺍﻟﺨﺒﺮ‪,‬‬ ‫ﻋﻨﻮﺍﻥ ﺍﻟﻌﺎﻣﻞ‬

‫ﺍﻟﺒﻴﺎﻧﺎﺕ ﺍﻟﻌﺎﻣﺔ‬
‫‪ ‬‬
‫ﻧﺸﺎﻁ ﺍﻟﻤﻨﺸﺄﺓ‬ ‫ﺍﻟﻌﺮﺑﻴﺔ‬ ‫ﺍﻟﻠﻐﺔ‬
‫ﺳﻠﻴﻤﺎﻥ ﻣﺤﻤﺪ ﺑﻦ ﺳﻠﻴﻤﺎﻥ ﺍﻟﺰﻧﻴﺪﻱ‬ ‫ﺍﻟﻤﻨﻄﻘﺔ ﺍﻟﺸﺮﻗﻴﺔ‬ ‫ﻣﻮﻗﻊ ﺍﻟﻌﻤﻞ‬
‫ﻣﺪﻳﺮ ﺍﻟﻤﻨﺸﺄﺓ‬
‫‪23/08/2020‬‬ ‫ﺗﺎﺭﻳﺦ ﺑﺪﺍﻳﺔ ﺍﻟﻌﻤﻞ‬
‫ﺍﻟﻌﻤﻞ ﺍﻷﺧﻴﺮ‬
‫ﺭﻗﻢ ﻫﺎﺗﻒ ﺍﻟﻤﻨﺸﺄﺓ‬ ‫‪30/06/2021‬‬ ‫ﺗﺎﺭﻳﺦ ﻧﻬﺎﻳﺔ ﺍﻟﻌﻤﻞ‬
‫ﻣﻌﻠﻢ‬ ‫ﺍﻟﻤﻬﻨﺔ‬
‫‪,2‬ﺍﻻﻣﻴﺮ ﻣﺘﻌﺐ‪,‬ﺍﻟﺮﻳﺎﺽ‪,‬ﺍﻟﺮﺣﺎﺏ‪,‬ﺟﺪﺓ‪23343,‬‬ ‫ﻋﻨﻮﺍﻥ ﺍﻟﻤﻨﺸﺄﺓ‬
‫ﺍﻟﻤﻬﻨﺔ ﺍﻟﻔﻌﻠﻴﺔ‬
‫ﻳﺎﻧﺎﺕ ﺍﻟﻮﻛﻴﻞ‬ ‫‪4100‬‬ ‫ﺍﻟﺮﺍﺗﺐ‬
‫ﺻﺎﺣﺐ ﺍﻟﻌﻤﻞ‬
‫ﻣﺆﺳﺴﺔ‬ ‫ﺍﻟﻤﺪﻋﻰ ﻋﻠﻴﻪ‬ ‫‪0542073747‬‬ ‫ﺭﻗﻢ ﺍﻟﺠﻮﺍﻝ‬
‫ﺍﻟﺸﺮﻛﺔ‬
‫ﺍﺻﻴﻞ‬
‫ﻣﻤﺜﻞ ﺍﻟﻤﺪﻋﻰ ﻋﻠﻴﻪ‬ ‫ﺭﻗﻢ ﺍﺿﺎﻓﻲ‬
‫ﻭﻛﻴﻞ‬

