SIEMENS Healthineers RS. St. Carolus Ji. Salemba Raya No.41, RT.3IRW.5, Paseban ‘Senen, Kota Jakarta Pusat, Jakarta - 10440 Bag radiologi Up. Ibu Uning : 082112525110 Pak Herman Rs. Carolus (#62 816-1380-840) Page 01 of 01 DISPATCH NOTE He 14438 26-Nov-18 [S40C-9004865.07.05 Tem | Quantiy 1 3P cs |Vest Skirt Shield Apron Pb 0.5 Lead IMerk : C-M: DM3MO676 (Code : NXR3: ISize: SM [Color : Dark Blue |For Proj. Somatom Pers; ALN ECCN:N 2 3Pcs [Thyroid shield Stand Collar Lead IMork : C-World [Code : NXR9t Size : All Size IColor : Dark Blue ALN ECCN:N ive 128, RS. St. Carolus |For Proj. Somatom Perspective 128, RS. St, Carolus P.T. Siemens Indonesi, Pw SIEM Daniel Kartawiguita Siemens I i@ianthe Received on behalf of lent Name Date Signature Goods Received in Good exter and condon P-T. Siemens Indonesia snosenew orice Pub Mas Ofc & Fey 0. Box 24691 10001, (egon Factory INDONESIA Ccuniomer Care Ofve nme sna semen. co48 customer cae Of Unrestricted ‘dha Ofee Park, Tower FJ... Smaupang Kav 88 “atata 12520, NDONESIA, Tas s62.21 2754200, Fay 06221 27548408 “aban Jenial Abra Yo Ka. 067-60, Plo Mas, Jakarta 19210, NDONESIA “aus 21 4729100, Fa 4715055, IEC Kav 8 2, Ctogon 42443, Jawa Bara INDONESIA Tol 62 25499248, Fan. $062 254 380202 Jalan Jerr Atnad Yani Ka, 957-68, Plo Mas, aka 19210, NOONESIA Tot 462214729100, Fax. 4716055 Jalan Jeo! Armd Yani Kay. 867-58, Pu Mas, eka 19210, NDONESIA Tot #48221 4720100, Fx. 4715055