| Descripción |
|---|
| section 1(b) of Executive Order 13224, as amended by Executive Order 13886 |
| País | Ciudad | Provincia | Calle | Código Postal | |
|---|---|---|---|---|---|
| SY - Siria | Idlib | ||||
| ID - Indonesia | Tasikmalaya | Kel. Sambonjaya |
| Nacionalidad | |
|---|---|
| ID - Indonesia |
| País Emisor | Tipo | Número | |
|---|---|---|---|
| ID - Indonesia | Identificación Nacional | 197607281998032001 | |
| ID - Indonesia | Número de Pasaporte | B 3306967 |
| Fecha |
|---|
| 28 Jul 1976 |
| Programa |
|---|
| SDGT |