DWI LINDA ALVENAH

201510100311202

TRANSLATION B

[state the police C

of Indonesia] DRIVING LICENSE (motor bike)
South Sulawesi

Name : DZAKIRA NISRINA FEMALE

Address : CENDANA HIJAU VILLAGE
WOTU DISTRICT
LUWU TIMUR REGENCY
[officially
Place of birth : PASURUAN
signed and
Date of birth : December, 08 1997
thumbprint]
Height : 155 cm
[photo] Occupation : COLLEGE STUDENT
License No : 97121943084
Valid through : December 08, 2021
MALILI, August, 22 2016
HEAD OF POLICE OFFICER
[officially signed]

PAROJAHAN SIMANJUNTAK. SIK

AKPB NRP 71090450
Ed/m.-

Kas no.1.453/CS/96.- CSL 0268958

REGISTRY OFFICE
(INDONESIAN NATIONALITY)
EXERPT OF

BIRTH CERTIFICATE
NO. 8.648/U/JR/1996.-

From the supplement register of birth pursuant to the state gazette of 1920 no.751.

Yo. 1927 no. 567 in Jakarta, it appears that in Jakarta on date fifth of April one

thousand nine hundred and ninety six was born a son:

“ HAIDAR ALI “

The first child to the husband and wife : PARNO with DAYANAH

---==oOo==---

This excerpt is accordance of date on this day.

Jakarta on date twelve of April

One thousand nine hundred and ninety six.

The head of civil regency

East Jakarta,

[officially signed
and stamped]

Drs. UCHI MASRUCHI.-

REG No: 010035714.
 [national seal] K 64720604002
FAMILY REGISTRATION CARD
No. 6472062511077773

Head of family : RUDI SASGO District : SUNGAI KUNJANG

Postal Address : Jl. PADAT KARYA Regency/Municipality : SAMARINDA
Neighborhood/Community unit : 073/- Postal Code : 75129
Village/Sub-districk : LOA BAKUNG Province : EAST BORNEO

No Full Name Personal Sex Place of birth Date of birth Religion Education Occupation
Regristration No.
(1) (2) (3) (4) (5) (6) (7) (8)
1 RUDI SASGO 6427061008670001 MALE PAYAKUMBUH 10-08-1967 ISLAM TERTIARY LEVEL PRIVATE EMPLOYEES
2 ERNAWATI 6427065003710002 FEMALE KEDIRI 10-03-1971 ISLAM SENINIOR SECONDARY LEVEL ENTREPRENEUR
3 M. GIRI GRAHANA KUSUMA 6427061910950001 MALE MUARA WAHAU 19-10-1995 ISLAM SENINIOR SECONDARY LEVEL STUDENT
4 AMIRA SARASWATI 6427064909980008 FEMALE KEDIRI 09-09-1998 ISLAM JUNIOR SECONDARY LEVEL STUDENT
5 ELLA KUSUMA NING AYU 6427065510000004 FEMALE SAMARINDA 25-10-2000 ISLAM PRIMARY LEVEL STUDENT
6 MUHAMMAD TIRTA KURNIAWAN 6427061810020002 MALE SAMARINDA 18-10-2002 ISLAM PRIMARY LEVEL STUDENT
7
8
9
10

Immigration document Parent name

No Marital status Status of Intra-group Relation Nationality Temporary/permanent
Passport number father mother
stay permit
(9) (10) (11) (12) (13) (15) (16)
1 MARIED THE HEAD OF HOUSE HOLD INDONESIA T JIPTONO GUNAWAN
2 MARIED WIFE INDONESIA MASHURI NOOR MULIK
3 UN MARIED BIOLOGICAL SON INDONESIA RUDI SASGO ERNAWATI
4 UN MARIED BIOLOGICAL DOUGHTER INDONESIA RUDI SASGO ERNAWATI
5 UN MARIED BIOLOGICAL DOUGHTER INDONESIA RUDI SASGO ERNAWATI
6 UN MARIED BIOLOGICAL SON INDONESIA RUDI SASGO ERNAWATI
7
8
9
10

Insued on : April 19, 2013

Copies : I. Head of family HEAD OF FAMILY HEAD OF POPULATION AND CIVIL REGISTRATION AGENCY
II. Neightbour unit [officially signed
[officially signed] and stamped]
III. Village/kelurahan
IV. District RUDI SASGO Drs. H JONY BACHTIAR SEMAN, M.Si
Signature/Thumppoint NIP. 195611232198003