PT Facronrinponesia ‘Atti oes weimanoge) RUMAH SAKIT PT FREEPORT INDONESIA 4 Numnor No, 1, Tembagspura (80087) Papua Indonesia “Telp: 0807 487868, Email DG-GRS-RS-PT Freeport Indonesia@fni.com CONFIDENTIAL RESULT OF PRE EMPLOYMENT MEDICAL EXAMINATION Certificates No.:04396/MCUIRS.PT.FUIN2021 ‘As per your request on 6 February 2021, we have conducted Pre- Employment Medical Examination to the folowing candidate: Name SBUDIARJO IDiRequisiion No. Place & Date of Bith EKALONGAN 6 JUNE 1965 Onsite Address Offsite Address Department BT. PP (Persero) Posiion/Job Type =: “PANTRY STAFF Work Location LOWLAND ‘The following isthe examination result Medically UNFIT (permanent ) Note: suspect CF, Hypotension Medica! Result Definitions: “Medical FT for wrk and Mobilization Medicaly suitable forthe required work ‘Medical UNFIT for wore and Mobiiation = Mecaly Unsuitable forthe required work * Mecicaly UNFIT for work and Mobiizaton” ~ The Applicant hs eter an acute medical conclon/Abnormeal laboratory reeurequies a retest of a medical parametorrequres futierinvestgation or rferal.A retest ofthe fect MAY render te applicant Fi for Werk and moblization within 14 days. FAEA2402 Rev. Nov 2017