POLRI DAERAH METRO JAYA \N JAKARTA SE FE OR ee CEBIVORAN LAMAN Nomor :09 - 0290822 Lama ~ a 240 whe &) IGAN CATATAN KEPOLISIAN POLICE RECORD Nomor: SKCK / YANMAS / 5170/ Vil /2021/ SEK KEB.LAMA certty that toe ie i MAHENDRA PRAKARSA Name Jenis Kelamin_ »Laki laki Sex s INDONESIA ‘Nationality Agama sISLAM Religion Ts n : Jakarta, 13 Januari 1977 Place and date of birth : Cipulir Rt.006/004 Kel. Cipulir Current adoress Kec.Kebayoran Lama Jakarta Selatan Pekeriaan Karyawan Swasta ‘Occupation ; ‘Nomor Kartu Tanda Pencuduk 31.7406.130177,0007 Citizens Card number é m PassporKITASIKITAP number ih a -Rusmus sidik jer} Veg Fingerprints Formula le Existing Police record va iki catatan atau ym keglatan briminal the bearer here of proves not to be involved . ‘gelama ia berada di Indonesia dari 13 Januari 1977 ‘during his / her stay in Indonesia from samoatcenoan 3 AGUSTUS 2021 juoUNgaL in nan This certificate is issued at the request to the applicant ‘Untuk keperiuen/menuiu” MELAMAR PEKERJAAN Eor the purpose ‘Beriaku deri tangael 3 AGUSTUS 2021 3 FEBRUARI 2072 Jakarta 3 AGUSTUS 2021_— \UA/KEPOLISIAN SEKTOR KEBAYORAN LAMA