IDENTITY CARD

PROVINCE DKI JAKARTA

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SERIAL REGISTER NUMBER        :

NAME                          :

CITY, DATE OF BIRTH           :

SEX                           : FEMALE

ADDRESS                       : PINANG EMAS 1

                      RT/RW   : 006/03

               SUB DISTRICT   : PONDOK PINANG

                    COUNTRY   : KEBAYORAN LAMA

                    REGENCY   : JAKARTA SELATAN

RELIGION                      : ISLAM

MARITAL STATUS                : UNMARRIED

OCCUPATION                    : STUDENT

NATIONALITY                 :WNI                 EXPIRY                        : 

SIGNATURE/ FINGER PRINT

HEAD OF SUB DISTRICT/HEAD OF VILLAGE