Akta
Kelahiran - Assignment
CIVIL REGISTRY
(INDONESIAN NATIONALITY)
EXCERPT OF BIRTH CERTIFICATE
No. 123_5/1756-Cs/1991
Based
on ————————————GENERAL———————————birth register by virtue of State Gazette —————————1920—————————
in –Jakarta –it was recorded that in ——————–Jakarta————————————————- on
date the twenty eighth day of June, at 19.35 WIB
——————————————in the year nineteen ———————————–ninety——————————— was born:
————————————————Muhammad
Rahman—————————————–
As the
second child to the married couple:
————————————————Nurhayati———————————————–
And
————————————————–Abdul
Riki————————————————-
This
extract is in accordance with the current conditions.
Jakarta.,
on date the third day of June
In
the year nineteen ninetyone
Head
of the Registry Office
Drs.
Abdul Rozak
———————————–
NIP.
020 052 078
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