Identity Card

                                                                               WEST JAVA PROVINCE

                                                                              DISTRICT OF BANDUNG

SERIAL REGISTER NUMBER : 32044408049603422532002

NAME  : FAUZI IMAMUL ARIFIN

CITY/BIRTH OF DATE : BANDUNG, 08-04-1996

SEX  : MALE                                                   BLOOD TYPE : AB

ADDRESS  : PARKEN BLOK.B.26 NO.9

                      RT/RW  : 003/007

SUBDISTRICT  :NAGRAK

                      DISTRICT: CANGKUANG

RELIGION: MOSLEM

MARITAL STATUS :HAVE NOT MARRIED

OCCUPATION: STUDENT

VALID TO: 31-12-2014                                                                                        BANDUNG, 30-05-2014

NATIONALLITY : INDONESIA                                                                        HEAD OF DEPARTMENT OF POPULATION

Signature/Finger Print ID Card HolderDrs. H.SALIMIN,M.Si