JavaScript isn't enabled in your browser, so this file can't be opened. Enable and reload.
VERIFICACIÓN DE SERVICIOS
Sign in to Google
to save your progress.
Learn more
* Indicates required question
FECHA DEL SERVICIO
*
MM
/
DD
/
YYYY
EMPRESA
*
Choose
MB
FSJ
LC
NASER
NUMERO DE CONTRATO DE SERVICIO
*
Your answer
NUMERO CEDAI
*
Your answer
NUMERO DE DATOS DE DEFUNCIÓN
*
Your answer
TIPO DE SERVICIO
*
Choose
CMD
INHD
INHC
CMC
CMR
INHR
TIPO DE CLIENTE
*
Choose
PI
CANTV
SAHUM
NI
CONVENIO
DETALLE PÓLIZA INDIVIDUAL
Choose
LATINO
ALCALDIA
BARRIO A
CUN
CRU
CLEZ
EDUCACION
SALUD
AVICOLA
CATACEZ
SUTIPLUZ
PROAVE
MINIST TRAB
IPOSTEL
NUTRICION
INCES
EL SOL
HOTELES
LA GRANDE
FIORELA
DINIAZCA
REDIPLAN
TASA DEL DIA
*
Your answer
UBICACION
*
Choose
LOCAL
FORANEO
NACIONAL
FORMA DE PAGO
*
ZELLE
CASH
TRANSF BS
PAGO MOVIL
PESOS
CUENTA POR COBRAR
PUNTO
Required
MONTO PAGADO ZELLE
Your answer
MONTO PAGADO CASH
Your answer
MONTO PAGADO BS
Your answer
MONTO DEL SERVICIO
*
Your answer
OBSERVACIONES
Your answer
CEMENTERIO
*
Choose
LA CHINITA
EDENCA
OKINAWA
ZULIA
OTRO
Nombre Cementerio Otro
Your answer
COORDINADOR
*
Choose
RENNY
JORELY
JORGE
VERIFICADO POR
*
Choose
MJose
A_Aguilar
Submit
Clear form
Never submit passwords through Google Forms.
This content is neither created nor endorsed by Google.
Report Abuse
-
Terms of Service
-
Privacy Policy
Forms
