__ PASPOR [DN passporr PERHATIAN dang Nomor 12°Tahun )eGaraan Republik ndénesia. ‘Keterangan atay visa terlebih dahulu “ gefempat_dan Kepala_Perwskilan Republik Indonesia terdekat dalam hal terjadi 5» Oi [Vaccine Typel 7-7 7 OW Vaccine Type] COVID-19 mRNA COVID-19 mRNA += [Manufacturer] A= 4 [Manufacturer] SUS Fe B/E FAY {Modernal [Moderna] {848% [Product Name] 2444; [Produer Name] COVID-197 7 FEF AF COVID-199 7 F747 UF [COVID-19 Vaccine Moderna] ICOVID-19 Vaccine Moderna} tha [Lot Number] ‘BiH [Lot Number] 3005235, 3005699 146 F1H [Vaccination Datel (YYYY-MM-DD) FEMME /IFI [Vaccination Datel (VYYY-MM-DD) 2021-09-03 2021-10-01 ‘eH [Country of Vaccination} ‘e461 [County of Vaccination] AA Ha UaPaN] UaPaN) TEDW SEF [Certificate Issuance Authority) ADEN A MEAT SE [Mayor of Higashiosaka City, Osaka Prefecture] HARTA [Miniter of Heath, Labour and Welfare, Government of Japan] SEMI [Cerificate Wdentiier] {eH SBETAEN H [sue Date] (YYY-MM-DD) 27272-2021 1014-00006 2021-10-14 :