{"id":4546,"date":"2022-12-26T12:13:58","date_gmt":"2022-12-26T17:13:58","guid":{"rendered":"https:\/\/fondesa.co\/?page_id=4546"},"modified":"2024-07-17T12:32:52","modified_gmt":"2024-07-17T17:32:52","slug":"formulario-de-afiliacion","status":"publish","type":"page","link":"https:\/\/fondesa.co\/formulario-de-afiliacion\/","title":{"rendered":"Formulario de Afiliaci\u00f3n"},"content":{"rendered":"\t\t<div data-elementor-type=\"wp-page\" data-elementor-id=\"4546\" class=\"elementor elementor-4546\" data-elementor-post-type=\"page\">\n\t\t\t\t\t\t<section class=\"elementor-section elementor-top-section elementor-element elementor-element-b85ee32 elementor-section-boxed elementor-section-height-default elementor-section-height-default exad-glass-effect-no exad-sticky-section-no\" data-id=\"b85ee32\" data-element_type=\"section\">\n\t\t\t\t\t\t<div class=\"elementor-container elementor-column-gap-default\">\n\t\t\t\t\t<div class=\"elementor-column elementor-col-100 elementor-top-column elementor-element elementor-element-4d051a1 exad-glass-effect-no exad-sticky-section-no\" data-id=\"4d051a1\" data-element_type=\"column\">\n\t\t\t<div class=\"elementor-widget-wrap elementor-element-populated\">\n\t\t\t\t\t\t<div class=\"elementor-element elementor-element-68e3dd8 exad-sticky-section-no exad-glass-effect-no elementor-widget elementor-widget-shortcode\" data-id=\"68e3dd8\" data-element_type=\"widget\" data-widget_type=\"shortcode.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t<div class=\"elementor-shortcode\"><div class=\"forminator-ui forminator-custom-form forminator-custom-form-4545 forminator-design--default  forminator_ajax\" data-forminator-render=\"0\" data-form=\"forminator-module-4545\" data-uid=\"6723188e7ef7b\"><br\/><\/div><form\r\n\t\t\t\tid=\"forminator-module-4545\"\r\n\t\t\t\tclass=\"forminator-ui forminator-custom-form forminator-custom-form-4545 forminator-design--default  forminator_ajax\"\r\n\t\t\t\tmethod=\"post\"\r\n\t\t\t\tdata-forminator-render=\"0\"\r\n\t\t\t\tdata-form-id=\"4545\"\r\n\t\t\t\t\r\n\t\t\t\tdata-design=\"default\"\r\n\t\t\t\t\r\n\t\t\t\t\r\n\t\t\t\t\r\n\t\t\t\tdata-grid=\"open\"\r\n\t\t\t\tenctype=\"multipart\/form-data\"\r\n\t\t\t\t\r\n\t\t\t\tstyle=\"display: none;\"\r\n\t\t\t\t\r\n\t\t\t\tdata-uid=\"6723188e7ef7b\"\r\n\t\t\t><div role=\"alert\" aria-live=\"polite\" class=\"forminator-response-message forminator-error\" aria-hidden=\"true\"><\/div><div class=\"forminator-row\"><div id=\"html-1\" class=\"forminator-field-html forminator-col forminator-col-12 \"><div class=\"forminator-field forminator-merge-tags\" data-field=\"html-1\"><div align=\"center\">\n<p>SUPERINTENDENCIA DE LA ECONOMIA SOLIDARIA<\/p>\n<h3><strong>FORMULARIO DE VINCULACION DEL ASOCIADO (CLIENTE)<\/strong><\/h3>\n<p>FORMATO N\u00b0 6<\/p>\n<p>FONDO DE EMPLEADOS DE SEGURIDAD OMEGA Y ADMINISTRACIONES GJ<\/p>\n<\/div><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"number-1\" class=\"forminator-field-number forminator-col forminator-col-6 \"><div class=\"forminator-field\"><label for=\"forminator-field-number-1_6723188e7ef7b\" id=\"forminator-field-number-1_6723188e7ef7b-label\" class=\"forminator-label\">C\u00f3digo Interno<\/label><input name=\"number-1\" value=\"\" placeholder=\"Ejemplo: 234\" id=\"forminator-field-number-1_6723188e7ef7b\" class=\"forminator-input forminator-number--field\" inputmode=\"decimal\" data-required=\"\" data-decimals=\"0\" aria-required=\"false\" data-inputmask=\"&#039;groupSeparator&#039;: &#039;&#039;, &#039;radixPoint&#039;: &#039;&#039;, &#039;digits&#039;: &#039;0&#039;\" type=\"number\" step=\"any\" min=\"1\" max=\"99999\" \/><\/div><\/div><div id=\"date-1\" class=\"forminator-field-date forminator-col forminator-col-6 \"><div class=\"forminator-field\"><label for=\"forminator-field-date-1-picker_6723188e7ef7b\" id=\"forminator-field-date-1-picker_6723188e7ef7b-label\" class=\"forminator-label\">Fecha Diligenciamiento <span class=\"forminator-required\">*<\/span><\/label><div class=\"forminator-input-with-icon\"><label for=\"forminator-field-date-1-picker_6723188e7ef7b\"><span class=\"forminator-icon-calendar\" aria-hidden=\"true\"><\/span><\/label><input autocomplete=\"off\" type=\"text\" size=\"1\" name=\"date-1\" value=\"\" placeholder=\"Elegir fecha\" id=\"forminator-field-date-1-picker_6723188e7ef7b\" class=\"forminator-input forminator-datepicker\" data-required=\"1\" data-format=\"dd-mm-yy\" data-restrict-type=\"\" data-restrict=\"\" data-start-year=\"2024\" data-end-year=\"2124\" data-past-dates=\"enable\" data-start-of-week=\"1\" data-start-date=\"2024-10-31\" data-end-date=\"\" data-start-field=\"\" data-end-field=\"\" data-start-offset=\"\" data-end-offset=\"\" data-disable-date=\"\" data-disable-range=\"\" \/><\/div><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"checkbox-1\" class=\"forminator-field-checkbox forminator-col forminator-col-6 \"><div role=\"group\" class=\"forminator-field required\" aria-labelledby=\"forminator-checkbox-group-6723188e7ef7b-label\"><span id=\"forminator-checkbox-group-6723188e7ef7b-label\" class=\"forminator-label\">Empresa <span class=\"forminator-required\">*<\/span><\/span><label id=\"forminator-field-checkbox-1-1-6723188e7ef7b-label\" for=\"forminator-field-checkbox-1-1-6723188e7ef7b\" class=\"forminator-checkbox\" title=\"Seguridad Omega Ltda\"><input type=\"checkbox\" name=\"checkbox-1[]\" value=\"one\" id=\"forminator-field-checkbox-1-1-6723188e7ef7b\" aria-labelledby=\"forminator-field-checkbox-1-1-6723188e7ef7b-label\" data-calculation=\"0\"  \/><span class=\"forminator-checkbox-box\" aria-hidden=\"true\"><\/span><span class=\"forminator-checkbox-label\">Seguridad Omega Ltda<\/span><\/label><label id=\"forminator-field-checkbox-1-2-6723188e7ef7b-label\" for=\"forminator-field-checkbox-1-2-6723188e7ef7b\" class=\"forminator-checkbox\" title=\"Administraciones Gj Ltda\"><input type=\"checkbox\" name=\"checkbox-1[]\" value=\"two\" id=\"forminator-field-checkbox-1-2-6723188e7ef7b\" aria-labelledby=\"forminator-field-checkbox-1-2-6723188e7ef7b-label\" data-calculation=\"0\"  \/><span class=\"forminator-checkbox-box\" aria-hidden=\"true\"><\/span><span class=\"forminator-checkbox-label\">Administraciones Gj Ltda<\/span><\/label><label id=\"forminator-field-checkbox-1-3-6723188e7ef7b-label\" for=\"forminator-field-checkbox-1-3-6723188e7ef7b\" class=\"forminator-checkbox\" title=\"Fondesa\"><input type=\"checkbox\" name=\"checkbox-1[]\" value=\"Fondesa\" id=\"forminator-field-checkbox-1-3-6723188e7ef7b\" aria-labelledby=\"forminator-field-checkbox-1-3-6723188e7ef7b-label\" data-calculation=\"0\"  \/><span class=\"forminator-checkbox-box\" aria-hidden=\"true\"><\/span><span class=\"forminator-checkbox-label\">Fondesa<\/span><\/label><\/div><\/div><div id=\"checkbox-2\" class=\"forminator-field-checkbox forminator-col forminator-col-6 \"><div role=\"group\" class=\"forminator-field required\" aria-labelledby=\"forminator-checkbox-group-6723188e7ef7b-label\"><span id=\"forminator-checkbox-group-6723188e7ef7b-label\" class=\"forminator-label\">Novedad <span class=\"forminator-required\">*<\/span><\/span><label id=\"forminator-field-checkbox-2-1-6723188e7ef7b-label\" for=\"forminator-field-checkbox-2-1-6723188e7ef7b\" class=\"forminator-checkbox\" title=\"Ingreso Asociado\"><input type=\"checkbox\" name=\"checkbox-2[]\" value=\"one\" id=\"forminator-field-checkbox-2-1-6723188e7ef7b\" aria-labelledby=\"forminator-field-checkbox-2-1-6723188e7ef7b-label\" data-calculation=\"0\"  \/><span class=\"forminator-checkbox-box\" aria-hidden=\"true\"><\/span><span