RUMAH SAKIT NAILI DBS

Jl. Ratulangi No 24 Kelurahan Kampung Jao Padang

Telp. (0751) 8951900, 8951901 Fax : ( 0751 ) 8951902 e-mail : rs.nailidbs@gmail.com
SURAT KETERANGAN
Nomor :

TO WHOM IT MAY CONCERN

Herewith the undersigned :

Name : dr. Silvia Erfan, Sp.KJ
Occupation : Psychiatrist
Workplace : RS.Naili DBS Padang

NOTIFIES THAT

Name : Ny.Jafni Sawir Binti Sawir

Date of Birth : Padang, 18 September 1959
Passport Number : C3220039
Flight :

For his/her own needs has to bring the following medicines

No. Items/ kind of medicines Unit Amount

Based on medical reasons, the above medicine are strickly prepared for daily personal use by the bearer, and this
notification is provided, to be shown/ produced to the Saudi Arabian Authority when necessary upon arrival for
clearance.
Padang, ............................................
Physician,

Name : .................................................
Registered Number : ...............................
 RUMAH SAKIT NAILI DBS
Jl. Ratulangi No 24 Kelurahan Kampung Jao Padang
Telp. (0751) 8951900, 8951901 Fax : ( 0751 ) 8951902 e-mail : rs.nailidbs@gmail.com