RUMAH SAKIT AL- ROHMAH

Jalan Achmad Yani no.37

JAJAG – GAMBIRAN - BANYUWANGI
Telp. 0333-397267 Fax. 0333-397361, email ; rs.alrohmah@gmail.com

To : EMBASSY OF SCHENGEN COUNTRIES

Re : Visitor Visa Application ( Tourist Visa )

Herewith I undersign and certify :

Name : dr. DWI SUNU BUDHIARDJO BIN SOEDHARTO

Position : KOMITE MEDIK RUMAH SAKIT AL-ROHMAH
Passport Number : A 7576097

Herewith I undersign and certify :

Name : ENDAH SULASI BINTI FADHIL DAHLAN

Position : WIFE
Passport Number : A 7576094

We will be travelling to European countries and departing from 10th July 2016 until 25th July 2016 for
holiday. All the expenses during the trip will be furnishing by their. We will guarantee that they will not
seek any employment or permanent stay in your country and will be return to Indonesia after the end
on the trip and also promise to obey every regulation in your country. It will be highly appreciate if you
could the tourist visa for me and my family to enter your country at your earliest convenience.

Thank you very much for your kind attention and good cooperation

Yours Sincerely,

Dr. DWI SUNU BUDHIARDJO BIN SOEDHARTO

KOMITE MEDIK RS AL-ROHMAH