ENGLISH EXTRACT TRANSLATION OF

INDONESIAN

LANGUAGE

BIRTH CERTIFICATE NAME OF REGISTERED CHILD: Date of Birth: Place of Birth: FATHER OF CHILD: Age of Father: Nationality of Father: MOTHER OF CHILD: Age of Mother: Nationality of Mother: PATERNAL GRANDPARENTS: MATERNAL GRANDPARENTS: PLACE AND DATE REGISTERED: Volume, Page and Number: Name of Magistrate: WITNESSES: DATE AND PLACE THIS COPY ISSUED: CERTIFICATION OF TRANSLATORS COMPETENCE I,
Name of person

Not listed Not listed____________________________________________

, attest to my competency to translate from

INDONESIAN INDONESIAN

to English, and I certify original.

that this is a correct English translation of all pertinent information from the

Name:
Date:

Signature