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Tanggal Cetak : 18 Apr 2018 12:29:50

REPUBLIC OF INDONESIA

MINISTRY OF HEALTH

Regency/Municipal Health Service 1000480519


of .............................................

TO WHOM IT MAY
CONCERN

Herewith the undersigned :

Name : dr. Warnadi

Address : Indonesia

NOTIFIES THAT

Name : EDY SUKOCO, DRS BIN MARSIDAN

Passport : 0
Number

Flight :

for his/her own needs has to bring the following medicines

No. Items/kind of medicines Unit Amount

1 Supertetra 30

2 Oskadon 30

3 fresh care 2

4 woods cair 3

Based on medical reasons, the above medicines are stricly prepared for daily
personal use by the bearer, and this notification is provided to be shown/produced
to the Saudi Arabian Authority when necessary uppon arrival for clearance

dr. Warnadi

NIP/NRP

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