Dinas Kesehatan Kabupaten Subang
UPTD Puskesmas Tanjungsiang
Jalan Raya Tanjungsiang - Subang -Indonesia
No.:123/120/SICK/II/2011 February 28, 2011
I, the undersigned, hereby certify that Sutarmaji, holder of passport number N2456789 was temporarily diagnosed for HNP Susp. on February 28, 2011 and he is not fit for duty for a month due to the diagnose of illness mentioned above.