class=\"forminator-checkbox-label\">Ingreso Asociado<\/span><\/label><label id=\"forminator-field-checkbox-2-2-6723188e7ef7b-label\" for=\"forminator-field-checkbox-2-2-6723188e7ef7b\" class=\"forminator-checkbox\" title=\"Actualizacion\"><input type=\"checkbox\" name=\"checkbox-2[]\" value=\"two\" id=\"forminator-field-checkbox-2-2-6723188e7ef7b\" aria-labelledby=\"forminator-field-checkbox-2-2-6723188e7ef7b-label\" data-calculation=\"0\"  \/><span class=\"forminator-checkbox-box\" aria-hidden=\"true\"><\/span><span class=\"forminator-checkbox-label\">Actualizacion<\/span><\/label><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"html-2\" class=\"forminator-field-html forminator-col forminator-col-12 \"><div class=\"forminator-field forminator-merge-tags\" data-field=\"html-2\"><div align=\"center\"><p><strong>A. PERSONAS NATURALES<\/strong><\/p><\/div><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"name-1\" class=\"forminator-field-name forminator-col forminator-col-4 \"><div class=\"forminator-field\"><label for=\"forminator-field-name-1_6723188e7ef7b\" id=\"forminator-field-name-1_6723188e7ef7b-label\" class=\"forminator-label\">Nombre Completo<\/label><input type=\"text\" name=\"name-1\" value=\"\" placeholder=\"Ejemplo: Juan P\u00e9rez\" id=\"forminator-field-name-1_6723188e7ef7b\" class=\"forminator-input forminator-name--field\" aria-required=\"false\" \/><\/div><\/div><div id=\"checkbox-3\" class=\"forminator-field-checkbox forminator-col forminator-col-4 \"><div role=\"group\" class=\"forminator-field\" aria-labelledby=\"forminator-checkbox-group-6723188e7ef7b-label\"><span id=\"forminator-checkbox-group-6723188e7ef7b-label\" class=\"forminator-label\">Tipo de Indentificaci\u00f3n<\/span><label id=\"forminator-field-checkbox-3-1-6723188e7ef7b-label\" for=\"forminator-field-checkbox-3-1-6723188e7ef7b\" class=\"forminator-checkbox forminator-checkbox-inline\" title=\"C.C\"><input type=\"checkbox\" name=\"checkbox-3[]\" value=\"one\" id=\"forminator-field-checkbox-3-1-6723188e7ef7b\" aria-labelledby=\"forminator-field-checkbox-3-1-6723188e7ef7b-label\" data-calculation=\"0\"  \/><span class=\"forminator-checkbox-box\" aria-hidden=\"true\"><\/span><span class=\"forminator-checkbox-label\">C.C<\/span><\/label><label id=\"forminator-field-checkbox-3-2-6723188e7ef7b-label\" for=\"forminator-field-checkbox-3-2-6723188e7ef7b\" class=\"forminator-checkbox forminator-checkbox-inline\" title=\"C.E\"><input type=\"checkbox\" name=\"checkbox-3[]\" value=\"two\" id=\"forminator-field-checkbox-3-2-6723188e7ef7b\" aria-labelledby=\"forminator-field-checkbox-3-2-6723188e7ef7b-label\" data-calculation=\"0\"  \/><span class=\"forminator-checkbox-box\" aria-hidden=\"true\"><\/span><span class=\"forminator-checkbox-label\">C.E<\/span><\/label><label id=\"forminator-field-checkbox-3-3-6723188e7ef7b-label\" for=\"forminator-field-checkbox-3-3-6723188e7ef7b\" class=\"forminator-checkbox forminator-checkbox-inline\" title=\"T.E\"><input type=\"checkbox\" name=\"checkbox-3[]\" value=\"TE\" id=\"forminator-field-checkbox-3-3-6723188e7ef7b\" aria-labelledby=\"forminator-field-checkbox-3-3-6723188e7ef7b-label\" data-calculation=\"0\"  \/><span class=\"forminator-checkbox-box\" aria-hidden=\"true\"><\/span><span class=\"forminator-checkbox-label\">T.E<\/span><\/label><\/div><\/div><div id=\"text-17\" class=\"forminator-field-text forminator-col forminator-col-4 \"><div class=\"forminator-field\"><label for=\"forminator-field-text-17_6723188e7ef7b\" id=\"forminator-field-text-17_6723188e7ef7b-label\" class=\"forminator-label\">No. Identificaci\u00f3n <span class=\"forminator-required\">*<\/span><\/label><input type=\"text\" name=\"text-17\" value=\"\" placeholder=\"CC | CE | TE\" id=\"forminator-field-text-17_6723188e7ef7b\" class=\"forminator-input forminator-name--field\" data-required=\"1\" \/><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"date-2\" class=\"forminator-field-date forminator-col forminator-col-3 \"><div class=\"forminator-field\"><label for=\"forminator-field-date-2-picker_6723188e7ef7b\" id=\"forminator-field-date-2-picker_6723188e7ef7b-label\" class=\"forminator-label\">Fecha de Expedici\u00f3n <span class=\"forminator-required\">*<\/span><\/label><div class=\"forminator-input-with-icon\"><label for=\"forminator-field-date-2-picker_6723188e7ef7b\"><span class=\"forminator-icon-calendar\" aria-hidden=\"true\"><\/span><\/label><input autocomplete=\"off\" type=\"text\" size=\"1\" name=\"date-2\" value=\"\" placeholder=\"Elegir fecha\" id=\"forminator-field-date-2-picker_6723188e7ef7b\" class=\"forminator-input forminator-datepicker\" data-required=\"1\" data-format=\"dd-mm-yy\" data-restrict-type=\"\" data-restrict=\"\" data-start-year=\"1924\" data-end-year=\"2124\" data-past-dates=\"enable\" data-start-of-week=\"1\" data-start-date=\"\" data-end-date=\"\" data-start-field=\"\" data-end-field=\"\" data-start-offset=\"\" data-end-offset=\"\" data-disable-date=\"\" data-disable-range=\"\" \/><\/div><\/div><\/div><div id=\"text-1\" class=\"forminator-field-text forminator-col forminator-col-3 \"><div class=\"forminator-field\"><label for=\"forminator-field-text-1_6723188e7ef7b\" id=\"forminator-field-text-1_6723188e7ef7b-label\" class=\"forminator-label\">Ciudad de Expedicion<\/label><input type=\"text\" name=\"text-1\" value=\"\" placeholder=\"\" id=\"forminator-field-text-1_6723188e7ef7b\" class=\"forminator-input forminator-name--field\" data-required=\"\" \/><\/div><\/div><div id=\"select-1\" class=\"forminator-field-select forminator-col forminator-col-3 \"><div class=\"forminator-field\"><label for=\"forminator-form-4545__field--select-1_6723188e7ef7b\" id=\"forminator-form-4545__field--select-1_6723188e7ef7b-label\" class=\"forminator-label\">Departamento de Expedici\u00f3n<\/label><select  id=\"forminator-form-4545__field--select-1_6723188e7ef7b\" class=\"forminator-select--field forminator-select2 forminator-select2-multiple\" data-required=\"\" name=\"select-1\" data-default-value=\"\" data-placeholder=\"Seleccionar\" data-search=\"false\" data-search-placeholder=\"Seleccionar\" data-checkbox=\"false\" data-allow-clear=\"false\" aria-labelledby=\"forminator-form-4545__field--select-1_6723188e7ef7b-label\"><option value=\"\"  >Seleccionar<\/option><option value=\"one\"  data-calculation=\"0\">Amazonas<\/option><option value=\"two\"  data-calculation=\"0\">Antioquia<\/option><option value=\"Arauca\"  data-calculation=\"0\">Arauca<\/option><option value=\"Atl\u00e1ntico\"  data-calculation=\"0\">Atl\u00e1ntico<\/option><option value=\"Bol\u00edvar\"  data-calculation=\"0\">Bol\u00edvar<\/option><option value=\"Boyac\u00e1\"  data-calculation=\"0\">Boyac\u00e1<\/option><option value=\"Caldas\"  data-calculation=\"0\">Caldas<\/option><option value=\"Caquet\u00e1\"  data-calculation=\"0\">Caquet\u00e1<\/option><option value=\"Casanare\"  data-calculation=\"0\">Casanare<\/option><option value=\"Cauca\"  data-calculation=\"0\">Cauca<\/option><option value=\"Cesar\"  data-calculation=\"0\">Cesar<\/option><option value=\"Choc\u00f3\"  data-calculation=\"0\">Choc\u00f3<\/option><option value=\"C\u00f3rdoba\"  data-calculation=\"0\">C\u00f3rdoba<\/option><option value=\"Cundinamarca\"  data-calculation=\"0\">Cundinamarca<\/option><option value=\"Guain\u00eda\"  data-calculation=\"0\">Guain\u00eda<\/option><option value=\"Guaviare\"  data-calculation=\"0\">Guaviare<\/option><option value=\"Huila\"  data-calculation=\"0\">Huila<\/option><option value=\"La-Guajira\"  data-calculation=\"0\">La Guajira<\/option><option