BIRTH CERTIFICATE
CIVIL REGISTRATION
(CITIZEN OF INDONESIA)
Jakarta
Excerpt of
BIRTH CERTIFICATE
No. 7680/JB/1990
By Virtue of Birth Certificate Number stbld 1920 no.750 Yo 1927 no.564 In accordance with state government gazette in Jakarta, that in JAKARTA on date twenty eigth of January on the year of Nineteen Ninety had been born a daughter, named : AFRIGUSTIANA Legitimate child of: spouse couple ZAFRIL DARA and YUDESNI
This quote in accordance with the state today.
Jakarta, on date four
september nineteen ninety
Head of the Civil Registration Office
West Jakarta Regency
Head of the Civil Registration Office
West Jakarta Regency
RAMADON SYUKRI SH
NIP 470017986
IDENTITY CARD
Province : DKI Jakarta
City : Jakarta
Serial Register Number : 09.5202.680890.5502
Name : Afrigustiana
Place / Date of Birth : Jakarta August 28th, 1990
Sex : Female Blood Type :
Address : Jl. Tawakal VA no. 23
Province : DKI Jakarta
City : Jakarta
Serial Register Number : 09.5202.680890.5502
Name : Afrigustiana
Place / Date of Birth : Jakarta August 28th, 1990
Sex : Female Blood Type :
Address : Jl. Tawakal VA no. 23
RT/RW : 005/009
Village : Tomang
Village : Tomang
Sub-District : Grogol Petamburan
City : West Jakarta Marital Status : Unmarried
Religion : Islam
Occupation : Student
Valid Until : August 28th, 2012
Nationality : Indonesian
City : West Jakarta Marital Status : Unmarried
Religion : Islam
Occupation : Student
Valid Until : August 28th, 2012
Nationality : Indonesian
Jakarta,
October 2nd 2007
a.n
Camat
Headman
_____________________________ SANTOSO.
MSI
Sign / Thumb Print ID Card Holder NIP : 010254312
Sign / Thumb Print ID Card Holder NIP : 010254312
MEMBER CARD
UG Smart Card
LITERATURE
ENGLISH LITERATURE
AFRIGUSTIANA
10608152
10608152
1. The identity card is valid
for card holder is on duty and has status as a student at the University of
Gunadarma.
2. These cards are the
property of Capital City Bank to be recovered or refunded if requested by the
GUNADARMA UNIVERSITY and or Bank DKI.
3. These cards are not
transferable in any way.
4. Use of this card is
governed and subject to applicable regulations.
5. If found this card please
return to: Bureau of Public Administration (BAU) Gunadarma University, Jl.
Margonda Raya 100, 16424th Depok Pondok China, tel. (021) 78881112 Ext. 206 or
nearest Capital City Bank, tel. (021) 2354 5555
MEMBER CARD
Participant’s card
ASKES
Health Insurance Specialist
0000045283645
AFRIGUSTIANA
28/08/1990
President Director
Dr. I Gede Subawa, M. Kes
Always ask for DPHO Drug
1. Participants card must be
brought during treatment.
2. If the card is misused,
will be penalized.
3. If there is a change of
data or loss of card, immediately report to the office of PT Askes (Limited)
around.
Toll Free 0800 11 27537 – 0800 11 ASKES
Call Center 500400
www.ptaskes.com
Toll Free 0800 11 27537 – 0800 11 ASKES
Call Center 500400
www.ptaskes.com
DIPLOMA
NATIONAL EDUCATION DEPARTMENT
REPUBLIC OF INDONESIA
DIPLOMA
SENIOR HIGH SCHOOL
STUDY PROGRAM : LANGUAGE
ACADEMIC YEAR 2007/2008
REPUBLIC OF INDONESIA
DIPLOMA
SENIOR HIGH SCHOOL
STUDY PROGRAM : LANGUAGE
ACADEMIC YEAR 2007/2008
The undersigned, Head of "SENIOR HIGH SCHOOL 23 JAKARTA" states that :
Name : AFRIGUSTIANA
Place / date of birth : Jakarta / August 28th, 1990
Name of Parent : Zafril Dara
Previous School : Senior High School 23 Jakarta
Register Number : 11369
PASSED
from the education units based on the results of National Examination and School Examination and has fulfilled all of the criteria in accordance with the legislation.
Jakarta, June 14th 2008
Headmaster,
Drs. Rukiman Lumban Batu
NIP : 131 273 033
