You are on page 1of 1

Tanggal Cetak : 02 Jul 2019 08:41:03

REPUBLIC OF INDONESIA

MINISTRY OF HEALTH

Regency/Municipal Health Service 1500065337


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

TO WHOM IT MAY
CONCERN

Herewith the undersigned :

Name : dr. Wiwik Nurlaela

Address : Indonesia

NOTIFIES THAT

Name : MASNUN BIN NURILAH DURILAH

Passport : 0
Number

Flight :

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

No. Items/kind of medicines Unit Amount

1 STIMUNO 40

2 AMLODIPINE 5mg 80

3 RAMIPRIL 5mg 10

4 DIAPET 10

5 PARACETAMOL 500mg 10

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. Wiwik Nurlaela

NIP/NRP

You might also like