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[12/4 17.

26] Mama Eki: Yg bertanda tangan dibawah ini:

Nama: Abdul syukur

Ttl: Majalengka 02-06-1980

Jenis kelamin: laki-laki

Alamat: kp.cijingga RT/RW 003/002 desa.serang kec.cikarang selatan

No KTP:3216190206800008

[12/4 17.28] Mama Eki: Yg Nerima kuasa

Nama: Dian nurdianti

Ttl:Ciamis 02-01-1986

Jenis kelamin: perempuan

Alamat: kp.cijingga RT/RW 003/002 desa.serang kec.cikarang selatan

No KTP: 3216194201860006

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