Name : ASNAH BINTI ISMAIL

Date Of Birth : : 04 Jul 1964

Sex: : FEMALE
Nationality : : INDONESIA
Vaccine of prophylaxis Meningitis ACWY
Date : -
Signature and professional status of
supervising clinician

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Manufacture and batch no of vaccine
-

Certificate valid
ASNAH BINTI ISMAIL From :
KAB. SAWAH LUNTO SIJUNJUNG Until :
Official stamp of the
300059394 administering center