8. OWNER III ...........................................................................................

PSM GROUP HOSPITAL AND HEALTH BUSINESS

WEBSITES : HTTP://KAIZENMEIJI.BLOGSPOT.COM
EMAIL
: KAIZENMEIJI@YAHOO.COM / KAIZENMEIJI@GMAIL.COM
D. / A.
: GRAHA GAYATRI ; DHARMAHUSADA DALAM STREET NO. 18 20
SURABAYA 60132 EAST JAVA INDONESIA
TELP.
: 031.33.1724.97 / 031.60515.610
FAX.
: 031.86732.97
CCI
: 08880.300.6468

9. ADDRESS ............................................................................................
PICTURE

10. POSTAL CODE ..................................................................................

11. TOWN

............................................................................................

8. OWNER IV ...........................................................................................
1. NAME

: ..........................................................................................

9. ADDRESS ............................................................................................

2. SPECIES

: ..... DOG

10. POSTAL CODE ..................................................................................

3. BREED

: ..........................................................................................

..... CAT

11. TOWN

............................................................................................

4. COLOUR : ..........................................................................................
5. SEX

: ..... MALE

6. DATE OF : .................

8. OWNER V ............................................................................................

..... FEMALE
.................

.................

9. ADDRESS ............................................................................................

7. IDENTIFICATION NUMBER

10. POSTAL CODE ..................................................................................

..... TATTONING

................................................................................

11. TOWN

..... MICROCHIP

................................................................................

REGISTERED AT

............................................................................................

8. OWNER VI ...........................................................................................
9. ADDRESS ............................................................................................

8. OWNER I ............................................................................................

10. POSTAL CODE ..................................................................................

9. ADDRESS ............................................................................................

11. TOWN

............................................................................................

10. POSTAL CODE ..................................................................................

11. TOWN

............................................................................................

8. OWNER VII ..........................................................................................

9. ADDRESS ............................................................................................

8. OWNER II ............................................................................................

10. POSTAL CODE ..................................................................................

9. ADDRESS ............................................................................................

11. TOWN

............................................................................................

10. POSTAL CODE ..................................................................................

11. TOWN

............................................................................................

12. BREEDER ..........................................................................................

ADDRESS

............................................................................................

13. RESERVED FOR THE VETERINARIAN

14. VACCINATIONS
15. DATE

16. TYPE OF VACCINE

DOG

DAY

MONTH

YEAR

17 LABEL

18. STAMP AND SIGNATURE OF THE VETERINARIAN

CAT

DISTEMPER

PANLEUKOP., LIVE

HEPAT. CAVI-2

RHINOTRACH./CALIC

PARVO.,LIVE

RABIES

PARVO.,LIVE
LEPTOSPIR
RABIES
PL2
BORDETELLA
DOG
DAY

MONTH

YEAR

CAT

DISTEMPER

PANLEUKOP., LIVE

HEPAT. CAVI-2

RHINOTRACH./CALIC

PARVO.,LIVE

RABIES

PARVO.,LIVE
LEPTOSPIR
RABIES
PL2
BORDETELLA
DOG
DAY

MONTH

YEAR

CAT

DISTEMPER

PANLEUKOP., LIVE

HEPAT. CAVI-2

RHINOTRACH./CALIC

PARVO.,LIVE

RABIES

PARVO.,LIVE
LEPTOSPIR
RABIES
PL2
BORDETELLA

LEGALIZATION : Dr. Nuky Rusianto, A.Md., SE., drh., WR., Lc., MBO., ISI., OIE (Veterinarian)

NOTE :
---------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------

PSM GROUP HOSPITAL AND HEALTH BUSINESS

WEBSITES : HTTP://KAIZENMEIJI.BLOGSPOT.COM
EMAIL
: KAIZENMEIJI@YAHOO.COM / KAIZENMEIJI@GMAIL.COM
D. / A.
: GRAHA GAYATRI ; DHARMAHUSADA DALAM STREET NO. 18 20
SURABAYA 60132 EAST JAVA INDONESIA
TELP.
: 031.33.1724.97 / 031.60515.610
FAX.
: 031.86732.97
CCI
: 08880.300.6468

13. RESERVED FOR THE VETERINARIAN

14. VACCINATIONS
15. DATE

16. TYPE OF VACCINE

DOG

DAY

MONTH

YEAR

17 LABEL

18. STAMP AND SIGNATURE OF THE VETERINARIAN

CAT

DISTEMPER

PANLEUKOP., LIVE

HEPAT. CAVI-2

RHINOTRACH./CALIC

PARVO.,LIVE

RABIES

PARVO.,LIVE
LEPTOSPIR
RABIES
PL2
BORDETELLA
DOG
DAY

MONTH

YEAR

CAT

DISTEMPER

PANLEUKOP., LIVE

HEPAT. CAVI-2

RHINOTRACH./CALIC

PARVO.,LIVE

RABIES

PARVO.,LIVE
LEPTOSPIR
RABIES
PL2
BORDETELLA
DOG
DAY

MONTH

YEAR

CAT

DISTEMPER

PANLEUKOP., LIVE

HEPAT. CAVI-2

RHINOTRACH./CALIC

PARVO.,LIVE

RABIES

PARVO.,LIVE
LEPTOSPIR
RABIES
PL2
BORDETELLA

LEGALIZATION : Dr. Nuky Rusianto, A.Md., SE., drh., WR., Lc., MBO., ISI., OIE (Veterinarian)

