Walailak University
Health Certificate
Kudus, indonesia
27 March 2019
‘am a medical doctor, holding a medical practice license number 33. Jer /449-1/-
place of practice... Wusvwi4ifa.. Mespebat, _ Kindiu-s 465/vi fae
1cQ
Hospital's address
undertook a medical examination of Mr Handoyo
Nationality indonesia Passport No. B9744538,
On date 27 month march year 2019
I hereby certify that Mr Handoyo
Dts Tis not a disabled person who is not capable of working.
11 suffers €¥does not suffer from mental disorder/sickness/retardation,
1 shows +27 does nat show symptoms of drug addiction,
Ds ef isnot a chronic alcoholic.
presents 42” does not Present symptoms of contagious leprosy.
1 suffers \2¥does not suffer from contagious tuberculosis.
1 shows 2 does not show symptoms of elephantiass.
Comment and recommendation to participate in the event of The 3° Walailak
Univeristy Cultural Camp in Tahiland.
| hereby certify that Mr Handoyo is in good physical and mental health.
Anwar