DKI JAKARTA PROVINCE
SERIAL REGISTER NUMBER : 3173056707910006
NAME : AYU MAWARDIKA
CITY/DATE OF
BIRTH : PURBALINGGA / JULY 27th , 1991
SEX : FEMALE
PHOTO : -
PHOTO : -
ADDRESS : JL.H.DAUD
RT/RW : 010/003
COUNTRY : SUKABUMI
SELATAN
SUB-DISTRICT : KEBON
JERUK
REGENCY : WEST JAKARTA
RELIGION : ISLAM
OCCUPATION : STUDENT
BLOOD TYPE : A
MARITAL
STATUS : UNMARRIED
NATIONALITY : INDONESIA
EXPIRY : JULY 27th , 2017
SIGNATURE/FINGERPRINT
( AYU MAWARDIKA)
HEAD OF SUB-DISTRICT / HEAD OF VILLAGE
HEAD OF SUB-DISTRICT / HEAD OF VILLAGE
(SUBAGYO)
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