value=\"Magdalena\"  data-calculation=\"0\">Magdalena<\/option><option value=\"Meta\"  data-calculation=\"0\">Meta<\/option><option value=\"Nari\u00f1o\"  data-calculation=\"0\">Nari\u00f1o<\/option><option value=\"Norte-de-Santander\"  data-calculation=\"0\">Norte de Santander<\/option><option value=\"Putumayo\"  data-calculation=\"0\">Putumayo<\/option><option value=\"Quind\u00edo\"  data-calculation=\"0\">Quind\u00edo<\/option><option value=\"Risaralda\"  data-calculation=\"0\">Risaralda<\/option><option value=\"San-Andr\u00e9s-y-Providencia\"  data-calculation=\"0\">San Andr\u00e9s y Providencia<\/option><option value=\"Santander\"  data-calculation=\"0\">Santander<\/option><option value=\"Sucre\"  data-calculation=\"0\">Sucre<\/option><option value=\"Tolima\"  data-calculation=\"0\">Tolima<\/option><option value=\"Valle-del-Cauca\"  data-calculation=\"0\">Valle del Cauca<\/option><option value=\"Vaup\u00e9s\"  data-calculation=\"0\">Vaup\u00e9s<\/option><option value=\"Vichada\"  data-calculation=\"0\">Vichada<\/option><\/select><\/div><\/div><div id=\"email-1\" class=\"forminator-field-email forminator-col forminator-col-3 \"><div class=\"forminator-field\"><label for=\"forminator-field-email-1_6723188e7ef7b\" id=\"forminator-field-email-1_6723188e7ef7b-label\" class=\"forminator-label\">Correo electr\u00f3nico <span class=\"forminator-required\">*<\/span><\/label><input type=\"email\" name=\"email-1\" value=\"\" placeholder=\"Ejemplo: juan@gmail.com\" id=\"forminator-field-email-1_6723188e7ef7b\" class=\"forminator-input forminator-email--field\" data-required=\"1\" aria-required=\"true\" \/><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"date-3\" class=\"forminator-field-date forminator-col forminator-col-3 \"><div class=\"forminator-field\"><label for=\"forminator-field-date-3-picker_6723188e7ef7b\" id=\"forminator-field-date-3-picker_6723188e7ef7b-label\" class=\"forminator-label\">Fecha de Nacimiento <span class=\"forminator-required\">*<\/span><\/label><div class=\"forminator-input-with-icon\"><label for=\"forminator-field-date-3-picker_6723188e7ef7b\"><span class=\"forminator-icon-calendar\" aria-hidden=\"true\"><\/span><\/label><input autocomplete=\"off\" type=\"text\" size=\"1\" name=\"date-3\" value=\"\" placeholder=\"Elegir fecha\" id=\"forminator-field-date-3-picker_6723188e7ef7b\" class=\"forminator-input forminator-datepicker\" data-required=\"1\" data-format=\"dd-mm-yy\" data-restrict-type=\"\" data-restrict=\"\" data-start-year=\"1924\" data-end-year=\"2124\" data-past-dates=\"enable\" data-start-of-week=\"1\" data-start-date=\"\" data-end-date=\"\" data-start-field=\"\" data-end-field=\"\" data-start-offset=\"\" data-end-offset=\"\" data-disable-date=\"\" data-disable-range=\"\" \/><\/div><\/div><\/div><div id=\"text-2\" class=\"forminator-field-text forminator-col forminator-col-3 \"><div class=\"forminator-field\"><label for=\"forminator-field-text-2_6723188e7ef7b\" id=\"forminator-field-text-2_6723188e7ef7b-label\" class=\"forminator-label\">Ciudad de Nacimiento<\/label><input type=\"text\" name=\"text-2\" value=\"\" placeholder=\"\" id=\"forminator-field-text-2_6723188e7ef7b\" class=\"forminator-input forminator-name--field\" data-required=\"\" \/><\/div><\/div><div id=\"select-2\" class=\"forminator-field-select forminator-col forminator-col-3 \"><div class=\"forminator-field\"><label for=\"forminator-form-4545__field--select-2_6723188e7ef7b\" id=\"forminator-form-4545__field--select-2_6723188e7ef7b-label\" class=\"forminator-label\">Departamento de Nacimiento<\/label><select  id=\"forminator-form-4545__field--select-2_6723188e7ef7b\" class=\"forminator-select--field forminator-select2 forminator-select2-multiple\" data-required=\"\" name=\"select-2\" data-default-value=\"\" data-placeholder=\"Seleccionar\" data-search=\"false\" data-search-placeholder=\"Seleccionar\" data-checkbox=\"false\" data-allow-clear=\"false\" aria-labelledby=\"forminator-form-4545__field--select-2_6723188e7ef7b-label\"><option value=\"\"  >Seleccionar<\/option><option value=\"one\"  data-calculation=\"0\">Amazonas<\/option><option value=\"two\"  data-calculation=\"0\">Antioquia<\/option><option value=\"Arauca\"  data-calculation=\"0\">Arauca<\/option><option value=\"Atl\u00e1ntico\"  data-calculation=\"0\">Atl\u00e1ntico<\/option><option value=\"Bol\u00edvar\"  data-calculation=\"0\">Bol\u00edvar<\/option><option value=\"Boyac\u00e1\"  data-calculation=\"0\">Boyac\u00e1<\/option><option value=\"Caldas\"  data-calculation=\"0\">Caldas<\/option><option value=\"Caquet\u00e1\"  data-calculation=\"0\">Caquet\u00e1<\/option><option value=\"Casanare\"  data-calculation=\"0\">Casanare<\/option><option value=\"Cauca\"  data-calculation=\"0\">Cauca<\/option><option value=\"Cesar\"  data-calculation=\"0\">Cesar<\/option><option value=\"Choc\u00f3\"  data-calculation=\"0\">Choc\u00f3<\/option><option value=\"C\u00f3rdoba\"  data-calculation=\"0\">C\u00f3rdoba<\/option><option value=\"Cundinamarca\"  data-calculation=\"0\">Cundinamarca<\/option><option value=\"Guain\u00eda\"  data-calculation=\"0\">Guain\u00eda<\/option><option value=\"Guaviare\"  data-calculation=\"0\">Guaviare<\/option><option value=\"Huila\"  data-calculation=\"0\">Huila<\/option><option value=\"La-Guajira\"  data-calculation=\"0\">La Guajira<\/option><option value=\"Magdalena\"  data-calculation=\"0\">Magdalena<\/option><option value=\"Meta\"  data-calculation=\"0\">Meta<\/option><option value=\"Nari\u00f1o\"  data-calculation=\"0\">Nari\u00f1o<\/option><option value=\"Norte-de-Santander\"  data-calculation=\"0\">Norte de Santander<\/option><option value=\"Putumayo\"  data-calculation=\"0\">Putumayo<\/option><option value=\"Quind\u00edo\"  data-calculation=\"0\">Quind\u00edo<\/option><option value=\"Risaralda\"  data-calculation=\"0\">Risaralda<\/option><option value=\"San-Andr\u00e9s-y-Providencia\"  data-calculation=\"0\">San Andr\u00e9s y Providencia<\/option><option value=\"Santander\"  data-calculation=\"0\">Santander<\/option><option value=\"Sucre\"  data-calculation=\"0\">Sucre<\/option><option value=\"Tolima\"  data-calculation=\"0\">Tolima<\/option><option value=\"Valle-del-Cauca\"  data-calculation=\"0\">Valle del Cauca<\/option><option value=\"Vaup\u00e9s\"  data-calculation=\"0\">Vaup\u00e9s<\/option><option value=\"Vichada\"  data-calculation=\"0\">Vichada<\/option><\/select><\/div><\/div><div id=\"select-3\" class=\"forminator-field-select forminator-col forminator-col-3 \"><div class=\"forminator-field\"><label for=\"forminator-form-4545__field--select-3_6723188e7ef7b\" id=\"forminator-form-4545__field--select-3_6723188e7ef7b-label\" class=\"forminator-label\">Estado Civil<\/label><select  id=\"forminator-form-4545__field--select-3_6723188e7ef7b\" class=\"forminator-select--field forminator-select2 forminator-select2-multiple\" data-required=\"\" name=\"select-3\" data-default-value=\"\" data-placeholder=\"Seleccionar\" data-search=\"false\" data-search-placeholder=\"Seleccionar\" data-checkbox=\"false\" data-allow-clear=\"false\" aria-labelledby=\"forminator-form-4545__field--select-3_6723188e7ef7b-label\"><option value=\"\"  >Seleccionar<\/option><option value=\"one\"  data-calculation=\"0\">Soltero(a)<\/option><option value=\"two\"  data-calculation=\"0\">Casado(a)<\/option><option value=\"Union-Libre\"  data-calculation=\"0\">Uni\u00f3n Libre<\/option><\/select><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"text-3\" class=\"forminator-field-text forminator-col forminator-col-3 \"><div class=\"forminator-field\"><label