Date: 26 August 2017

Wheelchair on Loan for Madam Ching Mee Eng

Business Development Wheelchair BD/13/10/16 is borrowed to Madam Ching Mee Eng (MRN
388932), patient under the care of Dr. Francis Ting from 26 August 2017 until 5 September 2017.
Prof. Nurakmal Abdullah @ Goh Tuo Ho (daughter) will return the wheelchair on 5 September 2017
to Patient Relations/Information Counter.

Signature of borrower :

………………………………………………………………….

Name: Prof. Nurakmal Abdullah @ Goh Tuo Ho (Daughter on behalf of patient)

I.C No: 641126-12-5088
Address: WP 601, Lot 2855 De Summit Condominium,
Muara Tebas Land District
Ulu Sg Stutong
Off BDC Lorong B4
Jalan Stutong
93350 Kuching
Tel: 0163110881

Witnessed by: ……………………………………………………………..

Name: …………………………………………………………………………