NOTE :
---------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------

PSM GROUP HOSPITAL AND HEALTH BUSINESS

WEBSITES : HTTP://KAIZENMEIJI.BLOGSPOT.COM
EMAIL
: KAIZENMEIJI@YAHOO.COM / KAIZENMEIJI@GMAIL.COM
D. / A.
: GRAHA GAYATRI ; DHARMAHUSADA DALAM STREET NO. 18 20
SURABAYA 60132 EAST JAVA INDONESIA
TELP.
: 031.33.1724.97 / 031.60515.610
FAX.
: 031.86732.97
CCI
: 08880.300.6468

13. RESERVED FOR THE VETERINARIAN

14. VACCINATIONS
15. DATE

16. TYPE OF VACCINE

DOG

DAY

MONTH

YEAR

17 LABEL

18. STAMP AND SIGNATURE OF THE VETERINARIAN

CAT

DISTEMPER

PANLEUKOP., LIVE

HEPAT. CAVI-2

RHINOTRACH./CALIC

PARVO.,LIVE

RABIES

PARVO.,LIVE
LEPTOSPIR
RABIES
PL2
BORDETELLA
DOG
DAY

MONTH

YEAR

CAT

DISTEMPER

PANLEUKOP., LIVE

HEPAT. CAVI-2

RHINOTRACH./CALIC

PARVO.,LIVE

RABIES

PARVO.,LIVE
LEPTOSPIR
RABIES
PL2
BORDETELLA
DOG
DAY

MONTH

YEAR

CAT

DISTEMPER

PANLEUKOP., LIVE

HEPAT. CAVI-2

RHINOTRACH./CALIC

PARVO.,LIVE

RABIES

PARVO.,LIVE
LEPTOSPIR
RABIES
PL2
BORDETELLA

LEGALIZATION : Dr. Nuky Rusianto, A.Md., SE., drh., WR., Lc., MBO., ISI., OIE (Veterinarian)

NOTE :
---------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------

PSM GROUP HOSPITAL AND HEALTH BUSINESS

WEBSITES : HTTP://KAIZENMEIJI.BLOGSPOT.COM
EMAIL
: KAIZENMEIJI@YAHOO.COM / KAIZENMEIJI@GMAIL.COM
D. / A.
: GRAHA GAYATRI ; DHARMAHUSADA DALAM STREET NO. 18 20
SURABAYA 60132 EAST JAVA INDONESIA
TELP.
: 031.33.1724.97 / 031.60515.610
FAX.
: 031.86732.97
CCI
: 08880.300.6468

13. RESERVED FOR THE VETERINARIAN

14. VACCINATIONS
15. DATE

16. TYPE OF VACCINE

DOG

DAY

MONTH

YEAR

17 LABEL

18. STAMP AND SIGNATURE OF THE VETERINARIAN

CAT

DISTEMPER

PANLEUKOP., LIVE

HEPAT. CAVI-2

RHINOTRACH./CALIC

PARVO.,LIVE

RABIES

PARVO.,LIVE
LEPTOSPIR
RABIES
PL2
BORDETELLA
DOG
DAY

MONTH

YEAR

CAT

DISTEMPER

PANLEUKOP., LIVE

HEPAT. CAVI-2

RHINOTRACH./CALIC

PARVO.,LIVE

RABIES

PARVO.,LIVE
LEPTOSPIR
RABIES
PL2
BORDETELLA
DOG
DAY

MONTH

YEAR

CAT

DISTEMPER

PANLEUKOP., LIVE

HEPAT. CAVI-2

RHINOTRACH./CALIC

PARVO.,LIVE

RABIES

PARVO.,LIVE
LEPTOSPIR
RABIES
PL2
BORDETELLA

LEGALIZATION : Dr. Nuky Rusianto, A.Md., SE., drh., WR., Lc., MBO., ISI., OIE (Veterinarian)

NOTE :
---------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------

PSM GROUP HOSPITAL AND HEALTH BUSINESS

WEBSITES : HTTP://KAIZENMEIJI.BLOGSPOT.COM
EMAIL
: KAIZENMEIJI@YAHOO.COM / KAIZENMEIJI@GMAIL.COM
D. / A.
: GRAHA GAYATRI ; DHARMAHUSADA DALAM STREET NO. 18 20
SURABAYA 60132 EAST JAVA INDONESIA
TELP.
: 031.33.1724.97 / 031.60515.610
FAX.
: 031.86732.97
CCI
: 08880.300.6468

