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Signed below
Name : Lia Ernawati
Place and date of birth : Garut, 15-09-1987
Address : kp.cikurantung RT.001 RW.009
Kel.cirapuhan kec.selaawi Garut West
Java
So this Statement I make with the truth without coercion from any party
Bandung, 11 march 2017