KEPOLISIAN NEGARA REPUBLIK INDONESIA Seinen Nomor: 15 -102963 is juddin Panda 8 SURAT .N CATATAN LISIAN POLICE RECORD Nome KCK/YANONAS/4502/XT/2018/SAT INTEL KAM DBueraugian ersomg int baa Thi i 00 cerry hat Name RAUDATUL JANNAH Name Jens Kelamin PEREMPUAN ‘Ser Ketanasaan NpONESI ‘Natonaty 4oama sam elon ie DDORIDUNGGA, 15 MEI 1996 Place and date of Dh “Tempat Tnagal Setarang [RT O11 RW 004 DESA DORIDUNGGA KEC, DONGGO KAB. SIMA Currant Address Pekenaan ‘ccipation 5206085103960001 (Ctzens card number ‘Nome Paspor/KITAS/KTTAP* : PaSSDOr RPPASAEAP NaTIBer ums Sick Jan PLiums Finger sit van ada: ‘ater having investigation until the Ssuance of this based on Maka dinyatalan sebooat bent; ‘ere wth we decare that person mentioned stove ‘Bahwa nama trsobut datas tidak meni catalan atau Keerbatan dalam kesatan criminal apapun ‘the bearer here of proves not to be involved in any criminal cases selama i berada Indonesia dat 15 MET 1996 ‘uring is / ter stay in Indonesia trom ‘amas. dengan 05 DESEMBER 2018, Ont eterangan ns ivectan berhubvogan dengan permohonan Thnsceriicate s ssued atthe request t0 the appicant _ Bieta ELANDUTIAN STUDY 05 DESEMBER 2018 (05 2u 2019) Dikelsarkan cs Panda Iesued in PadaTanaal_: 05 DESEMBER 2018 KEPOLISIAN RESOR BIMA i “hares ai) 8 ee SATUAN INTELKAM beso é Seton aac ‘emet ang ae pr 5 egia7 anaee namo SpSSPETOR POLIST SATU RRP 64120077