Medical Certificate

To whom it may concern:

This is to certify that

Name : Eric Carlo Wibisono

Date of Birth : 01 October 2022

Nationality : Indonesian

Passport number : C9399728

Has received vaccination as follow:

1. MMR Vaccine
 Vaccine Brand : MMR II (MSD
 Dose : First dose
 Batch Number :
 Date : June, 30th 2023
2. Meningococcal Vaccine (MenACWY vaccine)
 Vaccine Brand : Menactra ( Sanofi Pasteur)
 Dose : First dose
 Batch Number :
 Date : June, 30th 2023

Thus, this statement letter is made to be used accordingly.

Jakarta, June 30th 2023

Dr Santi Dwi Rahmawati

Operational Doctor Vaxine Care Clinic