| Street | Jl Palma | ||
| City/Town | Gorontalo | ||
| State/Province/Region | Gorontalo | ||
| Zip/Postal Code | 96128 | ||
| Phone Number | (0435) 8791900 | ||
| Country | Indonesia |
| Full Name | Ulya Laksmiwati | ||
| Gender | female | ||
| Birthday | 1995-07-17 | ||
| Social Security Number |
| Credit card brand | Visa | ||
| Credit card number | 4532396498375774 | ||
| Expire | 2027/5 | ||
| CVV | 718 |