RUMAH SAKIT CITRA HUSADA

Jl. Dharma Bakti No. 45C

Telp ( 0568 ) 22355 – Fax ( 0568 ) 21645

NANGA PINOH – MELAWI

Number : 123/CT/RSCH/III/2015 Nanga Pinoh, March 17st 2015

To:
Consular Visa Section
Embassy of Kingdom of Netherlands
Jalan HR Rasuna Said Kav.S-3
Jakarta 12950
Indonesia
Dear Sir/ Madam,
I, undersign below, declared that :

Name : Muhamad Alif

Place, date of birth : Jakarta, june 06st 1982

Is a doctor at the Citra Husada General Hospital and is permitted to take leave to have vacation from 16
may to 28 may 2015 to go to Europe.

Mr. Alif is applying for a Schengen visa. All expences will be borne by himself and I guarantee that as
soon as the trip is over, he will return to Indonesia. We therefore would appreciate your assistance to
him application. Your favorable consideration of application will be much appreciated.

Thank you very much for your kind attention and cooperation.

Head of Citra Husada General Hospital

(Dr. SANTOSO T., M.Si)