PEMERINTAH KABUPATEN KUBU RAYA

DINAS KESEHATAN
PUSKESMAS SUI RAYA DALAM
Jl. Arteri Supadio Telp. (0561)712050 Kecamatan Sui Raya Kode Pos 78391

Pontianak, 22 Nopember 2017

To : United state of America Embassy

Jln. Medan Merdeka Selatan no 3-5

RT 11 /RW 02 gambir Jakarta Pusat

DKI Jakarta 10110 Indonesia

This is to certify that,

Name : Mrs Ira Yuliana

Nationality : 6171015603790003

Passport no : B 7383792

Expired date : 13 Juli 2022

Mrs Ira Yuliana is permanently employed by our company at Puskesmas Sungai Raya Dalam
kabupaten Kubu Raya, Kalimantan Barat,Since 2009 up to now.

She has planned to hake her vacation to united state of America from 25 desember 2017 to 03 January
2018 at her own cost.

The letter also assured if the vissa applicant is only holding indonesia citizenship.with no intention

For permanent residency,employment or purposes other than said above in any places within United
State Of America,And will immediately return to Indonesia upon complection her vacation.

I would be highly appreciated if you can grant her the appropriate visa.

If you have any questions regarding him,feel free to contact at 081257119911.

Thanks you for you assistance and cooperation.

Sincerely

Supraptman,SKM
 PEMERINTAH KABUPATEN KUBU RAYA
DINAS KESEHATAN
PUSKESMAS SUI RAYA DALAM
Jl. Arteri Supadio Telp. (0561)712050 Kecamatam Sui Raya Kode Pos 78391

Pontianak, 21 September 2018

Embassy 0f south korea

Jln Jendral gatot subroto kav 57

Jakarta 12950 indonesia

Subject : applying tourist visa

To whom it may concern.

This is to certify that Mrs Ira Yuliana is permanent employee in Puskesmas Sungai raya dalam and is
permitted to take leave to have vacation with the small groups from 27 november – 2 december 2018.

Ira yuliana is applying for tourist visa and will visit south korea for about 5 day, she is expected to
return to indonesia before 3 November 2018, We therefore would appreciate your assstance to his
application. Your favorable cinsideration of the application will be much appreciated.

Please feel free to contact us if you have any question, thanks you

Your Sincerely

Kepala Puskesmas Sungai Raya dalam

Supratman,SKM

NIP. 19710526 199303 1 006