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Personal, Addres, Phone Name Provided Full Name Other Name Used Sex Marital Status Date of Birth

Place of Birth INDONESIA Nationality Other Nationalities National Identification Number U.S Social Security Number U.S Taxpayer ID Number Home Address

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M.NOOR RAKHMAN MURSALIN, ASEP M.NOOR RAKHMAN MURSALIN NO MALE MARRIED 17 JULI 1984 LANDASAN ULIN, SOUTH BORNEO,

: INDONESIA : NO : 6271011707840004 : DOES NOT APPLY : DOES NOT APPLY : JL. KARRANGGAN NO. 22 RT. 002 RW 04 KELURAHAN TANJUNG PINANG City : PALANGKARAYA State/Province : CENTRAL KALIMANTAN Postal Zone/ZIP Code : 73111 Country : INDONESIA Work Phone Number : (0536)322871 Email Address : cecep_21@ymail.com Passport/travel Document Type : P Passport/travel Document Number : W 973160 Passport Book Number : 1A11ZA3370-KQU Country : INDONESIA City : PALANGKARAYA Province : CENTRAL KALIMANTAN Country : INDONESIA Issuance Date : 25 August 2011 Expiration Date : 25 August 2016 Have you ever lost a passport or had one stolen : NO Travel Information Kosongin Aja .. .. Family Information Fathers Surnames Fathers Given Names Fathers Date of Birht Is your father in the U.S? Mothers Surnames Mothers Given Names : . : :

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HIDAYAT 10 OKTOBER 1957 NO ONA FATIMAH -

Mothers Date of Birth : 10 OKTOBER 1960 Is your mother in the U.S? : NO Do you have any immediate relative, not including parents In the U.S? : NO Do you have any other relatives in the U.S? : NO Spouses Full Name : EKA FITERA ASTUTY Spouses Date of Birth : 30 JUNI 1984 Spouses Nationality : INDONESIA Spouses City of Birth : AMUNTAI,SOUTH KALIMANTAN Spouses Country of Birth : INDONESIA Spouses Address : SAME AS HOME ADDRESS Work/Education/Training Information Primary Occupation Present Employer or School Name : GOVERMENT (CIVIL SERVANT) : METEOROLOGY STATION TJILIK RIWUT PALANGKARAYA Address : BANDAR UDARA TJILIK RIWUT JL. ADONIS City : PALANGKARAYA State/Province : CENTRAL KALIMANTAN Postal Zone/ZIP Code : 73111 Country : INDONESIA Work Phone Number : (0536)3223141 Monthly Salary in Local Currency (if employed) : Briefly Describe your Duties : WAETHER INFORMATION SERVICES Were you previously employed : NO Have you attended any educational institution at secondary level or above? : YES Name of Institution (1) : Civil Aviation Safety and Engineering Academy Address of Institution : JL. Penerbangan No.85 Jamin Ginting KM 8,5 City : NORTH SUMATERA State/Province : PADANG BULAN,MEDAN Postal Zone/ZIP Code : 20131 Country : INDONESIA Course of Study : RADIO TECHNIC Date of Attendance From : 7 OKTOBER 2007 Date of Attendance To : 24 MARET 2010 Name of Institution (2) Address of Institution City State/Province Postal Zone/ZIP Code Country Course of Study Date of Attendance From Date of Attendance To :: : : : :: : : -

Name of Institution (3) Address of Institution City State/Province Postal Zone/ZIP Code Country Course of Study Date of Attendance From Date of Attendance To Name of Institution (4) Address of Institution City State/Province Postal Zone/ZIP Code Country Course of Study Date of Attendance From Date of Attendance To

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SMA N 4 Palangkaraya JL. Sisingamangaraja III PALANGKARAYA CENTRAL KALIMANTAN 73111 INDONESIA PHISICS 5 JUNE 1999 20 JUNE 2002 SMP N 6 Palangkaraya JL. SETHADJI PALANGKARAYA CENTRAL KALIMANTAN 73111 INDONESIA GENERAL 26 JULY 1996 26 JULY 1999

Name of Institution (5) : SD N PAHANDUT 3 Address of Institution : JL. P.M.NOOR City : PALANGKARAYA State/Province : CENTRAL PALANGKARAYA Postal Zone/ZIP Code : 73111 Country : INDONESIA Course of Study : GENERAL Date of Attendance From : 9 JULY 1990 Date of Attendance To : 7 JUNE 1996 Do you belong to a clan or tribe? : NO Provide a List of Languages You Speak Language Name (1) : INDOSENIA Language Name (2) : ENGLISH Have you traveled to any countries within the last five years? : NO Have you belonged to, contributed to, or worked for any professional, social or charitable organization : NO SELEBIHNY.. : NO Security and background information . . Dst ; NO ; NO : NO