| Descripción |
|---|
| section 1(b) of Executive Order 13224, as amended by Executive Order 13886 |
| País | Ciudad | Provincia | Calle | Código Postal | |
|---|---|---|---|---|---|
| ID - Indonesia | Tasikmalaya | West Java | Cempakawarna Rt |
| Nacionalidad | |
|---|---|
| ID - Indonesia |
| País Emisor | Tipo | Número | |
|---|---|---|---|
| ID - Indonesia | Número de Pasaporte | A 8799177 |
| Fecha |
|---|
| 16 Feb 1990 |
| Programa |
|---|
| SDGT |