| Nama | : | SAMSINAR . |
| Tempat, Tanggal Lahir | : | [30], 18 Maret 1907 |
| Nomor Sertifikat | : | 89162/SOU/IV/2021 |
| Nomor STTPL | : | 2871 |
| Tahun Kelulusan | : | 2021 |
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