AUTHORIZED TRANSLATION

GOVERNMENT OF THE SPECIAL CAPITAL PROVINCE OF JAKARTA

DEPARTMENT OF POPULATION AND CIVIL REGISTRATION
OFFICE OF POPULATION AND CIVIL RECORDING
CITY OF ADMINISTRATION NORTH JAKARTA
Jl. Berdikari No. 2 Rawa Badak Utara Koja
Phone (021) 43938775, (021) 43930358 Fax. (021) 43757508, email: dukcapil-jakut@gmail.com
JAKARTA
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CERTIFICATE
NUMBER: 0179/3172011004/12/2019

The undersigned :
Full Name : CHATALINA NAOMI DAE PANY, S.AP.
NIP : 197507072000032001
Position : Head of Service of Population Registration of Kelurahan PEJAGALAN

Explained that :

NIK : 3173012908850018
Full Name : RENDY
Place/Date of Birth : MEDAN, 29-08-1985
Sex Type : MALE
Address : JL. JEMBATAN GAMBANG 2
RT/RW : 005 / 001
Sub-District/Village : PEJAGALAN
District : PENJARINGAN
Religion : BUDDHIST
Marital Status : SINGLE
Occupation : PRIVATE EMPLOYEE
Citizenship : INDONESIAN

The said resident him truly registered electronic national identification and said resident was documented at Population
Database

Thus we convey this certificate as the substitute of electronic national identification, to be used for General Election,
Immigration, Banking, Police Department, Insurance, BPJS, Defense, Marriage, Taxation and others. Thus to be notified
whom it may concern.
JAKARTA, 10-12-2019
On behalf Head of Office of Population and Civil
Recording City od Administration North Jakarta
Head of Service of Population Registration of
Kelurahan PEJAGALAN
Applicant
[signed] [stamped,signed]
RENDY CHATALINA NAOMI DAE PANY, S.AP.
NIK. 3173012908850018 NIP. 197507072000032001

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AFFIDAVIT

The undersigned, an authorized and sworn translator in Jakarta, this is to certify that I have translated the
foregoing document from Indonesian to English, that is true and complete and I am competent in both
languages.

SOESILO
Decree of Governor of KDKI Jakarta No. 527/1995

PT. Buana International - The Authorized Translation Office

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