Akte Kelahiran

CIVIL REGISTRY

(INDONESIAN NATIONALITY)

EXCERPT OF BIRTH CERTIFICATE

No. 484_1/1774-Cs/1990

Based on ————————————GENERAL———————————birth register by virtue of State Gazette —————————1991————————— in –Jakarta–it was recorded that in ——————–Jakarta————————————————- on date     the sixteenth  day of December,  at 18.45 WIB ——————————————in the year nineteen ———————————–ninety——————————— was born:

————————————————KHAIRUNNISA———————————————–

As the fourth child to the married couple:

————————————————-MASUDI———————————————–

And

————————————————–NURHAYATI————————————————-

This extract is in accordance with the current conditions.

Jakarta., on date the third day of March

In the year nineteen ninety one

Head of the Registry Office

Drs. H. ASEP KADARMAN

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