CIVIL REGISTER
(INDONESIAN CITIZEN)
JAKARTA
EXCERPT OF
BIRTH CERTIFICATE
No.1100887/1992.-
From GENERAL Register of Civil Registration for Indonesia Citizen about births pursuant to the State Gazatte in Jakarta, that in Jakarta on date fourth of February nineteen ninety two was born: MICHELIA CHAMPACA daughter of married couple : E.RASIDI and SITI CHADIDJAH
This expert conforms to the condition on this day
Jakarta, dated sixth of Marc
Nineteen ninety two,
Head of Civil Registration Office.
sulalstri astuti
NIP.9665342546
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