for=\"forminator-field-text-3_6723188e7ef7b\" id=\"forminator-field-text-3_6723188e7ef7b-label\" class=\"forminator-label\">Direcci\u00f3n domicilio<\/label><input type=\"text\" name=\"text-3\" value=\"\" placeholder=\"\" id=\"forminator-field-text-3_6723188e7ef7b\" class=\"forminator-input forminator-name--field\" data-required=\"\" \/><\/div><\/div><div id=\"select-4\" class=\"forminator-field-select forminator-col forminator-col-3 \"><div class=\"forminator-field\"><label for=\"forminator-form-4545__field--select-4_6723188e7ef7b\" id=\"forminator-form-4545__field--select-4_6723188e7ef7b-label\" class=\"forminator-label\">Departamento<\/label><select  id=\"forminator-form-4545__field--select-4_6723188e7ef7b\" class=\"forminator-select--field forminator-select2 forminator-select2-multiple\" data-required=\"\" name=\"select-4\" data-default-value=\"\" data-placeholder=\"Seleccionar\" data-search=\"false\" data-search-placeholder=\"Seleccionar\" data-checkbox=\"false\" data-allow-clear=\"false\" aria-labelledby=\"forminator-form-4545__field--select-4_6723188e7ef7b-label\"><option value=\"\"  >Seleccionar<\/option><option value=\"one\"  data-calculation=\"0\">Amazonas<\/option><option value=\"two\"  data-calculation=\"0\">Antioquia<\/option><option value=\"Arauca\"  data-calculation=\"0\">Arauca<\/option><option value=\"Atl\u00e1ntico\"  data-calculation=\"0\">Atl\u00e1ntico<\/option><option value=\"Bol\u00edvar\"  data-calculation=\"0\">Bol\u00edvar<\/option><option value=\"Boyac\u00e1\"  data-calculation=\"0\">Boyac\u00e1<\/option><option value=\"Caldas\"  data-calculation=\"0\">Caldas<\/option><option value=\"Caquet\u00e1\"  data-calculation=\"0\">Caquet\u00e1<\/option><option value=\"Casanare\"  data-calculation=\"0\">Casanare<\/option><option value=\"Cauca\"  data-calculation=\"0\">Cauca<\/option><option value=\"Cesar\"  data-calculation=\"0\">Cesar<\/option><option value=\"Choc\u00f3\"  data-calculation=\"0\">Choc\u00f3<\/option><option value=\"C\u00f3rdoba\"  data-calculation=\"0\">C\u00f3rdoba<\/option><option value=\"Cundinamarca\"  data-calculation=\"0\">Cundinamarca<\/option><option value=\"Guain\u00eda\"  data-calculation=\"0\">Guain\u00eda<\/option><option value=\"Guaviare\"  data-calculation=\"0\">Guaviare<\/option><option value=\"Huila\"  data-calculation=\"0\">Huila<\/option><option value=\"La-Guajira\"  data-calculation=\"0\">La Guajira<\/option><option value=\"Magdalena\"  data-calculation=\"0\">Magdalena<\/option><option value=\"Meta\"  data-calculation=\"0\">Meta<\/option><option value=\"Nari\u00f1o\"  data-calculation=\"0\">Nari\u00f1o<\/option><option value=\"Norte-de-Santander\"  data-calculation=\"0\">Norte de Santander<\/option><option value=\"Putumayo\"  data-calculation=\"0\">Putumayo<\/option><option value=\"Quind\u00edo\"  data-calculation=\"0\">Quind\u00edo<\/option><option value=\"Risaralda\"  data-calculation=\"0\">Risaralda<\/option><option value=\"San-Andr\u00e9s-y-Providencia\"  data-calculation=\"0\">San Andr\u00e9s y Providencia<\/option><option value=\"Santander\"  data-calculation=\"0\">Santander<\/option><option value=\"Sucre\"  data-calculation=\"0\">Sucre<\/option><option value=\"Tolima\"  data-calculation=\"0\">Tolima<\/option><option value=\"Valle-del-Cauca\"  data-calculation=\"0\">Valle del Cauca<\/option><option value=\"Vaup\u00e9s\"  data-calculation=\"0\">Vaup\u00e9s<\/option><option value=\"Vichada\"  data-calculation=\"0\">Vichada<\/option><\/select><\/div><\/div><div id=\"text-4\" class=\"forminator-field-text forminator-col forminator-col-3 \"><div class=\"forminator-field\"><label for=\"forminator-field-text-4_6723188e7ef7b\" id=\"forminator-field-text-4_6723188e7ef7b-label\" class=\"forminator-label\">Municipio<\/label><input type=\"text\" name=\"text-4\" value=\"\" placeholder=\"\" id=\"forminator-field-text-4_6723188e7ef7b\" class=\"forminator-input forminator-name--field\" data-required=\"\" \/><\/div><\/div><div id=\"radio-1\" class=\"forminator-field-radio forminator-col forminator-col-3 \"><div role=\"radiogroup\" class=\"forminator-field\" aria-labelledby=\"forminator-radiogroup-6723188e7ef7b-label\"><span id=\"forminator-radiogroup-6723188e7ef7b-label\" class=\"forminator-label\">Sexo <span class=\"forminator-required\">*<\/span><\/span><label id=\"forminator-field-radio-1-label-1\" for=\"forminator-field-radio-1-1-6723188e7ef7b\" class=\"forminator-radio forminator-radio-inline\" title=\"Hombre\"><input type=\"radio\" name=\"radio-1\" value=\"one\" id=\"forminator-field-radio-1-1-6723188e7ef7b\" aria-labelledby=\"forminator-field-radio-1-label-1\" data-calculation=\"0\"  \/><span class=\"forminator-radio-bullet\" aria-hidden=\"true\"><\/span><span class=\"forminator-radio-label\">Hombre<\/span><\/label><label id=\"forminator-field-radio-1-label-2\" for=\"forminator-field-radio-1-2-6723188e7ef7b\" class=\"forminator-radio forminator-radio-inline\" title=\"Mujer\"><input type=\"radio\" name=\"radio-1\" value=\"two\" id=\"forminator-field-radio-1-2-6723188e7ef7b\" aria-labelledby=\"forminator-field-radio-1-label-2\" data-calculation=\"0\"  \/><span class=\"forminator-radio-bullet\" aria-hidden=\"true\"><\/span><span class=\"forminator-radio-label\">Mujer<\/span><\/label><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"phone-1\" class=\"forminator-field-phone forminator-col forminator-col-6 \"><div class=\"forminator-field\"><label for=\"forminator-field-phone-1_6723188e7ef7b\" id=\"forminator-field-phone-1_6723188e7ef7b-label\" class=\"forminator-label\">Celular <span class=\"forminator-required\">*<\/span><\/label><input type=\"text\" name=\"phone-1\" value=\"\" placeholder=\"Ejemplo: 300 400 5000\" id=\"forminator-field-phone-1_6723188e7ef7b\" class=\"forminator-input forminator-field--phone\" data-required=\"1\" aria-required=\"true\" autocomplete=\"off\" maxlength=\"10\" data-validation=\"character_limit\" \/><span id=\"forminator-field-phone-1_6723188e7ef7b-description\" class=\"forminator-description\" id=\"forminator-field-phone-1_6723188e7ef7b-description\"><span data-limit=\"10\" data-type=\"\">0 \/ 10<\/span><\/span><\/div><\/div><div id=\"phone-2\" class=\"forminator-field-phone forminator-col forminator-col-6 \"><div class=\"forminator-field\"><label for=\"forminator-field-phone-2_6723188e7ef7b\" id=\"forminator-field-phone-2_6723188e7ef7b-label\" class=\"forminator-label\">Tel\u00e9fono<\/label><input type=\"text\" name=\"phone-2\" value=\"\" placeholder=\"Ejemplo: 999 99 99\" id=\"forminator-field-phone-2_6723188e7ef7b\" class=\"forminator-input forminator-field--phone\" data-required=\"\" aria-required=\"false\" autocomplete=\"off\" maxlength=\"10\" data-validation=\"character_limit\" \/><span id=\"forminator-field-phone-2_6723188e7ef7b-description\" class=\"forminator-description\" id=\"forminator-field-phone-2_6723188e7ef7b-description\"><span data-limit=\"10\" data-type=\"\">0 \/ 10<\/span><\/span><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"select-5\" class=\"forminator-field-select forminator-col forminator-col-3 \"><div class=\"forminator-field\"><label for=\"forminator-form-4545__field--select-5_6723188e7ef7b\" id=\"forminator-form-4545__field--select-5_6723188e7ef7b-label\" class=\"forminator-label\">Tipo de Vivienda<\/label><select  id=\"forminator-form-4545__field--select-5_6723188e7ef7b\" class=\"forminator-select--field forminator-select2 forminator-select2-multiple\" data-required=\"\" name=\"select-5\" data-default-value=\"\" data-placeholder=\"Seleccionar\" data-search=\"false\" data-search-placeholder=\"Seleccionar\" data-checkbox=\"false\" data-allow-clear=\"false\" aria-labelledby=\"forminator-form-4545__field--select-5_6723188e7ef7b-label\"><option