Health Certificate

To whom it may concern,

This letter is to certify that Mr/Mrs/Ms PATHAMA SIRIKUL has undergo medical screening in
Indonesia, on Monday, November 23rd, 2020. With result as follow:

Name PATHAMA SIRIKUL

Date Of Birth September 18 th, 1970

Anamnesis
Current Symptoms Nothing
CoMorbid Condition Nothing

Physical Examination
Blood Pressure 116/71 mmHg
Heart Rate 77 times/minute
Respiratory Rate 20 times/minute
Temperature 36.4 oC
Head and Neck Within Normal Range
Heart Within Normal Range
Lung Auscultation Normal
Abdomen Within Normal Range

Laboratory
RT-PCR SARS CoV-2 Swab Test NEGATIVE

Therefore, Mr/Mrs/Ms current health condition is concluded as Healthy on the time of examination
and we recommend that you Due to physical distancing, isolate yourself, use mask everywhere you go
and practice routine handwashing to prevent COVID-19 infection. During these pandemic days the
risk of exposure is high, please amend self quarantine and immedietely contact medical service if
necessary.

Monday, November 23rd, 2020

Examined, Checked and Verified,

Dr. Juan Alexander Manurung

(SIP No. 446.1/DU/I/507-DPMPTSP/2020)
General Practitioner
Ciputra Hospital Citra Raya Tangerang