DECLARATION AMD RELEASE SHEET

The undersigned

Name

: Siti Alfiah, S. H.

Employment Number : 67050016

Rank

: Police Commissioner

Position

: Head of Intelligence

Name of Entity

: Badan Narkotika Nasional Provinsi Daerah Istimewa

Yogyakarta

Address

: Jalan Brigjen Katamso Komplek Perkantoran, Yogyakarta

I hereby declare that the Intern

Name

: Rimtado Julius Caesario Tampubolon

Student Number

: 13/348968/HK/19640

Study Program

: Law Studies

has completed the Internship at Badan Narkotika Nasional Provinsi Daerah

Istimewa Yogyakarta from 23rd July 2015 to 20th August 2015 and by the end of
the Internship, the aforesaid Intern does not bear anything to our institution.

Yogyakarta, 17 September 2015

Field Supervisor,

Siti Alfiah, S. H.
Head of Intelligence