Translation of Kartu Tanda Penduduk

(Indonesian Identity Card)

Province : Banten
City : Tangerang Selatan (South Tangerang)

NIK (Citizen Number) : xxxxxxxxxxxxxxxxxxxxx

Name : Zerosugar.
Place, Date of Birth : Jakarta, 09 June 1975
Sex : Male
Address : Jl. Peluru Blok E-35 / 26 Blood Type :
Neighborhood Ward : 005 / 007 Marital Status : Married
Village Administrative Unit : Benda Baru
District : Pamulang
City : South Tangerang
Religion : Moslem
Occupation : Civil Servant
Valid thru : 09 June 2015

On behalf of City Mayor

District Head

Signed
H. Abu Hurairah
 Translation of KARTU KELUARGA
(Family Registers)
No. 3172010907100041

Name of Head of Family : KHO CING SIONG District : PENJARINGAN

Address : Jl. KENARI GOLF VI NO. 37 City : NORTH JAKARTA
Neighborhood Ward : 006 / 006 Postal Code : 14470
Village Administrative Unit : KAMAL MUARA Province : DKI JAKARTA

No Full Name Citizen Number Sex Place of Birth Date of Birth Religion Education Occupation
1 2 3 4 5 6 7 8 9
1 KHO CING SIONG 31.73.02.220872.0007 MALE BG SIAPI API 22-08-1972 CHRISTIAN DIPLOMA IV/ EMPLOYEE
GRADUATE
2 HARIAWATY GANI 31.72.01.410176.0024 FEMALE PALEMBANG 01-01-1976 CHRISTIAN ACADEMY/ HOUSEWIFE
DIPLOMA III
3 KIMBERLY DIANA KHO 31.72.01.631108.0002 FEMALE JAKARTA 23-11-2008 CHRISTIAN
4
5

Immigration Document Parents

No Marital Status Relation Nationality
Passport Number KITA/KITAP Father Mother
10 11 12 13 14 15 16 17
1
2
3
4
5

Issued on 25-05-2009 Head of Family District Head

Copy I. Head of Family
II. RT (Neighborhood Ward) signed signed
III. Sub District
IV. District Zerosugar. H. Abu Hurairah
 Translation of Kutipan Akta Nikah
(Marriage Certificate)

(Page 1) (Page 2)

Republic of Indonesia Day : Monday

Religion Affair Service Date, month, year : 05 September 2011
Hijri Calendar : 15 Jumadil Awal 1422
District : Cimahi Selatan (South Cimahi) Time : 08.00
City : Tangerang Selatan
Province : Jawa Barat (West Java) Hereby, is the marriage of

Page (3) 1. Name : Zerosugar

2. Father : H. Zerosin
Witnessed by wali nikah 3. Place, Date of Birth : Jakarta, 09 June 1975
4. Nationality : Indonesia
1. Name : Bapaknya Luna Maya 5. Religion : Islam
2. Place, Date of Birth : Zurich, 05 - 11 - 1966 6. Address : Jl. Cimanuk
3. Nationality : Indonesia 7. Marital Status : Not married
4. Religion : Islam 8. Occupation : Civil Servant
5. Address : Sukowati
6. Occupation : Businessman with a woman, namely

Act as a family representative, with the marriage gift of 27.9 grams of 1. Name : Luna Maya
gold, and praying accessories, in cash. 2. Father : Bapaknya
3. Place, Date of Birth : Bali, 07 Juni 1974
Bandung, 06 September 2010 4. Nationality : Indonesia
Religious Affairs Service Office of South Cimahi 5. Religion : Islam
6. Address : Sukowati
Signed 7. Marital Status : Not married
8. Occupation : Actress
I Gde Sekali