‫ﻣﻮﺿﻮﻋﺎﺕ ﺍﻟﺪﻋﻮﻯ‬
‫ﺍﻟﻔﺌﺔ ﺍﻟﺮﺋﻴﺴﻴﺔ ‪ :‬ﺩﻋﻮﻯ ﻃﻠﺐ ﺗﻐﻴﻴﺮ ﺳﺒﺐ ﺇﻧﻬﺎﺀ ﻋﻘﺪ ﺍﻟﻌﻤﻞ‬
‫ﺍﻟﻔﺌﺔ ﺍﻟﻔﺮﻋﻴﺔ ‪ :‬ﻃﻠﺐ ﺗﻐﻴﻴﺮ ﺳﺒﺐ ﺇﻧﻬﺎﺀ ﻋﻘﺪ ﺍﻟﻌﻤﻞ‬
‫ﺍﻟﻔﺌﺔ ﺍﻟﺮﺋﻴﺴﻴﺔ ‪ :‬ﺩﻋﻮﻯ ﻃﻠﺐ ﺗﺬﺍﻛﺮ ﺳﻔﺮ‬
‫ﺍﻟﻔﺌﺔ ﺍﻟﻔﺮﻋﻴﺔ ‪ :‬ﻃﻠﺐ ﺗﺬﺍﻛﺮ ﺳﻔﺮ‬
‫ﺍﻟﻔﺌﺔ ﺍﻟﺮﺋﻴﺴﻴﺔ ‪ :‬ﺩﻋﻮﻯ ﻃﻠﺐ ﺗﻌﻮﻳﺾ‬
‫ﺍﻟﻔﺌﺔ ﺍﻟﻔﺮﻋﻴﺔ ‪ :‬ﺗﻌﻮﻳﺾ ﺁﺧﺮ‬
‫ﺍﻟﻔﺌﺔ ﺍﻟﺮﺋﻴﺴﻴﺔ ‪ :‬ﺩﻋﻮﻯ ﻃﻠﺐ ﺭﺳﻮﻡ‬
‫ﺍﻟﻔﺌﺔ ﺍﻟﻔﺮﻋﻴﺔ ‪ :‬ﻃﻠﺐ ﻣﺒﻠﻎ ﺍﻟﺮﺳﻮﻡ ﺍﻟﻤﺴﺘﺤﻘﺔ‬
‫ﺍﻟﻔﺌﺔ ﺍﻟﺮﺋﻴﺴﻴﺔ ‪ :‬ﺩﻋﻮﻯ ﻃﻠﺐ ﺷﻬﺎﺩﺓ ﺧﺪﻣﺔ‬
‫ﺍﻟﻔﺌﺔ ﺍﻟﻔﺮﻋﻴﺔ ‪ :‬ﻃﻠﺐ ﺷﻬﺎﺩﺓ ﺧﺪﻣﺔ‬
‫‪ ‬‬

‫ﺍﺧﺮﻯ‬
‫‪ ‬‬
‫‪ ‬‬
‫‪ ‬‬
‫‪ ‬‬

‫ﺗﻔﺼﻴﻞ ﺍﻟﻄﻠﺒﺎﺕ‬
‫‪ ‬‬
‫‪ ‬‬
‫‪ ‬‬
‫‪ ‬‬

‫‪Non-malicious Prosecution Affidavit‬‬ ‫ﺇﻗﺮﺍﺭ ﺑﺄﻥ ﺍﻟﺪﻋﻮﻯ ﻏﻴﺮ ﻛﻴﺪﻳﺔ‬


‫ﻗﺮ ﺃﻧﺎ ﺑﺄﻧﻨﻲ ﻗﺮﺃﺕ ﻣﺎ ﻧﺼﺖ ﻋﻠﻴﻪ ﺍﻟﻤﺎﺩﺓ )ﺍﻟﺮﺍﺑﻌﺔ( ﻣﻦ ﻗﺮﺍﺭ ﻣﺠﻠﺲ‬
‫‪I hereby confirm that I have read the provision of article (4) of council of‬‬
‫ﺍﻟﻮﺯﺭﺍﺀ ﺭﻗﻢ )‪ (94‬ﻭﺗﺎﺭﻳﺦ ‪1406/04/25‬ﻫـ ﺍﻟﺬﻱ ﻳﻨﺺ ﺑﻤﺎ ﻳﻠﻲ‬
‫‪ministers Resolution No.(94) Date 25\04\1406 H, which provides for the following:‬‬
‫)ﻣﻦ ﺗﻘﺪﻡ ﺑﺪﻋﻮﻯ ﺧﺎﺻﺔ ﻭﺛﺒﺖ ﻟﻠﻤﺤﻜﻤﺔ ﻛﺬﺏ ﺍﻟﻤﺪﻋﻲ ﻓﻲ ﺩﻋﻮﺍﻩ‬
‫‪(If the applicant filed a private prosecution and proved to the plaintiff lied in his‬‬
‫ﻓﻠﻠﻘﺎﺿﻲ ﺃﻥ ﻳﻨﻈﺮ ﻓﻲ ﺗﻌﺰﻳﺮﻩ ﻭﻟﻠﻤﺪﻋﻰ ﻋﻠﻴﻪ ﺍﻟﻤﻄﺎﻟﺒﺔ ﺑﺎﻟﺘﻌﻮﻳﺾ‬
‫‪case, judge has right to penalize his/her case and defendant reserves right to claim‬‬
‫ﻋﻤﺎ ﻟﺤﻘﻪ ﻣﻦ ﺿﺮﺭ ﺑﺴﺒﺐ ﻫﺬﻩ ﺍﻟﺪﻋﻮﻯ(‬
‫) ‪compensation for damage incurred by him /her due to this case‬‬
‫ﻭﺑﻨﺎﺀ ﻋﻠﻴﻪ ﺃﻗﺮ ﺑﺄﻥ ﺩﻋﻮﺍﻱ ﺍﻟﺘﻲ ﺃﻧﺎ ﺑﺼﺪﺩ ﺗﻘﺪﻳﻤﻬﺎ ﻏﻴﺮ ﻛﻴﺪﻳﺔ‬
‫‪I hereby declare that my case is not malicious and if the case proves to be‬‬
‫ﻭﻓﻲ ﺣﺎﻝ ﺛﺒﺖ ﺃﻥ ﺍﻟﺪﻋﻮﻯ ﻛﻴﺪﻳﺔ ﻓﺈﻧﻨﻲ ﻟﺘﻄﺒﻴﻖ ﺍﻟﻤﺎﺩﺓ ﺍﻟﻤﺸﺎﺭ ﺇﻟﻴﻬﺎ‬
‫‪malicious, I shall be subject to the aforementioned article.‬‬
‫ﺃﻋﻼﻩ ﻓﻲ ﺣﻘﻲ‪.‬‬

