KEPOLISIAN NEGARA REPUBLIK INDONESIA, Nic
DAERAH JAIVA BARAT 9-0959370
RESOR GARUT
Ji Jenderal 144118
he
SURAT KETERANGAN CATATAN KEPOLISIAN
| POLICE RECORD
Nomor : SKCK/ YANMAS /28390 // 2018 / SAT. INTELKAM
Diterenakan bersama ini bahwa
“Tei to ce th:
Name MIFTA FARID
Nane
nis Kelamin Laki - laki
Sex
Kebangsaan Indonesia
Nationality
Agama : Islam
Religion
‘Tempat dan tal lair : Gatut, 17 Agustus 1994
Place and Date of birch
‘Tempat tinggal sekarang : Kp. Cigoleah Rt. 01 Rw. 02 Ds. Margamulya Kec. Cisompet
Current address Kab. Garut
Pekeriaan ite he
Occupation
Nomor Kartu Tanda Penduduk 32.05, 23 (i Ve
Citizens card number —
Nomer Paes TASIKITAP px pO OAK BERLAK
ik Jari UIOM. KEWAR NEGERI
Fingerprints Formula i
Setelah diadakan peneiitian
As of screening thraugh the issu
a. Catatan Kepolisian yai
Bestg ple eo
b. Surat Keterangan &
ia berada di Indonesia dari
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