REPUBLIK OF INDONESIA ‫ﺇ ﻧ ﺩ ﻭ ﻧ ﻳﺳ ﻳ ﺎﺟ‬

MINISTRY OF HEALTH ‫ﺟﺟﺟﺟﺟﺟ‬

Regency / Muncipal health Service ‫ﺟ‬/ ‫ﺟﺟﺟﺟﺟﺟﺟ ﺟﺟﺟﺟﺟﺟ ﺟﺟﺟﺟﺟﺟﺟ‬
Indonesian Hajj Health Team ‫ﺟ ﺟﺟﺟﺟﺟﺟﺟﺟﺟﺟ ﺟﺟﺟﺟ ﺟﺟﺟﺟﺟ‬
TO WHOM IT MAY CONCERN ‫ﺟﺟﺟﺟ ﻳ ﻬ ﻣ ﻬ ﻣﻥﺇﻟ‬
‫ﻲ‬
herewith the undersigned : ‫ﺃ ﺩ ﻧ ﺎ ﻩ ﺟﺟﺟﺟﺟﺟ ﻫﻧﺎ‬
Name : ‫ﺟﺟﺟ‬
Occupation : Physician ‫ﺟﺟﺟﺟﺟﺟﺟ‬
Address : Ministry of Health Republic Indonesia ‫ﺟﺟﺟﺟﺟ‬

NOTIFIES THAT ‫ﺃﻥ ﺑ ﺈﻋﻼﻡ‬

Name :
‫ﺟﺟﺟ‬
Passport Number : ‫ﺟﺟﺟﺟﺟ ﺟﺟﺟﺟﺟ‬
Flight : ‫ﺟﺟﺟﺟﺟ‬
‫ﺟ‬/ ‫ﺟﺟﺟﺟﺟﺟﺟ ﺟﺟﺟﺟﺟﺟ ﺟﺟﺟﺟ ﺃﻥ ﻟﻬ ﺎ ﻟﻬ ﺟﺟﺟﺟﺟﺟﺟ‬
for his / her own needs has to bring the following medicines
no Items/kind of medicines unit amount
‫ ﺟﺟﺟﺟﺟﺟ‬/ ‫ﺟﺟﺟﺟﺟﺟ ﺟﺟﺟ‬ ‫ﻭ ﺣﺩﺓ‬ ‫ﻛﻣ ﻳﺔ‬
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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
‫ ﺗ ﻘ ﺩ ﻳ ﻣﻬ ﻟ ﻳ ﺗﻡ ﺟﺟﺟﺟﺟﺟ ﺟﺟﺟ ﺗ ﻘ ﺩ ﻳﻡ ﻭ ﻳ ﺗﻡ ﺟ ﺣ ﺎ ﻣ ﻠﻬ ﺎ ﺟﺟﺟ ﻣﻥ ﺟﺟﺟﺟﺟﺟ ﺟﺟﺟﺟﺟﺟ ﺟﺟﺟﺟﺟﺟﺟﺟ ﺟﺟﺟﺟ ﺟﺟﺟﺟ ﺃﻋﻼ ﻩ ﺟﺟﺟﺟﺟﺟﺟﺟﺟ‬/ ‫ﺟﺟﺟﺟﺟﺟﺟ ﻋ ﻧ ﺩ ﺟﺟﺟﺟﺟﺟﺟﺟ ﺟﺟﺟﺟﺟﺟﺟ ﺟﺟﺟﺟﺟﺟ ﺇ ﻟﻰ ﺇ ﻧ ﺗ ﺎﺟﻬ‬ ‫ﺟﺟﺟﺟﺟ ﻳ ﺗ ﻡ ﺟ ﻁ ﺑ ﻳ ﺔ ﺟﺟﺟﺟﺟ ﻋ ﻠﻰ ﺟﺟﺟﺟﺟ‬

Physician ‫ﺟﺟﺟﺟﺟﺟﺟﺟ‬