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Formulario Inscripción descuento Combustible y Parafina
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"Autorizo a la Municipalidad de Los Andes a compartir los siguientes datos personales para el Convenio de Descuentos con Petrobras"
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SI
No
CORREO ELECTRÓNICO
Your answer
NOMBRES
*
Your answer
APELLIDOS PATERNO Y MATERNO
*
Your answer
RUT
*
Your answer
FONO O CELULAR CONTACTO
*
Your answer
EDAD
*
Your answer
FECHA DE NACIMIENTO
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MM
/
DD
/
YYYY
DIRECCIÓN
*
Your answer
COMUNA
*
Your answer
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