‫ﺍﻟﺘﻮﻗﻴﻌﺎﺕ ﻭﺍﻻﻋﺘﻤﺎﺩﺍﺕ‬
‫ﺍﺳﻢ ﺍﻟﻤﺪﻋﻲ )ﻋﺎﻣﻞ‬
‫ـــ ـــ ‪ /‬ـــ ـــ ‪ /‬ـــ ـــ ـــ ـــ ﻫـ‬ ‫ﺍﻟﺘﺎﺭﻳﺦ‬ ‫ﺍﻟﺘﻮﻗﻴﻊ‬
‫‪ /‬ﺻﺎﺣﺐ ﻋﻤﻞ(‬
‫ﺍﺳﻢ ﺍﻟﻤﻮﻇﻒ‬
‫ـــ ـــ ‪ /‬ـــ ـــ ‪ /‬ـــ ـــ ـــ ـــ ﻫـ‬ ‫ﺍﻟﺘﺎﺭﻳﺦ‬ ‫ﺍﻟﺘﻮﻗﻴﻊ‬
‫ﺍﻟﺸﺎﻣﻞ‬
‫‪:‬ﺍﺭﺷﺎﺩﺍﺕ‬
‫ﻳﺠﺐ ﻋﻠﻰ ﻣﻘﺪﻡ ﺍﻟﺪﻋﻮﻯ ﺍﺭﻓﺎﻕ ﺍﻻﺗﻲ‪ :‬ـ‬
‫ﺻﻮﺭﺓ ﻣﻦ ﺍﻹﻗﺎﻣﺔ ‪/‬ﺍﻟﻬﻮﻳﺔ )ﺇﻥ ﻛﺎﻥ ﺍﻟﻤﺪﻋﻲ ﻋﺎﻣﻼً(‬
‫ﺻﻮﺭﺓ ﻣﻦ ﺍﻟﺴﺠﻞ ﺍﻟﺘﺠﺎﺭﻱ )ﺇﻥ ﻛﺎﻥ ﺍﻟﻤﺪﻋﻲ ﻣﻤﺜﻞ ﻣﻨﺸﺄﺓ(‬
‫ﻧﺴﺨﺔ ﻣﻦ ﻋﻘﺪ ﺍﻟﻌﻤﻞ‬
‫ﺻﻮﺭﺓ ﻣﻦ ﺍﻟﻤﺴﺘﻨﺪﺍﺕ ﺍﻟﺘﻲ ﺗﺜﺒﺖ ﺻﺤﺔ ﺍﻟﺪﻋﻮﻯ‬
‫ﺃﺻﻞ ﺍﻟﻮﻛﺎﻟﺔ ﺍﻟﺸﺮﻋﻴﺔ ﻟﻠﻮﻙ‬

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