HEALTH CERTIFICATE

Number:

Name : Niky Aulia Putri

NIK : 6408046404020005
Place and Date of Birth : Banyuwangi, 24th April 2002
Address : Gg. Batara 2 No. 06 Sangatta Utara
Occupation : College Student
Necessity : Register “Kampus Mengajar Angkatan 3” Program

The results of the current physical examination are as follows:

1. Height/Weight : (cm)/(kg)
2. Blood Type :
3. Blood Pressure : (mmHg)
4. Color blindness : Positive/Negative
5. Body Temperature :℃
6. Waist Line : (cm)

Conclusion: HEALTHY
Thus this certificate is made so that it can be used as it should be.

Date and Sign of the Examiner's Doctor