TO WHOM IT MAY CONCERN

The signing doctor below, hereby confirms that:

Name : Kendrick Timothy Pelle

Date of Birth : 28 November 2017

Those who is responsible for the patient : Bonik Kurniati Amalo

Has obtained immunisation below, has not suffered from any serious diseases and now he is in good
condition.

VACCINE TIME DATE GIVEN AGE

(dd/mm/yy)

BCG First 07/12/2017 1 month

Hepatitis B First 28/11/2017 0 month

Second 29/12/2017 1 month

Third 29/05/2018 6 months

Polio First 07/12/2017 1 month

Second 06/01/2018 2 months

Third 06/02/2018 3 months

Fourth 06/03/2018 4 months

DPT (Diptheria, Pertussis & First 06/01/2018 2 months

Tetanus)
Second 06/02/2018 3 months

Third 06/03/2018 4 months

MR First 12/09/2018 9 months

HiB First 06/01/2018 2 months

Second 06/02/2018 3 months

Third 06/03/2018 4 months

I made this letter with true condition and to be used properly. Thank you for your kind attention.

Kupang, December 17th, 2018

Sincerely yours,

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