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Tanggal Cetak : 05 Jun 2023 22:44:28

REPUBLIC OF INDONESIA

MINISTRY OF HEALTH

Regency/Municipal Health Service 300074644


of .............................................

TO WHOM IT MAY
CONCERN

Herewith the undersigned :

Name : DR. ASEP HUKAMDA

Address : Indonesia

NOTIFIES THAT

Name : AHMAD SUHAIMI BIN MHD. NUR

Passport : 0
Number

Flight :

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

No. Items/kind of medicines Unit Amount

1 SIMVASTATIN 40

2 Metformin 40

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

DR. ASEP HUKAMDA

NIP/NRP

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