Jakarta, Februari 2020

Head of Consulate Visa Section

THE EMBASSY OF (FRENCH)
Jakarta

Dear Sir / Madam

With this letter, I would like to inform you that I am the undersignet,
Name : DR.dr. Imam Ahmadi Farid,SpOG,(K)
Position : Director Of RSIA Prof dr H M Farid
Adress : Jl dr Wahidin Sudirohusodo 23O Makassar 90171

Certify that,
Name : dr. Retno Budiati Farid,SpOG,(K)
Position : Mother Of dr.Imam
Passport No : B 7964327

She is planning to have a vacation to your country, on March 2020

This letter guarantees that she will not seek any employment or permanent stay in your country and
will return to Indonesia soon after her holiday trip is completed. Any and all expenses during the
aforementioned trip are fully convered by (Dr.dr.Imam Ahmadi Farid, SpOG,(K)) personal account.

We kindly request that you grant her the necessary entry visa in order to partake in the tour program.
Your assistance is highly appreciated.

Sincerely yours,

DR.dr.Imam Ahmadi Farid,SpOG,(K)

Director
 FORM DATA TAMBAHAN UNTUK PROSES VISA

Nama lengkap (sesusi passport) : RETNO BUDIATI FARID

Alamat lengkap rumah : JL. DR. WAHIDIN SUDIROHUSODO 103

MAKASSAR,INDONESIA 90171

Berapa lama tinggal : 12 HARI

Nomor tlp Rumah dan HP : 0411-3615872 / 081141413641

Jabatan Kerja/pelajar :

Nama Perusahaan/sekolah : RSIA PROF DR H M FARID

Alamat lengkap kantor/Sekolah : JL DR WAHIDIN SUDIROHUSODO 23O MAKASSAR

90171

Nomor Telepon Kantor/sekolah : 0411 – 36

Lama Kerja : 10 TAHUN

Nama Suami : PROF. dr. HM FARID (ALM)

Tempat & tanggal lahir suami : WATAMPONE, 07 – 12 – 1941

Nama lengkap ayah : KOL. R SUPARMAN (ALM)

Nama lengkap Ibu : NY SURYATMI (ALM)

Dibiayai siapa (Nama & Hubungan) : DR.dr. IMAM AHMADI FARID,SpOG,(K) (ANAK)

Apakah pernah punya visa schengen dalam 3 tahun terakhir :………………………………………

(nama Negara pembuat visa, tanggal, bulan, tahun issued & expired

Austria, 21 – 06 – 2019 s/d 15 – 12 - 2019