Tanggal Cetak : 21/02/2017 12:29:26

REPUBLIC OF INDONESIA

MINISTRY OF HEALTH

Regency/Municipal Health Service 1300424104

of .............................................

TO WHOM IT MAY
CONCERN

Herewith the undersigned :

Name : dr. edu

Address : Indonesia

NOTIFIES THAT

Name : TAMLIYAH BINTI QOMAR

Passport : A2935661
Number

Flight :

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

No. Items/kind of medicines Unit Amount

1 parasetamol 30

2 Paramek 30

3 Bodrek 40

Based on medical reasons, the above medicines are stricly prepared for daily
personal use by the bearer, and this notification is provided to be shown/produced
to the Saudi Arabian Authority when necessary uppon arrival for clearance

dr. edu

NIP/NRP