| Street | Jl. Garuda No. 20 Bedeng Agung | ||
| City/Town | Lubuklinggau | ||
| State/Province/Region | Sumatera Selatan | ||
| Zip/Postal Code | 31616 | ||
| Phone Number | (021) 29278888 | ||
| Country | Indonesia |
| Full Name | Elvina Ani Usada S.E.I | ||
| Gender | female | ||
| Birthday | 1971-10-29 | ||
| Social Security Number |
| Credit card brand | Diners Club | ||
| Credit card number | 3845300367859664 | ||
| Expire | 2029/9 | ||
| CVV | 409 |