Akta Kelahiran - Assignment

CIVIL REGISTRY

(INDONESIAN NATIONALITY)

EXCERPT OF BIRTH CERTIFICATE

No. 484_1/1774-Cs/1990

Based on ————————————GENERAL———————————birth register by virtue of State Gazette —————————1920————————— in –Tangerang–it was recorded that in ——————–Tangerang————————————————- on date     the twenty eighth day of March,  at 20.35 WIB ——————————————in the year nineteen ———————————–ninety——————————— was born:

————————————————Andita Frista———————————————–

As the second child to the married couple:

————————————————JHON———————————————–

And

————————————————–PATRICIA————————————————-

This extract is in accordance with the current conditions.

Tangerang., on date the third day of May

In the year nineteen ninety

Head of the Registry Office

Drs. H. ASEP KADARMAN

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                                                                                                          NIP. 010 062 075