Code : T.

HR DKCSL 0338247
Acc. No. : 8645
Dated : 02.04.2004

CIVIL REGISTRATION
(INDONESIAN CITIZEN)

EXCERPT OF
BIRTH CERTIFICATE
No.: 467/U/JS/2004

Referring to the general register of births in accordance with State Gazette No. 75/1933 in
conjunction with No. 607/1936 in Jakarta, it is found that in Jakarta, on the third of March
two thousand and four, there was born:

TRUDY GRACE FORTUNE

first child, female, to married couple: SIRAIT, Johnny and OPPUSUNGGU, Amy Diana
Ruth.

This excerpt corresponds to the state of affairs at the

moment of issue.
January, the second of April two thousand and four.

15 April 2004 Head of Population and Civil Registration

LEGES Sub-Department of Jakarta Selatan Municipality
District Court of Jakarta Selatan
No. 1759/ ACR/KH/2004 PNJS [sealed and signed]
Legalization Ro. 1000
Initials Paraf - Drs. MOHAMMAD HATTA, MM
EIN. 470055720