MANDATORY CERTIFICATE OF IMMUNIZATION

This is to certify that

Name :
Date of Birth :
Sex :

has on the date indicated been vaccinated or received prophylaxis against

No Vaccine of prophylaxis Batch no Date

required signature of physician or health facility to verify immunization history

Signature :

Name :

Country : Indonesia
Address of physician : Rumah Vaksinasi
Jl. Percetakan Negara IV B No.48 RT.009 RW.09 Johar Baru
Central Jakarta, City Jakarta 10560
Ph +6287776097885
 MANDATORY CERTIFICATE OF IMMUNIZATION

This is to certify that

Name :
Date of Birth :
Sex :

has on the date indicated been vaccinated or received prophylaxis against

No Vaccine of prophylaxis Batch no Date

required signature of physician or health facility to verify immunization history

Signature :

Name :

Country : Indonesia
Address of physician : Rumah Vaksinasi
Blok PAL 41 Jl. Raya Lontar Babatan Kec. Wiyung
Kota Surabaya Jawa Timur 60227
Ph +6282230764050
 MANDATORY CERTIFICATE OF IMMUNIZATION

This is to certify that

Name :
Date of Birth :
Sex :

has on the date indicated been vaccinated or received prophylaxis against

No Vaccine of prophylaxis Batch no Date

required signature of physician or health facility to verify immunization history

Signature :

Name :

Country : Indonesia
Address of physician : Rumah Vaksinasi
Jl Pucang Adi No.39 Kertajaya Kec. Gubeng
Kota Surabaya Jawa Timur 60282
Ph +6281322254621
 MANDATORY CERTIFICATE OF IMMUNIZATION

This is to certify that

Name :
Date of Birth :
Sex :

has on the date indicated been vaccinated or received prophylaxis against

No Vaccine of prophylaxis Batch no Date

required signature of physician or health facility to verify immunization history

Signature :

Name :

Country : Indonesia
Address of physician : Rumah Vaksinasi
Jl Sawangan No.13 Mampang Kec. Pancoran Mas
Kota Depok Jawa Barat 16436
Ph +6281221351408
 MANDATORY CERTIFICATE OF IMMUNIZATION

This is to certify that

Name :
Date of Birth :
Sex :

has on the date indicated been vaccinated or received prophylaxis against

No Vaccine of prophylaxis Batch no Date

required signature of physician or health facility to verify immunization history

Signature :

Name :

Country : Indonesia
Address of physician : Rumah Vaksinasi
Jl Salatiga No.21S Dupak Kec. Krembangan
Kota Surabaya Jawa Timur 60179
Ph +6281244410021
 MANDATORY CERTIFICATE OF IMMUNIZATION

This is to certify that

Name :
Date of Birth :
Sex :

has on the date indicated been vaccinated or received prophylaxis against

No Vaccine of prophylaxis Batch no Date

required signature of physician or health facility to verify immunization history

Signature :

Name :

Country : Indonesia
Address of physician : Rumah Vaksinasi
Jl Hamid Rusdi No.101 G Bunulrejo
Kec. Blimbing Kota Malang Jawa Timur 65126
Ph +6281333200322
 MANDATORY CERTIFICATE OF IMMUNIZATION

This is to certify that

Name :
Date of Birth :
Sex :

has on the date indicated been vaccinated or received prophylaxis against

No Vaccine of prophylaxis Batch no Date

required signature of physician or health facility to verify immunization history

Signature :

Name :

Country : Indonesia
Address of physician : Rumah Vaksinasi
Jl. Raya Kelapa Dua Wetan RT.005 RW.05
Kelapa Dua Wetan, Kec. Ciracas, Jakarta Timur 13730
Ph +6281320204441
 MANDATORY CERTIFICATE OF IMMUNIZATION

This is to certify that

Name :
Date of Birth :
Sex :

has on the date indicated been vaccinated or received prophylaxis against

No Vaccine of prophylaxis Batch no Date

required signature of physician or health facility to verify immunization history

Signature :

Name :

Country : Indonesia
Address of physician : Rumah Vaksinasi
H. Mencong Jl. Cipto Mangunkusumo No.Kav.35 Sudimara Tim
Kec. Ciledug, Kota Tangerang, Banten 15151
Ph +6287844443211
 MANDATORY CERTIFICATE OF IMMUNIZATION

This is to certify that

Name :
Date of Birth :
Sex :

has on the date indicated been vaccinated or received prophylaxis against

No Vaccine of prophylaxis Batch no Date

required signature of physician or health facility to verify immunization history

Signature :

Name :

Country : Indonesia
Address of physician : Rumah Vaksinasi
Jl. Pinang Raya Ruko Taman Yasmin Sektor VI No.32
Curug Mekar Kec. Bogor, Kota Bogor Jawa Barat 16113
Ph +6287842423334
 MANDATORY CERTIFICATE OF IMMUNIZATION

This is to certify that

Name :
Date of Birth :
Sex :

has on the date indicated been vaccinated or received prophylaxis against

No Vaccine of prophylaxis Batch no Date

required signature of physician or health facility to verify immunization history

Signature :

Name :

Country : Indonesia
Address of physician : Rumah Vaksinasi
Jl. MT. Haryono No.517E Karang Kidul Kec. Semarang Tengah
Kota Semarang Jawa Tengah 50136
Ph +6282213002221