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Type/Type

CodeofIssuing/CodedeIEta

t

DOCUMEN

TNo.

C

StateGODemetteur

JC1357887531

Name/Nom

Nationality/Na

tionalite

OUTOFTHISWORLD

DateofBirth/D

atedenaissance

BAPTISM

Gender/Gendre

PlaceofBirth/Lie

udenaissance

NOTAPPLICABLE

EARTH

DateofIssue/D

atededelivrance

HoldersSignatu

re/

SECONDCOMING

Signaturedutitulaire

DateofExpiry/Datedexpiration

ETERNITY

Authority/Auto

rite

HEAVEN

OUTOFTHISWORLD