| Street | Komplek Pasar Gusher Blok A-103. Jl. Gajah Mada Kel. Karang Rejo, Kec. Tarakan Barat, Kota Tarakan | ||
| City/Town | Tarakan | ||
| State/Province/Region | Kalimantan Utara | ||
| Zip/Postal Code | 7711 | ||
| Phone Number | (0551) 21933 | ||
| Country | Indonesia |
| Full Name | Yani Agustina | ||
| Gender | female | ||
| Birthday | 1998-05-18 | ||
| Social Security Number |
| Credit card brand | Diners Club | ||
| Credit card number | 3037351694434257 | ||
| Expire | 2027/1 | ||
| CVV | 894 |