Live simply, Love generously, Care deeply, Speak kindly, Leave the rest to God

Kamis, 07 Maret 2013

identity


WEST JAVA PROVINCE
DEPOK CITY

Serial Register Number                 : 123xxxxxxxxx
Name                                             : Bulan
City / Date of Birth                        : Jakarta, 1991 – 12 – 30
Sex                                                 : Female
Address                                          : Pendidikan                                                       Blood Type: -
                RT / RW                         : 08/09
                Country                          : Limo
                Sub – District                 : Grogol
Religion                                         : Islam
Material Status                               : Unmarried
Occupation                                     : Student
Nasionality                                     : Indonesia
Expiring                                          : 2017 – 07 – 10


Print Finger                                                                                                         Signature

Tidak ada komentar:

Posting Komentar