Tanggal Cetak : 02 Jul 2019 22:07:42

REPUBLIC OF INDONESIA

MINISTRY OF HEALTH

Regency/Municipal Health Service 1900059584

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

TO WHOM IT MAY
CONCERN

Herewith the undersigned :

Name : dr. Hj. Asmaul Husna, M.Kes

Address : Indonesia

NOTIFIES THAT

Name : AKHMAD ROZANI, BE BIN H.ZAWAWI

M.AINI

Passport : 0
Number

Flight :

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

No. Items/kind of medicines Unit Amount

1 Stimuno 50

2 Candesartan 45

3 Sandepril 50 mg 25

4 Kapsul Racikan 50

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. Hj. Asmaul Husna,

M.Kes

NIP/NRP