e PetroChina Halfaya'FZ-LLC First Nam Faizur it FOC ne | Makassar Family Name* ‘Abu Bakar Nationality Indonesian ene PT. Saipem Indonesia Passport No 6903380 Date of Birth 17 August 1890 Place of issue | KBRI Manama Place of Birth Selok Manis Country of Issue | Indonesia Country of Birth Indonesia Issue Date 29 June 2020 Gender Male Expiry Date | 29 June 2025 Marital Status Married Father's Name | Abu Bakar Religion Islam Mother's Name | Asyidah __| *Names must be as on passport. If you wish to be known by a shorter name, please state below Preferred Namo Embassy Address _| JI. Teuku Umar No.38 Menteng Jakarta10350 Indonesia Qualification Bachelor Degree Major Mechanical Engineer Major ‘Address in home country (Full Adcress mustb files) | Address in UAE / current work country JL Keadilan No. 182 address 4 Kec.Pangkajene, South | address 4 Sulawesi 90616 address 2 address 2 Town / City Makassar address 3 Country Indonesia Country home telephone | +6281342103 home telephone +6262195303393) mobile no ee mobile no Page 1 of 3PetroChina Halfaya FZ-LLC izurmecha66@gmail.com/ 7 email izur mecha@vehoo com JL Keadilan —_No.182 Name Yuliane Bohr address 1 Kec-Pangkajene, South Sulawesi Relationship Spouse = address 2 ae Home telephone | +6281342103778 address 3 Mobile no Country Indonesia Work telephone Email ‘Anha0Sizur@amail.com Yuliana Indonesian Middle Name Bohari Passport No 88184909 Family Name Samialia Place of Issue Makassar Date of Birth 038 October 1991 Country of Issue | indonesia Place of Birth | Pangkep Issue Date 10” October 2017, Country of Birth | Indonesia Expiry Date 10 October 2022 [Gender Female Mother's name __| HV. Marhana Child 4 First Name Asiyah Nationality Indonesian Middle Name | Al Muhajir Passport No 38184910 Family Name | Faizur Al Muhajir Place of Issue Makassar Date of Birth 27° September 2015 Country of Issue | indonesia Place of Birth | Pangkep Issue Date 410 October 2017 Country of Birth | Indonesia Expiry Date 40% October 2022 Gender Female Child 2 First Namo Abdulloh Nationality Indonesian Middle Name | Al Muhajir Passport No 88184908 Family Name __| Faizur Al Muhajir Place of Issue Makassar Date of Birth 27 August 2017 Country of issue _| Indonesia yo Page 2 of 3 ales!e PetroChina Halfaya FZ-LLC Place of Birth Pangkep Issue Date 40" October 2017 Country of Birth | Indonesia Expiry Date | 10" October 2022 Gender Male = Child 3 —_ First Name Asma ~__ | Nationality | Indonesia Middle Name Faizur Passport No 02768255 Family Name ‘Al Muhalir Place of Issue KBRI Jeddah Date of Birth 12% May 2019 Country of Issue _| Indonesia i Place of Birth | Jeddah Issue Date 23% June 2018 Country of Birth | Saudi Arabia Expiry Date 23% June 2024 Gender [Female | declare that all the information provided above is correct and further that | will update the Company of any changes promptly to ensure all records are kept up-to-date. Signature: Date: O08 Mac 202% Page 3 of 3