Introduction
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Government Hospital
Private Hospital
Hospital Name
City
Address
Personal
Name
ID #
Address
Establishment
Name of Establishment
CR #
MDNR #
MDEL #
Other
Tel. No
Mobile No
Fax No
Email Address
Address
Business
Demo/Exhibtions
Research/Clinical Trials
Personal Use
Custom Made
others, specify
Applicant Name
Tel. No
Mobile No
Fax No
Email Address
Arrival Port:
-- Select one option --
King Khalid international Airport – RAP (RUH)
Dry Port – RDP (RUH)
King Abdulaziz International Airport – JAP (JED)
Jeddah Islamic Sea port -JSP (JED)
King Fahad International airport -DAP (DMM)
King Abdulaziz sea port – DSP (DMM)
King Fahad causeway- DBP (DMM)
Hadithah Port – QBP (NS)
Batha Port – BBP (ES)
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Riyadh (RUH)
Jeddah (JED)
Dammam (DMM)
North Side (NS)
East Side (ES)
Date
Importing Licensing #
Bill of lading No:
Name
Mobile No
Establishment warehouse
Customer, Specify
Other, Specify
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