Tanggal Cetak : 07 Jun 2022 19:26:45

REPUBLIC OF INDONESIA

MINISTRY OF HEALTH
Regency/Municipal Health Service
of Kudus 1100438388

TO WHOM IT MAY
CONCERN

Herewith the undersigned :

Name :

Address : Indonesia

NOTIFIES THAT

Name : AHMAD NILNAL MUNACHIFDLIL 'ULA

BIN AHMAD ARWAN

Passport :
Number

Flight :

for his/her own needs has to bring the following medicines

No. Items/kind of medicines Unit Amount

1 Voltadex 0.5 mg 12

2 Kayuputih Ointment 1

3 Freshcare Ointment 1

Based on medical reasons, the above medicines are stricly prepared for daily
personal use by the bearer, and this notification is provided to be shown/produced
to the Saudi Arabian Authority when necessary uppon arrival for clearance

Kloter SOC