value=\"\"  >Seleccionar<\/option><option value=\"one\"  data-calculation=\"0\">Propia<\/option><option value=\"two\"  data-calculation=\"0\">Alquilada<\/option><option value=\"Un-solo-ambiente\"  data-calculation=\"0\">Familiar<\/option><\/select><\/div><\/div><div id=\"select-6\" class=\"forminator-field-select forminator-col forminator-col-3 \"><div class=\"forminator-field\"><label for=\"forminator-form-4545__field--select-6_6723188e7ef7b\" id=\"forminator-form-4545__field--select-6_6723188e7ef7b-label\" class=\"forminator-label\">Nivel Acad\u00e9mico<\/label><select  id=\"forminator-form-4545__field--select-6_6723188e7ef7b\" class=\"forminator-select--field forminator-select2 forminator-select2-multiple\" data-required=\"\" name=\"select-6\" data-default-value=\"\" data-placeholder=\"Seleccionar\" data-search=\"false\" data-search-placeholder=\"Seleccionar\" data-checkbox=\"false\" data-allow-clear=\"false\" aria-labelledby=\"forminator-form-4545__field--select-6_6723188e7ef7b-label\"><option value=\"\"  >Seleccionar<\/option><option value=\"one\"  data-calculation=\"0\">Primaria<\/option><option value=\"two\"  data-calculation=\"0\">Bachillerato<\/option><option value=\"Un-solo-ambiente\"  data-calculation=\"0\">T\u00e9cnico Profesional<\/option><option value=\"Tecnol\u00f3gica\"  data-calculation=\"0\">Tecnol\u00f3gica<\/option><option value=\"Profesional\"  data-calculation=\"0\">Profesional<\/option><option value=\"Especializaci\u00f3n\"  data-calculation=\"0\">Especializaci\u00f3n<\/option><option value=\"Maestr\u00eda\"  data-calculation=\"0\">Maestr\u00eda<\/option><option value=\"Doctorado\"  data-calculation=\"0\">Doctorado<\/option><\/select><\/div><\/div><div id=\"text-5\" class=\"forminator-field-text forminator-col forminator-col-3 \"><div class=\"forminator-field\"><label for=\"forminator-field-text-5_6723188e7ef7b\" id=\"forminator-field-text-5_6723188e7ef7b-label\" class=\"forminator-label\">Profesi\u00f3n, Ocupaci\u00f3n u Oficio<\/label><input type=\"text\" name=\"text-5\" value=\"\" placeholder=\"\" id=\"forminator-field-text-5_6723188e7ef7b\" class=\"forminator-input forminator-name--field\" data-required=\"\" \/><\/div><\/div><div id=\"radio-2\" class=\"forminator-field-radio forminator-col forminator-col-3 \"><div role=\"radiogroup\" class=\"forminator-field\" aria-labelledby=\"forminator-radiogroup-6723188e7ef7b-label\"><span id=\"forminator-radiogroup-6723188e7ef7b-label\" class=\"forminator-label\">Declara Renta<\/span><label id=\"forminator-field-radio-2-label-1\" for=\"forminator-field-radio-2-1-6723188e7ef7b\" class=\"forminator-radio forminator-radio-inline\" title=\"Si\"><input type=\"radio\" name=\"radio-2\" value=\"one\" id=\"forminator-field-radio-2-1-6723188e7ef7b\" aria-labelledby=\"forminator-field-radio-2-label-1\" data-calculation=\"0\"  \/><span class=\"forminator-radio-bullet\" aria-hidden=\"true\"><\/span><span class=\"forminator-radio-label\">Si<\/span><\/label><label id=\"forminator-field-radio-2-label-2\" for=\"forminator-field-radio-2-2-6723188e7ef7b\" class=\"forminator-radio forminator-radio-inline\" title=\"No\"><input type=\"radio\" name=\"radio-2\" value=\"two\" id=\"forminator-field-radio-2-2-6723188e7ef7b\" aria-labelledby=\"forminator-field-radio-2-label-2\" data-calculation=\"0\"  \/><span class=\"forminator-radio-bullet\" aria-hidden=\"true\"><\/span><span class=\"forminator-radio-label\">No<\/span><\/label><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"text-6\" class=\"forminator-field-text forminator-col forminator-col-3 \"><div class=\"forminator-field\"><label for=\"forminator-field-text-6_6723188e7ef7b\" id=\"forminator-field-text-6_6723188e7ef7b-label\" class=\"forminator-label\">Nombre de la empresa donde labora<\/label><input type=\"text\" name=\"text-6\" value=\"\" placeholder=\"\" id=\"forminator-field-text-6_6723188e7ef7b\" class=\"forminator-input forminator-name--field\" data-required=\"\" \/><\/div><\/div><div id=\"text-7\" class=\"forminator-field-text forminator-col forminator-col-3 \"><div class=\"forminator-field\"><label for=\"forminator-field-text-7_6723188e7ef7b\" id=\"forminator-field-text-7_6723188e7ef7b-label\" class=\"forminator-label\">Direcci\u00f3n del Trabajo<\/label><input type=\"text\" name=\"text-7\" value=\"\" placeholder=\"\" id=\"forminator-field-text-7_6723188e7ef7b\" class=\"forminator-input forminator-name--field\" data-required=\"\" \/><\/div><\/div><div id=\"select-7\" class=\"forminator-field-select forminator-col forminator-col-3 \"><div class=\"forminator-field\"><label for=\"forminator-form-4545__field--select-7_6723188e7ef7b\" id=\"forminator-form-4545__field--select-7_6723188e7ef7b-label\" class=\"forminator-label\">Departamento<\/label><select  id=\"forminator-form-4545__field--select-7_6723188e7ef7b\" class=\"forminator-select--field forminator-select2 forminator-select2-multiple\" data-required=\"\" name=\"select-7\" data-default-value=\"\" data-placeholder=\"Seleccionar\" data-search=\"false\" data-search-placeholder=\"Seleccionar\" data-checkbox=\"false\" data-allow-clear=\"false\" aria-labelledby=\"forminator-form-4545__field--select-7_6723188e7ef7b-label\"><option value=\"\"  >Seleccionar<\/option><option value=\"one\"  data-calculation=\"0\">Amazonas<\/option><option value=\"two\"  data-calculation=\"0\">Antioquia<\/option><option value=\"Arauca\"  data-calculation=\"0\">Arauca<\/option><option value=\"Atl\u00e1ntico\"  data-calculation=\"0\">Atl\u00e1ntico<\/option><option value=\"Bol\u00edvar\"  data-calculation=\"0\">Bol\u00edvar<\/option><option value=\"Boyac\u00e1\"  data-calculation=\"0\">Boyac\u00e1<\/option><option value=\"Caldas\"  data-calculation=\"0\">Caldas<\/option><option value=\"Caquet\u00e1\"  data-calculation=\"0\">Caquet\u00e1<\/option><option value=\"Casanare\"  data-calculation=\"0\">Casanare<\/option><option value=\"Cauca\"  data-calculation=\"0\">Cauca<\/option><option value=\"Cesar\"  data-calculation=\"0\">Cesar<\/option><option value=\"Choc\u00f3\"  data-calculation=\"0\">Choc\u00f3<\/option><option value=\"C\u00f3rdoba\"  data-calculation=\"0\">C\u00f3rdoba<\/option><option value=\"Cundinamarca\"  data-calculation=\"0\">Cundinamarca<\/option><option value=\"Guain\u00eda\"  data-calculation=\"0\">Guain\u00eda<\/option><option value=\"Guaviare\"  data-calculation=\"0\">Guaviare<\/option><option value=\"Huila\"  data-calculation=\"0\">Huila<\/option><option value=\"La-Guajira\"  data-calculation=\"0\">La Guajira<\/option><option value=\"Magdalena\"  data-calculation=\"0\">Magdalena<\/option><option value=\"Meta\"  data-calculation=\"0\">Meta<\/option><option value=\"Nari\u00f1o\"  data-calculation=\"0\">Nari\u00f1o<\/option><option value=\"Norte-de-Santander\"  data-calculation=\"0\">Norte de Santander<\/option><option value=\"Putumayo\"  data-calculation=\"0\">Putumayo<\/option><option value=\"Quind\u00edo\"  data-calculation=\"0\">Quind\u00edo<\/option><option value=\"Risaralda\"  data-calculation=\"0\">Risaralda<\/option><option value=\"San-Andr\u00e9s-y-Providencia\"  data-calculation=\"0\">San Andr\u00e9s y Providencia<\/option><option value=\"Santander\"  data-calculation=\"0\">Santander<\/option><option value=\"Sucre\"  data-calculation=\"0\">Sucre<\/option><option value=\"Tolima\"  data-calculation=\"0\">Tolima<\/option><option value=\"Valle-del-Cauca\"  data-calculation=\"0\">Valle del Cauca<\/option><option value=\"Vaup\u00e9s\"  data-calculation=\"0\">Vaup\u00e9s<\/option><option