LCENEIS o gteeT esc TMG Ey TERT CG -49-9242401 POURIOAERAH JaWa TIMUR Nomor: 13-924 “oexronmonan eT rn olan Fava Wankulon 02 Pucikfemongen 62247 | ASLI} POLIGE RECORD Nome SKCIIYANMASIO2D YAN 2 ‘2023 ELAM . Tne f curtiy tho Nama PANCA SATRIA ADITAMA None Lok - Lak See Kebanasaan Indonesia tonality anna tam moa Lamongen.24 Oktoer 2008 ober Proce and date of bth R003 Rw.002 Desa Pucuk Kecamatn Pucuk, Current address Kabupaten Lamongen Poeriaan 3 Sccupaton 382418 241003 0003, Clizers card oumbor Information trom local Authorities A at ! spapun {he boarer hereof proves not tobe involved in any criminal cases ia 0 24 Oktober 2003 during hsher stay m Indonesia Fom ‘sempai dengan 06 Mei 2023 fa This certificate is issued al the request fo the applicant eruiy® Persyaratan Melamar Pokeriaan For the purpose 08 Moi 2028 Vakd rom ‘Samoa dengan 95 November 2029 To a ruins Po NRP 67120105 4 ceed tan ta ac & Dipindai dengan CamScanner