13. RESERVED FOR THE VETERINARIAN

14. VACCINATIONS
15. DATE

16. TYPE OF VACCINE

DOG

DAY

MONTH

YEAR

17 LABEL

18. STAMP AND SIGNATURE OF THE VETERINARIAN

CAT

DISTEMPER

PANLEUKOP., LIVE

HEPAT. CAVI-2

RHINOTRACH./CALIC

PARVO.,LIVE

RABIES

PARVO.,LIVE
LEPTOSPIR
RABIES
PL2
BORDETELLA
DOG
DAY

MONTH

YEAR

CAT

DISTEMPER

PANLEUKOP., LIVE

HEPAT. CAVI-2

RHINOTRACH./CALIC

PARVO.,LIVE

RABIES

PARVO.,LIVE
LEPTOSPIR
RABIES
PL2
BORDETELLA
DOG
DAY

MONTH

YEAR

CAT

DISTEMPER

PANLEUKOP., LIVE

HEPAT. CAVI-2

RHINOTRACH./CALIC

PARVO.,LIVE

RABIES

PARVO.,LIVE
LEPTOSPIR
RABIES
PL2
BORDETELLA

LEGALIZATION : Dr. Nuky Rusianto, A.Md., SE., drh., WR., Lc., MBO., ISI., OIE (Veterinarian)

NOTE :
---------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------

PSM GROUP HOSPITAL AND HEALTH BUSINESS

WEBSITES : HTTP://KAIZENMEIJI.BLOGSPOT.COM
EMAIL
: KAIZENMEIJI@YAHOO.COM / KAIZENMEIJI@GMAIL.COM
D. / A.
: GRAHA GAYATRI ; DHARMAHUSADA DALAM STREET NO. 18 20
SURABAYA 60132 EAST JAVA INDONESIA
TELP.
: 031.33.1724.97 / 031.60515.610
FAX.
: 031.86732.97
CCI
: 08880.300.6468

19. NOTE

20. VACCINES
R

Rabies

RABISIN

Parvovirosis

PRIMODOG

BPI

Bordetella, Parainfluenza
(kennel cough)

PNEUMODOG

DHL

Distemper, Hepatitis,
Leptospirosis

CANIFA

DHPLR

Distemper, Hepatitis,
Parvovirosis, Leptosporosis,
Rabies

HEXADOG

DHPPI

Distemper, Hepatitis,
Parvovirosis, Parainfluenza

EURICAN 4

DHPPI-L

Distemper, Hepatitis,
Parvovirosis, Parainfluenza,
Leptospirosis

EURICAN 6

DHPPI-2LR

Distemper, Hepatitis,
Parvovirosis, Parainfluenza,
Leptospirosis, Rabies

EURICAN 7

Cat Panleucopenia

FELLINIFFA

Cat Panleucopenia, Herpes /

Rhinotracheitis, Calici

LEUCORIFELIN

VACCINATION PROGRAMME RECOMENDATION

DOGS
PRIMOVAKSINASI
6 WEEKS

PRIMODOG

8 WEEKS

EURICAN 4 ATAU EURICAN 6

12 WEEKS

EURICAN 7

Annual VAKSINASI
1 ST YEAR

EURICAN 7

YERALY

EURICAN 7
CATS

8 WEEKS

LEUCORIFELIN

12 WEEKS

LEUCORIFELIN

14 WEEKS

RABISIN

Annual VAKSINASI

PSM GROUP HOSPITAL AND HEALTH BUSINESS

WEBSITES : HTTP://KAIZENMEIJI.BLOGSPOT.COM
EMAIL
: KAIZENMEIJI@YAHOO.COM / KAIZENMEIJI@GMAIL.COM
D. / A.
: GRAHA GAYATRI ; DHARMAHUSADA DALAM STREET NO. 18 20
SURABAYA 60132 EAST JAVA INDONESIA
TELP.
: 031.33.1724.97 / 031.60515.610
FAX.
: 031.86732.97
CCI
: 08880.300.6468

1 ST YEAR

RABISIN

YEARLY

LEUCORIFELIN

EVERY THREE YEARS

RABISIN

CONSULTING THIS PROGRAMME WITH YOUR VETERINARIAN

http://iepsmgroup.blogspot.com

PSM GROUP INTERNATIONAL FOUNDATION

NOTARY DEED : RETNI NATALIA WR, SH., M.HUM

VACCINATION
CERTIFICATE
for
DOGS and CATS

NOTARY DEED : DADANG KOESBOEDIWITJAKSONO, SH

NO. 5. FEBRUARY 21, 2008

PSM GROUP HOSPITAL AND HEALTH BUSINESS

WEBSITES : HTTP://KAIZENMEIJI.BLOGSPOT.COM
EMAIL
: KAIZENMEIJI@YAHOO.COM / KAIZENMEIJI@GMAIL.COM
D. / A.
: GRAHA GAYATRI ; DHARMAHUSADA DALAM STREET NO. 18 20
SURABAYA 60132 EAST JAVA INDONESIA
TELP.
: 031.33.1724.97 / 031.60515.610
FAX.
: 031.86732.97
CCI
: 08880.300.6468

http://kaizenmeiji.blogspot.com