value=\"Vichada\"  data-calculation=\"0\">Vichada<\/option><\/select><\/div><\/div><div id=\"text-8\" class=\"forminator-field-text forminator-col forminator-col-3 \"><div class=\"forminator-field\"><label for=\"forminator-field-text-8_6723188e7ef7b\" id=\"forminator-field-text-8_6723188e7ef7b-label\" class=\"forminator-label\">Municipio<\/label><input type=\"text\" name=\"text-8\" value=\"\" placeholder=\"\" id=\"forminator-field-text-8_6723188e7ef7b\" class=\"forminator-input forminator-name--field\" data-required=\"\" \/><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"text-9\" class=\"forminator-field-text forminator-col forminator-col-6 \"><div class=\"forminator-field\"><label for=\"forminator-field-text-9_6723188e7ef7b\" id=\"forminator-field-text-9_6723188e7ef7b-label\" class=\"forminator-label\">Cargo que desempe\u00f1a<\/label><input type=\"text\" name=\"text-9\" value=\"\" placeholder=\"\" id=\"forminator-field-text-9_6723188e7ef7b\" class=\"forminator-input forminator-name--field\" data-required=\"\" \/><\/div><\/div><div id=\"phone-3\" class=\"forminator-field-phone forminator-col forminator-col-6 \"><div class=\"forminator-field\"><label for=\"forminator-field-phone-3_6723188e7ef7b\" id=\"forminator-field-phone-3_6723188e7ef7b-label\" class=\"forminator-label\">Tel\u00e9fono del trabajo<\/label><input type=\"text\" name=\"phone-3\" value=\"\" placeholder=\"Ejemplo: 300 400 5000\" id=\"forminator-field-phone-3_6723188e7ef7b\" class=\"forminator-input forminator-field--phone\" data-required=\"\" aria-required=\"false\" autocomplete=\"off\" maxlength=\"10\" data-validation=\"character_limit\" \/><span id=\"forminator-field-phone-3_6723188e7ef7b-description\" class=\"forminator-description\" id=\"forminator-field-phone-3_6723188e7ef7b-description\"><span data-limit=\"10\" data-type=\"\">0 \/ 10<\/span><\/span><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"radio-5\" class=\"forminator-field-radio forminator-col forminator-col-6 \"><div role=\"radiogroup\" class=\"forminator-field\" aria-labelledby=\"forminator-radiogroup-6723188e7ef7b-label\"><span id=\"forminator-radiogroup-6723188e7ef7b-label\" class=\"forminator-label\">\u00bfPor su actividad u oficio goza usted de reconocimiento publico?<\/span><label id=\"forminator-field-radio-5-label-1\" for=\"forminator-field-radio-5-1-6723188e7ef7b\" class=\"forminator-radio forminator-radio-inline\" title=\"Si\"><input type=\"radio\" name=\"radio-5\" value=\"one\" id=\"forminator-field-radio-5-1-6723188e7ef7b\" aria-labelledby=\"forminator-field-radio-5-label-1\" data-calculation=\"0\"  \/><span class=\"forminator-radio-bullet\" aria-hidden=\"true\"><\/span><span class=\"forminator-radio-label\">Si<\/span><\/label><label id=\"forminator-field-radio-5-label-2\" for=\"forminator-field-radio-5-2-6723188e7ef7b\" class=\"forminator-radio forminator-radio-inline\" title=\"No\"><input type=\"radio\" name=\"radio-5\" value=\"two\" id=\"forminator-field-radio-5-2-6723188e7ef7b\" aria-labelledby=\"forminator-field-radio-5-label-2\" data-calculation=\"0\"  \/><span class=\"forminator-radio-bullet\" aria-hidden=\"true\"><\/span><span class=\"forminator-radio-label\">No<\/span><\/label><\/div><\/div><div id=\"radio-3\" class=\"forminator-field-radio forminator-col forminator-col-6 \"><div role=\"radiogroup\" class=\"forminator-field\" aria-labelledby=\"forminator-radiogroup-6723188e7ef7b-label\"><span id=\"forminator-radiogroup-6723188e7ef7b-label\" class=\"forminator-label\">\u00bfPor su cargo administra recursos p\u00fablicos?<\/span><label id=\"forminator-field-radio-3-label-1\" for=\"forminator-field-radio-3-1-6723188e7ef7b\" class=\"forminator-radio forminator-radio-inline\" title=\"Si\"><input type=\"radio\" name=\"radio-3\" value=\"one\" id=\"forminator-field-radio-3-1-6723188e7ef7b\" aria-labelledby=\"forminator-field-radio-3-label-1\" data-calculation=\"0\"  \/><span class=\"forminator-radio-bullet\" aria-hidden=\"true\"><\/span><span class=\"forminator-radio-label\">Si<\/span><\/label><label id=\"forminator-field-radio-3-label-2\" for=\"forminator-field-radio-3-2-6723188e7ef7b\" class=\"forminator-radio forminator-radio-inline\" title=\"No\"><input type=\"radio\" name=\"radio-3\" value=\"two\" id=\"forminator-field-radio-3-2-6723188e7ef7b\" aria-labelledby=\"forminator-field-radio-3-label-2\" data-calculation=\"0\"  \/><span class=\"forminator-radio-bullet\" aria-hidden=\"true\"><\/span><span class=\"forminator-radio-label\">No<\/span><\/label><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"radio-4\" class=\"forminator-field-radio forminator-col forminator-col-6 \"><div role=\"radiogroup\" class=\"forminator-field\" aria-labelledby=\"forminator-radiogroup-6723188e7ef7b-label\"><span id=\"forminator-radiogroup-6723188e7ef7b-label\" class=\"forminator-label\">\u00bfPor su cargo o actividad ejerce algun grado de poder publico?<\/span><label id=\"forminator-field-radio-4-label-1\" for=\"forminator-field-radio-4-1-6723188e7ef7b\" class=\"forminator-radio forminator-radio-inline\" title=\"Si\"><input type=\"radio\" name=\"radio-4\" value=\"one\" id=\"forminator-field-radio-4-1-6723188e7ef7b\" aria-labelledby=\"forminator-field-radio-4-label-1\" data-calculation=\"0\"  \/><span class=\"forminator-radio-bullet\" aria-hidden=\"true\"><\/span><span class=\"forminator-radio-label\">Si<\/span><\/label><label id=\"forminator-field-radio-4-label-2\" for=\"forminator-field-radio-4-2-6723188e7ef7b\" class=\"forminator-radio forminator-radio-inline\" title=\"No\"><input type=\"radio\" name=\"radio-4\" value=\"two\" id=\"forminator-field-radio-4-2-6723188e7ef7b\" aria-labelledby=\"forminator-field-radio-4-label-2\" data-calculation=\"0\"  \/><span class=\"forminator-radio-bullet\" aria-hidden=\"true\"><\/span><span class=\"forminator-radio-label\">No<\/span><\/label><\/div><\/div><div id=\"radio-6\" class=\"forminator-field-radio forminator-col forminator-col-6 \"><div role=\"radiogroup\" class=\"forminator-field\" aria-labelledby=\"forminator-radiogroup-6723188e7ef7b-label\"><span id=\"forminator-radiogroup-6723188e7ef7b-label\" class=\"forminator-label\">\u00bfExiste algun vinculo entre usted y una Peps?<\/span><label id=\"forminator-field-radio-6-label-1\" for=\"forminator-field-radio-6-1-6723188e7ef7b\" class=\"forminator-radio forminator-radio-inline\" title=\"Si\"><input type=\"radio\" name=\"radio-6\" value=\"one\" id=\"forminator-field-radio-6-1-6723188e7ef7b\" aria-labelledby=\"forminator-field-radio-6-label-1\" data-calculation=\"0\"  \/><span class=\"forminator-radio-bullet\" aria-hidden=\"true\"><\/span><span class=\"forminator-radio-label\">Si<\/span><\/label><label id=\"forminator-field-radio-6-label-2\" for=\"forminator-field-radio-6-2-6723188e7ef7b\" class=\"forminator-radio forminator-radio-inline\" title=\"No\"><input type=\"radio\" name=\"radio-6\" value=\"two\" id=\"forminator-field-radio-6-2-6723188e7ef7b\" aria-labelledby=\"forminator-field-radio-6-label-2\" data-calculation=\"0\"  \/><span class=\"forminator-radio-bullet\" aria-hidden=\"true\"><\/span><span class=\"forminator-radio-label\">No<\/span><\/label><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"number-3\" class=\"forminator-field-number forminator-col forminator-col-4 \"><div class=\"forminator-field\"><label for=\"forminator-field-number-3_6723188e7ef7b\" id=\"forminator-field-number-3_6723188e7ef7b-label\" class=\"forminator-label\">C\u00f3digo Ciiu<\/label><input name=\"number-3\" value=\"\" placeholder=\"\" id=\"forminator-field-number-3_6723188e7ef7b\" class=\"forminator-input