2To: 3Agus Rizal Ardy Hariandy Hamid, MD, PhD 4Medical Journal of Indonesia 5 6 I am …, representing all authors in this manuscript. I would like to submit our 7manuscript titled “…”. This study … 8 This article is not currently under consideration in another journal and it was/not 9submitted to another journal. It has/not been presented in a congress. 10 11 12 13 14 Sincerely yours, 15 (Full name) 1