(Kop Surat Rumah sakit)

Jakarta, November 30, 2018

Ref. no. :
Re :

To :
Visa Section
The Embassy of France
Jakarta

Dear Sirs/Madam,

I. the undersigned
Name : dr Hophoptua N. Manurung Sp. S Mars
Position : Director of PGI Cikini Hospital
Address : Raden Saleh Raya Street No.40, RT.12 / RW.2, Cikini,
Menteng, Central Jakarta City, Jakarta Special Capital Region 10330

Herewith to certify that:

Name : Samuel Keryanto Rumende
Position : General Practitioner
Passport No. : B 1326418

Are planning to have vacation to Japan, including your country, on December 21,
2018 until December 27, 2018.

I acknowledge and guarantee that he will not seek any employment or

permanent stay into your country and will return to Indonesia soon after their
holiday trip is completed. All kinds of expenses during the trip of above purpose
are fully covered by their personal account.

Kindly grant them the necessary entry visa in order to join in the tour program.
Your kind assistance will be very highly appreciated.

Your Sincerely,

dr Hophoptua N. Manurung Sp. S Mars
Director