Tanggal Cetak : 25 Jun 2019 12:03:36

REPUBLIC OF INDONESIA

MINISTRY OF HEALTH

Regency/Municipal Health Service 1000545268

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

TO WHOM IT MAY
CONCERN

Herewith the undersigned :

Name : drg. Meta Damajanti

Address : Indonesia

NOTIFIES THAT

Name : SITI MARYAM BINTI ABDUL GANI

Passport :
Number

Flight :

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

No. Items/kind of medicines Unit Amount

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

drg. Meta Damajanti

NIP/NRP