| Type | ID# | Country | Issue Date | Expire Date |
| Passport | N35635875 | | | |
| National ID No. | 0081798301 | | | |
| Birth Certificate Number | 11770 | | | |
| Gender | Male | | | |
| Secondary sanctions risk: | section 1(b) of Executive Order 13224, as amended by Executive Order 13886 | | | |
| Additional Sanctions Information - | Subject to Secondary Sanctions | | | |