| Descripción |
|---|
| section 1(b) of Executive Order 13224, as amended by Executive Order 13886 |
| País | Ciudad | Provincia | Calle | Código Postal | |
|---|---|---|---|---|---|
| ID - Indonesia | Bogor | West Java |
| Nacionalidad | |
|---|---|
| ID - Indonesia |
| País Emisor | Tipo | Número | |
|---|---|---|---|
| ID - Indonesia | Número de Pasaporte | B 2315612 |
| Fecha |
|---|
| 21 Sep 1973 |
| Programa |
|---|
| SDGT |