PEMERINTAH KABUPATEN TELUK WONDAMA

RUMAH SAKIT UMUM DAERAH

JALAN RAYA MANGGURAI – RASIEI

Teluk Wondama, November 5th 2019

To :

Embassy of the Commonwealth of Australia

JAKARTA

Dear Sir/Madam,

We hereby certify that the named person as below :

Name : Hendrik Samuel Torey

Passport No. : A 9463529

Is currently being employed by our Hospital since April 2016 as a Medical Doctor with earning montlhy
salary IDR 15.000.000,00. The said employee will be going to Australia for holiday start from December
28th 2019 until January 4th, 2020.

All necessary expenses to be incurred during the trip will be borne by himself. We do guarantee that he
will return to Indonesia and will not seek any permanent job in your company.

It will be highly appreciate if you could grant the necessary visa for the above employee to enter your
country.

Thank you in advance for your attention and good cooperation.

Sincerely Yours,

dr. Ristom D. Mora.