KEPOLISIAN NEGARA REPUBLIK INDONESIA, RESOR SUKABUM! Nomor : 10 - 0080965 'SEKTOR JAMPANG TENGAH “7 Jalan Bojonglopang No.18 Jampana tengah 43171 sl SAN. POLICE RECORD. Nomor: SKCK/YANMAS/ 1508 / IX / 2022 / Sekdor MOHAMAD DIPA ASSIDIK ta -La INOONESIA ‘su Tepe! dant lati SUKABUMI 17 SEPTEMBER 1998 Face era tute of oh enoal nooel stara JL PANUMBANGAN RT. 028006, DESA PANUMBANGAN area eae EC. JAMPANG TENGAH KAS, SUKABUMI = -—= \ Petanaen ELM BEER \ AIT ‘Nomor Kartu Tanda Pendudse ms TESS Czens card number a ‘Nomor Paspor/KITAS/KITAP* PassporKITASKITAP number umus sigh jan tdiatas td the bearer hereof proves not fo be involved in any 17 SEPTEMBER 1998 selama uring hirer stayin Indonesia from ss2mpei dengan 19 SEPTEMBER 2022 to This catfcate is issued atthe request fo the applicant imenuiu* PERSYARATAN MELAMAR PEKERJAAN For the purpose 19 SEPTEMBER 2022 Valid from ‘Semeai dengan 19 MARET = 2023