forminator-number--field\" inputmode=\"decimal\" data-required=\"\" data-decimals=\"0\" aria-required=\"false\" data-inputmask=\"&#039;groupSeparator&#039;: &#039;&#039;, &#039;radixPoint&#039;: &#039;&#039;, &#039;digits&#039;: &#039;0&#039;\" type=\"number\" step=\"any\" min=\"1\" max=\"99999\" \/><\/div><\/div><div id=\"text-10\" class=\"forminator-field-text forminator-col forminator-col-4 \"><div class=\"forminator-field\"><label for=\"forminator-field-text-10_6723188e7ef7b\" id=\"forminator-field-text-10_6723188e7ef7b-label\" class=\"forminator-label\">Descripcion Actividad Econ\u00f3mica<\/label><input type=\"text\" name=\"text-10\" value=\"\" placeholder=\"\" id=\"forminator-field-text-10_6723188e7ef7b\" class=\"forminator-input forminator-name--field\" data-required=\"\" \/><\/div><\/div><div id=\"number-5\" class=\"forminator-field-number forminator-col forminator-col-4 \"><div class=\"forminator-field\"><label for=\"forminator-field-number-5_6723188e7ef7b\" id=\"forminator-field-number-5_6723188e7ef7b-label\" class=\"forminator-label\">Egresos mensuales<\/label><input name=\"number-5\" value=\"\" placeholder=\"Ejemplo: $ 1.000.000\" id=\"forminator-field-number-5_6723188e7ef7b\" class=\"forminator-input forminator-number--field\" inputmode=\"decimal\" data-required=\"\" data-decimals=\"0\" aria-required=\"false\" data-inputmask=\"&#039;groupSeparator&#039;: &#039;&#039;, &#039;radixPoint&#039;: &#039;&#039;, &#039;digits&#039;: &#039;0&#039;\" type=\"number\" step=\"any\" min=\"1\" max=\"70000000\" \/><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"html-3\" class=\"forminator-field-html forminator-col forminator-col-12 \"><div class=\"forminator-field forminator-merge-tags\" data-field=\"html-3\"><p><strong>INFORMACION FINANCIERA ($)<\/strong><\/p><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"number-4\" class=\"forminator-field-number forminator-col forminator-col-4 \"><div class=\"forminator-field\"><label for=\"forminator-field-number-4_6723188e7ef7b\" id=\"forminator-field-number-4_6723188e7ef7b-label\" class=\"forminator-label\">Ingresos mensuales derivados de su actividad principal<\/label><input name=\"number-4\" value=\"\" placeholder=\"Ejemplo: $ 1.000.000\" id=\"forminator-field-number-4_6723188e7ef7b\" class=\"forminator-input forminator-number--field\" inputmode=\"decimal\" data-required=\"\" data-decimals=\"0\" aria-required=\"false\" data-inputmask=\"&#039;groupSeparator&#039;: &#039;&#039;, &#039;radixPoint&#039;: &#039;&#039;, &#039;digits&#039;: &#039;0&#039;\" type=\"number\" step=\"any\" min=\"1\" max=\"70000000\" aria-describedby=\"forminator-field-number-4_6723188e7ef7b-description\" \/><span id=\"forminator-field-number-4_6723188e7ef7b-description\" class=\"forminator-description\">Ejemplo: $ 1.000.000<\/span><\/div><\/div><div id=\"text-11\" class=\"forminator-field-text forminator-col forminator-col-4 \"><div class=\"forminator-field\"><label for=\"forminator-field-text-11_6723188e7ef7b\" id=\"forminator-field-text-11_6723188e7ef7b-label\" class=\"forminator-label\">Otros ingresos: \u00bfC\u00faales?<\/label><input type=\"text\" name=\"text-11\" value=\"\" placeholder=\"Ejemplo: venta minorista\" id=\"forminator-field-text-11_6723188e7ef7b\" class=\"forminator-input forminator-name--field\" data-required=\"\" \/><\/div><\/div><div id=\"number-8\" class=\"forminator-field-number forminator-col forminator-col-4 \"><div class=\"forminator-field\"><label for=\"forminator-field-number-8_6723188e7ef7b\" id=\"forminator-field-number-8_6723188e7ef7b-label\" class=\"forminator-label\">Monto de otros ingresos<\/label><input name=\"number-8\" value=\"\" placeholder=\"Ejemplo: $100.000\" id=\"forminator-field-number-8_6723188e7ef7b\" class=\"forminator-input forminator-number--field\" inputmode=\"decimal\" data-required=\"\" data-decimals=\"0\" aria-required=\"false\" data-inputmask=\"&#039;groupSeparator&#039;: &#039;&#039;, &#039;radixPoint&#039;: &#039;&#039;, &#039;digits&#039;: &#039;0&#039;\" type=\"number\" step=\"any\" min=\"1\" max=\"10000000\" \/><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"number-6\" class=\"forminator-field-number forminator-col forminator-col-6 \"><div class=\"forminator-field\"><label for=\"forminator-field-number-6_6723188e7ef7b\" id=\"forminator-field-number-6_6723188e7ef7b-label\" class=\"forminator-label\">Total activos<\/label><input name=\"number-6\" value=\"\" placeholder=\"\" id=\"forminator-field-number-6_6723188e7ef7b\" class=\"forminator-input forminator-number--field\" inputmode=\"decimal\" data-required=\"\" data-decimals=\"0\" aria-required=\"false\" data-inputmask=\"&#039;groupSeparator&#039;: &#039;&#039;, &#039;radixPoint&#039;: &#039;&#039;, &#039;digits&#039;: &#039;0&#039;\" type=\"number\" step=\"any\" min=\"1\" max=\"70000000\" \/><\/div><\/div><div id=\"number-7\" class=\"forminator-field-number forminator-col forminator-col-6 \"><div class=\"forminator-field\"><label for=\"forminator-field-number-7_6723188e7ef7b\" id=\"forminator-field-number-7_6723188e7ef7b-label\" class=\"forminator-label\">Total pasivos<\/label><input name=\"number-7\" value=\"\" placeholder=\"\" id=\"forminator-field-number-7_6723188e7ef7b\" class=\"forminator-input forminator-number--field\" inputmode=\"decimal\" data-required=\"\" data-decimals=\"0\" aria-required=\"false\" data-inputmask=\"&#039;groupSeparator&#039;: &#039;&#039;, &#039;radixPoint&#039;: &#039;&#039;, &#039;digits&#039;: &#039;0&#039;\" type=\"number\" step=\"any\" min=\"1\" max=\"70000000\" \/><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"html-4\" class=\"forminator-field-html forminator-col forminator-col-12 \"><div class=\"forminator-field forminator-merge-tags\" data-field=\"html-4\"><div align=\"center\">\n<p>\u00a0<\/p>\n<p><strong>B. OPERACIONES EN MONEDA EXTRANJERA<\/strong><\/p>\n<\/div><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"radio-7\" class=\"forminator-field-radio forminator-col forminator-col-4 \"><div role=\"radiogroup\" class=\"forminator-field\" aria-labelledby=\"forminator-radiogroup-6723188e7ef7b-label\"><span id=\"forminator-radiogroup-6723188e7ef7b-label\" class=\"forminator-label\">\u00bfRealiza operaciones en moneda extranjera?<\/span><label id=\"forminator-field-radio-7-label-1\" for=\"forminator-field-radio-7-1-6723188e7ef7b\" class=\"forminator-radio forminator-radio-inline\" title=\"Si\"><input type=\"radio\" name=\"radio-7\" value=\"one\" id=\"forminator-field-radio-7-1-6723188e7ef7b\" aria-labelledby=\"forminator-field-radio-7-label-1\" data-calculation=\"0\"  \/><span class=\"forminator-radio-bullet\" aria-hidden=\"true\"><\/span><span class=\"forminator-radio-label\">Si<\/span><\/label><label id=\"forminator-field-radio-7-label-2\" for=\"forminator-field-radio-7-2-6723188e7ef7b\" class=\"forminator-radio forminator-radio-inline\" title=\"No\"><input type=\"radio\" name=\"radio-7\" value=\"two\" id=\"forminator-field-radio-7-2-6723188e7ef7b\" aria-labelledby=\"forminator-field-radio-7-label-2\" data-calculation=\"0\"  \/><span class=\"forminator-radio-bullet\" aria-hidden=\"true\"><\/span><span class=\"forminator-radio-label\">No<\/span><\/label><\/div><\/div><div id=\"text-12\" class=\"forminator-field-text forminator-col forminator-col-4 \"><div class=\"forminator-field\"><label for=\"forminator-field-text-12_6723188e7ef7b\" id=\"forminator-field-text-12_6723188e7ef7b-label\" class=\"forminator-label\">\u00bfC\u00faales?