POLRI DAERAH METRO JAYA Nomor : 09 - 02231 4L-

RESORT METRO JAKARTA TIMUR

POLSEK KRAMATJATI

suRAT !(ETERANGAN CATATAN KEPOLISIAN

POLICE RECORD
Nomor: SKCI( YANMAS t 4.037 tlV 12018 / SEK" KJ'

DiteranoKan bersama ini b :

Ihis is certifY that :

Nama ANDRE WILLIAM
Name
Jefte kelaxru_0 LAKI - LAKI
Sex
Keb€nqsaA-[ INDONESIA
Nationality
Aoama KRISTEN
Religion
Temoat dan tql lahir JAKARTA, 04 OKTOBER 1994
Place and date of birth
Tempat tinooal sekaranq JL MUNGGANG NO.2OD RT,OO8 RW.OO1, KEL.BALEKAMBANG
Present addres KECAMATAN KRAMATJATI, JAKARTA TIMUR
Pekeriaan sekaranq
Occupation
Nomor Kartu Tanda Pendudtlk 31 7504 041094 1001
Resident ldentitY card number
Nomor Pasoor/KITAS/KlTAP"
Pa spo rt/Kl T A S/K lT A P. num be r
Rumus Sidik Jari e013u[_909
Fingerpnnts Formuta I26UIII
Setelah diadakan oenelitian hinooa saat dikeluarkan s :

As of screen ing through fhe issue here of by viftue of :

Catatan Keoolisian va.no adlt
isting Police record
a dinvatakan sebaoai beriEut :
Here with we declare that person mentioned abave

{h{bearer here of proves not to be invalved ln any criminal cases

Se/ama ia berada di lndonesia dari : 04
OKTOBER 1994
During his/her stay in indonesia from
SaJoaidengan : 09 APRIL 2018
Until
KeEranoan ini diberikan berhubunoan denqan oermohonan
This certificafe ts r'ssued at the request to the applicant
U ntu k ke oe rlueCI m glgtg- : FERSIAHATA|I llEUllAP PEKERJAAN
For the purpose or to
Berlaku daritanooal : 09 APRIL 2018
Valid from
Samoai denqan : 09 OKTOBER 2018
Until
dikeluarkan di Jakarta
sued in
Pada tangoal Og APril 2018

Cataten l
SEKTOR KRAMATJATI
Noted
Aoabila dkemudian hari
Ybs terlibat keiahatan/
D€lanooaran. SKCK ini
0ifiYaiahan tiCut Putlu,.'

lf the future is concerned

involved in the crimel
viotatron, skck is
, \\ \

deolarecl invalrd

S POLISI NRP 64030I?5