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PEMERIruTAI.I KAEUPATEru NGA&IJI.JK

RUMAI-I SAKIT' L"'MN..!$W DAERAH ruGANJI.JK
Jalan Doktor Soetomo Nomor 62 NGANJUK 64415
Telepon (0358) 321 81 8, 32647 4, 3?6652, 328429 Faksimile (0358) 325003
MUD NGANJUK

N g a nj u k,/-oPeb rua ri 20 1 I
Nomor . 09at 74 t411.8A12019 Kepada
Sifat : Penting Yth. BUPATI NGANJUK
Lampiran :- di
Perihal : liin Tugas Dinas Luar Daerah NGANJUK

Sesuai dengan Surat dari lnaSH House tentang 13th Scientific

Meeting Of lndonesian Society of Hypertension 2019, dengan ini kami
mengajukan permohonan ijin untuk melaksanakan Tugas Dinas Luar
Daerah dengan penjelasan sebagai berikut:
Har i : Jumat s/d Minggu
Tanggal : 22 Februari 2019 sld 24 Februari 2019
Pukul : 08.00 WIB - Selesai
Tempat : Sheraton Grand Gandaria City Hotel Jakarta
Acara : Mengikuti 13th Scientific Meeting Of
lndonesian Society of Hypertension 2019

Demikian untuk menjadikan maklum

DIREKTUR
RUMAH SAKIT UMUM DAERAH NGANJUK

dr. F.X. Tequh Prartono H.U., Sp.PD FINASIM

Pembina Utama
NlP. 19590830 198703 1007
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Garuda tnoonesnN,.|
 THE 13th SCIENTIFIC MEETING OF THE INDONESIAN SOCIETY OF HYPERTENSION
Feb 22 -24, 2019 Sheraton Jakarta Gandaria City Hotel
Secretariat :

Jl. Danau Diatas No.8'1, Bendungan Hilir Jakarta lndonesia

1 elp: 62-21 -5714978, Fax : 62-21 -5734978
Efiail : inash@inash.or.id ; sci€ntific@inash.6r-id
Website : ww.inash.or.id

HOTEL RESERVATION CONFIRMATION

TEGUH PRARTONO, MD
Confirmation Number
RSUD NGANJUK

43
Phone: Fax:
Email: Reg Date: II

Sheraton Jakarta Gandaria City Hotel

Jln Sultan lskandar Muda, Kebayoran Baru , Jakarta1224A, Phone 021-80630888

Type Requested: Check ln: Check Out:

Deluxe Room (lncluding Breakfast) 22t02t2019 24tlzt2A19

Room Rate: Rp1,850,000,- Total: Rp 3,700,000,-

Sponsor by: PT. ESCOLAB Paid

Jakarta,
Yours sincerely, 3 3snusri 201 9

Ekawatidani Yulianti, MD
Accomodation Subcommittee
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PT GARUDA I NDONESTA (PERSERO) Tbk./NPWp 01 .001 .634.3-093.000

JL. KEBON SIRIH NO,44 GAMBIR JAKARTA PUSAT-10110
\AIV!^lu, GAR U DA- I N DON ESIA. COM

Electronic Ticket Receipt

Booking Reference: PXWYBC Office
At check-in, you must show a photo lD. HARYONO HO SUB
JL.SULAWESI NO.27-29

SURABAYA
Telephone; 03 1 -5033000

Passenger Ticket number

Teguh Prartono Mr (ADT) 126 2656045558

Itinerary
From To Flight Class Date Departure Arrival Resa(1) NVB(2) NVA(3) Lastcheck-in Baggage(4) Seat

SURABAYA JAKARTA GA0307 Y 22Feb 07:50 09:25 Ok 22May 07.2A 20K

JUANDA SOEKARNO
HATTA INTL
Terminal 2 Terminal 3 Fare Basis YRT
Operated by GARUDA INDONESIA Marketed by GARUDA INDONESIA

JAKARTA SURABAYA GAO322 Y 24Feb '17:1O 18:50 Ok 22May 1625 20K

SOEKARNO JUANDA
HATTA INTL
Terminal 3 Terminal 2 Fare Basis YRT
Operated by GARUDA INDONESIA Marketed by GARUDA INDONESIA

(1 ) Ok = confirmed (2) NVB = Not valid before (3) NVA = Not valid after (4)Each passenger can check in a speciric amount of baggage at no extra cost as indicated
above in the column baggage.

Receipt
Name : Teguh Pmrtono Mr {ADT}
Ticket number : 126 2656045558
Form of payment :CASH : 3097700: lDR0
Fare : IDR 2607000
Taxes : IDR 10000 YR IDR 220000 D5 IDR 260700 ID
Total Amount : IDR 3097700
lssuing Airline and date : GARUDA INDONESIA O3Jan19 IATA : 15057836
Restriction(s[Endorsements : Condition Applies
Fare Calculation : SUB GA JKT1303500.00GA SU81303500.001DR2607000.00END

The fare that applies on the date of purchase is only valid for the entire itinerary and the specific travel dates mentioned on the ticket.

Garuda lndonesia wishes you a very pleasant trlp.

This document establishes the creation ot your eleetronic tlcket{s} in our computer systems.

The carriage ofcerlain hazardous materials, like aerosols, fleworks, and fannnable liquids, aboard theaircraf is forbidden. ll you do not understand these resirictions,
further information may be oblained from your airline,

Data Protection Notice: Your personal data will be processed in accordance with the applicable carier's privacy policy and, if your booking is made via a reservation
sJstem provider ( GDS ), with its privacy policy. These are available at httpr/www.iatatravelcenter.cofirprivacy or from the carrier or GDS directly. You should read this
documentation, which applies to your booking and specifies, for example, how your personal data is collected, stored, used, disclosed and transferred,(applicable tor
interline carriage)

Please bring this receipt, credit card and your identity card on your travel in case required by airportlcheckin counter/customs and irnmigration oflicials as proof of
purchase.
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Event Registration Confi rmation #f462bfd9-

Certificate Name : dr. Teguh Prartono, Sp.PD Name :Teguh Prartono lnstitution : RSUD NGANJUK
Email : escolabjtm@yahoo.com Mobile : 08123403480 Phone :A$8483527
City :Kediri Country : lndonesia

Event Name Fee Payment Status Sponeor Notes

Symposium Rupiah 1,850,000 (from Validated PT. Dipa Pharmalab lntersains
201 8-01 -01 to 201 8-'12-31 )
or
Rupiah 2,200,000 (from
201 9-01 -0 1 b 2419-42-24)

lmportant :

- This is not a payment invoice. lf you have not completed the payment, please complete it immediately.
- Please bring this confirmation letter and show it to the registration counter when you re-register.

Reregistration Code Jakarta, 3 January 2019

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OF ATTENDANCE

This ls to certify that

Teguh Prartono, MD

has participated in

*L SCIENTIFIC MEETING OF HYPERTENSION 2019:

rr r lppgNEstAN soctETY oF GLOBAL RISK MANAGEMENT
HYPERTENSION 2019
IN HYPERTENSION

Sheraton Grand Gandaria City Hotel Jakarta, lndonesla

February 22 - 24,2019

AS

PARTICIPANT

t^/
ffi Tungt@l D. Situmorang, MD
President
lnaSH lndonesian Society of Hypertension

Accredited by lndonesian Medlcal Association No. : 0'1 98/PB I 4.410212019

Participant 10 SKP Speaker 12 SKP, Moderator 4 SKe
Organizing Committee 2 SKP