Attachment of Circular Letter of The Supreme Court R.

I Number : 1 Year 1997

SERIES :I

NO : 4124

DIVORCE CERTIFICATE

Number : 293/AC/2000/PA/Bks

The Clerk of The Religion Court/Syar’iyah Court*) of Bekasi explains, that on this day

Monday, on the date 17th July 2000 M, coincides with 15th Rabi’ul Akhir 1421 H, based on

The Decision/Statute of Bekasi Religion Court Number 160/Pdt.G/2000/PA.Bks on the date

01st July 2000 M, which has a permanent legal force, has occurred a divorce between:

HASTO age 43 years, Religion : Islam, Occupation :

Entrepreneurship, Resides in Perumahan,

Bumi Alam Hijau Jl. Durian XIII/32 RT.05/5

Village of Pedurenan, Bantar Gebang District

Regency/City*) of DT. II Bekasi

With :

SURYATI age 51 years, Religion : Islam,

Occupation: Private Employee, Resides in

Perumahan Bumi Alam Hijau Jl. Durian XIII/32

RT 05/5, Village of Pedurenan, Bantar Gebang

District, Regency / City*) of DT. II Bekasi.

.
With Divorce By Talaq/Divorce by Accountability*)

- This is the 1st (first) Divorce

- The Requested Party /Plaintiff (former wife) in the condition of qabla/ba’da*) dukhul

- The Requested Party /Plaintiff (former wife) in a holy/menstrual/pregnant*) state

- Quote from Marriage Certificate of KUA (Religion Affairs Office) of Center

Semarang District, Regency/City*) of DT. II Semarang, Date 16th November 1978,

Number :335/28/1978

Thus this Divorce Certificate is created, signed by us A. Sarodji, S.Ag The Clerk of Religion

Court/Syar’iyah Court*) of Bekasi

Clerk

[signed & sealed]

*) Cross the unnecessary ones (A. SARODJI. S.Ag)

NIP. 150 169 321

I, FATCHUROZAK, a Sworn and Authorized Translator

by the virtue of Jakarta Capital Territory Governor’s Decree No. 3065/2003, practicing
in Jakarta, do solemnly and sincerely declare that the foregoing document is a true and
faithful translation from Indonesian into English of the original version.
Jakarta, November 06, 2017