SIEMENS
Healthineers
RS. St. Carolus
Ji. Salemba Raya No.41, RT.3IRW.5, Paseban
‘Senen, Kota Jakarta Pusat,
Jakarta - 10440
Bag radiologi
Up. Ibu Uning : 082112525110
Pak Herman Rs. Carolus (#62 816-1380-840)
Page 01 of 01
DISPATCH NOTE He 14438
26-Nov-18
[S40C-9004865.07.05
Tem | Quantiy
1 3P cs |Vest Skirt Shield Apron Pb 0.5 Lead
IMerk : C-M: DM3MO676
(Code : NXR3:
ISize: SM
[Color : Dark Blue
|For Proj. Somatom Pers;
ALN ECCN:N
2 3Pcs [Thyroid shield Stand Collar Lead
IMork : C-World
[Code : NXR9t
Size : All Size
IColor : Dark Blue
ALN ECCN:N
ive 128, RS. St. Carolus
|For Proj. Somatom Perspective 128, RS. St, Carolus
P.T. Siemens Indonesi,
Pw SIEM
Daniel Kartawiguita Siemens I i@ianthe
Received on behalf of lent
Name
Date
Signature
Goods Received in Good exter and condon
P-T. Siemens Indonesia snosenew orice
Pub Mas Ofc & Fey
0. Box 24691 10001, (egon Factory
INDONESIA
Ccuniomer Care Ofve
nme sna semen. co48
customer cae Of
Unrestricted
‘dha Ofee Park, Tower FJ... Smaupang Kav 88
“atata 12520, NDONESIA, Tas s62.21 2754200, Fay 06221 27548408
“aban Jenial Abra Yo Ka. 067-60, Plo Mas, Jakarta 19210, NDONESIA
“aus 21 4729100, Fa 4715055,
IEC Kav 8 2, Ctogon 42443, Jawa Bara INDONESIA
Tol 62 25499248, Fan. $062 254 380202
Jalan Jerr Atnad Yani Ka, 957-68, Plo Mas, aka 19210, NOONESIA
Tot 462214729100, Fax. 4716055
Jalan Jeo! Armd Yani Kay. 867-58, Pu Mas, eka 19210, NDONESIA
Tot #48221 4720100, Fx. 4715055