<\/label><input type=\"text\" name=\"text-12\" value=\"\" placeholder=\"\" id=\"forminator-field-text-12_6723188e7ef7b\" class=\"forminator-input forminator-name--field\" data-required=\"\" \/><\/div><\/div><div id=\"text-13\" class=\"forminator-field-text forminator-col forminator-col-4 \"><div class=\"forminator-field\"><label for=\"forminator-field-text-13_6723188e7ef7b\" id=\"forminator-field-text-13_6723188e7ef7b-label\" class=\"forminator-label\">Banco<\/label><input type=\"text\" name=\"text-13\" value=\"\" placeholder=\"\" id=\"forminator-field-text-13_6723188e7ef7b\" class=\"forminator-input forminator-name--field\" data-required=\"\" \/><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"text-14\" class=\"forminator-field-text forminator-col forminator-col-3 \"><div class=\"forminator-field\"><label for=\"forminator-field-text-14_6723188e7ef7b\" id=\"forminator-field-text-14_6723188e7ef7b-label\" class=\"forminator-label\">Moneda<\/label><input type=\"text\" name=\"text-14\" value=\"\" placeholder=\"\" id=\"forminator-field-text-14_6723188e7ef7b\" class=\"forminator-input forminator-name--field\" data-required=\"\" \/><\/div><\/div><div id=\"text-15\" class=\"forminator-field-text forminator-col forminator-col-3 \"><div class=\"forminator-field\"><label for=\"forminator-field-text-15_6723188e7ef7b\" id=\"forminator-field-text-15_6723188e7ef7b-label\" class=\"forminator-label\">Ciudad<\/label><input type=\"text\" name=\"text-15\" value=\"\" placeholder=\"\" id=\"forminator-field-text-15_6723188e7ef7b\" class=\"forminator-input forminator-name--field\" data-required=\"\" \/><\/div><\/div><div id=\"text-16\" class=\"forminator-field-text forminator-col forminator-col-3 \"><div class=\"forminator-field\"><label for=\"forminator-field-text-16_6723188e7ef7b\" id=\"forminator-field-text-16_6723188e7ef7b-label\" class=\"forminator-label\">Pa\u00eds<\/label><input type=\"text\" name=\"text-16\" value=\"\" placeholder=\"\" id=\"forminator-field-text-16_6723188e7ef7b\" class=\"forminator-input forminator-name--field\" data-required=\"\" \/><\/div><\/div><div id=\"text-18\" class=\"forminator-field-text forminator-col forminator-col-3 \"><div class=\"forminator-field\"><label for=\"forminator-field-text-18_6723188e7ef7b\" id=\"forminator-field-text-18_6723188e7ef7b-label\" class=\"forminator-label\">No. Cuenta<\/label><input type=\"text\" name=\"text-18\" value=\"\" placeholder=\"\" id=\"forminator-field-text-18_6723188e7ef7b\" class=\"forminator-input forminator-name--field\" data-required=\"\" \/><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"html-5\" class=\"forminator-field-html forminator-col forminator-col-12 \"><div class=\"forminator-field forminator-merge-tags\" data-field=\"html-5\"><p>Declaro que no realizo transacciones en moneda extranjera.<\/p><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"signature-1\" class=\"forminator-field-signature forminator-col forminator-col-6 \"><div class=\"forminator-field forminator-field-signature\"><label for=\"forminator-field-ctlSignature6723188e99f11\" id=\"forminator-field-ctlSignature6723188e99f11-label\" class=\"forminator-label\">Firma Cliente <span class=\"forminator-required\">*<\/span><\/label><div class=\"forminator-signature\" data-elementheight=\"180\"><span id=\"ctlSignature6723188e99f11_placeholder\" class=\"forminator-signature--placeholder\" aria-hidden=\"true\">Escribe tu frima aqu\u00ed<\/span><div id=\"ctlSignature6723188e99f11_Container\" class=\"forminator-signature--container\"><canvas id=\"ctlSignature6723188e99f11\" class=\"forminator-signature-canvas\" height=\"180\" tabindex=\"-1\"><p>Your browser does not support e-Signature field.<\/p><\/canvas><\/div><\/div><input type=\"hidden\" name=\"field-signature-1\" value=\"6723188e99f11\" class=\"signature-prefix\"><\/div><\/div><div id=\"upload-2\" class=\"forminator-field-upload forminator-col forminator-col-6 \"><div class=\"forminator-field\"><label for=\"forminator-field-upload-2_6723188e7ef7b\" id=\"forminator-field-upload-2_6723188e7ef7b-label\" class=\"forminator-label\">Subir Archivo Adjunto<\/label><div class=\"forminator-file-upload \" data-element=\"upload-2_6723188e7ef7b\" aria-describedby=\"forminator-field-upload-2_6723188e7ef7b-description\"><input type=\"file\" name=\"upload-2\" id=\"forminator-field-upload-2_6723188e7ef7b\" class=\"forminator-input-file\" accept=\".webp,.svg,.svgz,.pdf,.docx,.doc\"><button id=\"forminator-field-upload-2_6723188e7ef7b_button\" class=\"forminator-button forminator-button-upload\" data-id=\"forminator-field-upload-2_6723188e7ef7b\">Choose File<\/button><span data-empty-text=\"No file chosen\">No file chosen<\/span><button class=\"forminator-button-delete\" style=\"display: none;\"><i class=\"forminator-icon-close\" aria-hidden=\"true\"><\/i><span class=\"forminator-screen-reader-only\">Delete uploaded file<\/span><\/button><\/div><span id=\"forminator-field-upload-2_6723188e7ef7b-description\" class=\"forminator-description\">Suministre su huella de indice derecho en formato digital (PDF | Doc).<\/span><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"html-6\" class=\"forminator-field-html forminator-col forminator-col-12 \"><div class=\"forminator-field forminator-merge-tags\" data-field=\"html-6\"><div align=\"center\"><p><strong>C. DESCUENTOS AUTORIZADOS CON LA PRESENTE SOLICITUD<\/strong><\/p><\/div><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"number-10\" class=\"forminator-field-number forminator-col forminator-col-6 \"><div class=\"forminator-field\"><label for=\"forminator-field-number-10_6723188e7ef7b\" id=\"forminator-field-number-10_6723188e7ef7b-label\" class=\"forminator-label\">AFILIACION: (PERIODICIDAD | UNA SOLA VEZ)<\/label><input name=\"number-10\" value=\"30000\" placeholder=\"(VALOR: $ 30.000)\" id=\"forminator-field-number-10_6723188e7ef7b\" class=\"forminator-input forminator-number--field\" inputmode=\"decimal\" data-required=\"\" data-decimals=\"0\" aria-required=\"false\" data-inputmask=\"&#039;groupSeparator&#039;: &#039;&#039;, &#039;radixPoint&#039;: &#039;&#039;, &#039;digits&#039;: &#039;0&#039;\" type=\"number\" step=\"any\" min=\"30000\" max=\"30001\" aria-describedby=\"forminator-field-number-10_6723188e7ef7b-description\" \/><span id=\"forminator-field-number-10_6723188e7ef7b-description\" class=\"forminator-description\">(VALOR: $ 30.000)<\/span><\/div><\/div><div id=\"number-11\" class=\"forminator-field-number forminator-col forminator-col-6 \"><div class=\"forminator-field\"><label for=\"forminator-field-number-11_6723188e7ef7b\" id=\"forminator-field-number-11_6723188e7ef7b-label\" class=\"forminator-label\">FONDO SOLIDARIDAD: (PERIODICIDAD | MENSUAL)<\/label><input name=\"number-11\" value=\"2000\" placeholder=\"(VALOR: $ 2.000)\" id=\"forminator-field-number-11_6723188e7ef7b\" class=\"forminator-input forminator-number--field\" inputmode=\"decimal\" data-required=\"\" data-decimals=\"0\" aria-required=\"false\" data-inputmask=\"&#039;groupSeparator&#039;: &#039;&#039;, &#039;radixPoint&#039;: &#039;&#039;, &#039;digits&#039;: &#039;0&#039;\" type=\"number\" step=\"any\" min=\"2000\" max=\"2001\" aria-describedby=\"forminator-field-number-11_6723188e7ef7b-description\" \/><span id=\"forminator-field-number-11_6723188e7ef7b-description\" class=\"forminator-description\">(VALOR: $ 2.000)<\/span><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"number-12\" class=\"forminator-field-number forminator-col forminator-col-6 \"><div class=\"forminator-field\"><label for=\"forminator-field-number-12_6723188e7ef7b\" id=\"forminator-field-number-12_6723188e7ef7b-label\" class=\"forminator-label\">APORTE OBLIGATORIO: (PERIODICIDAD | QUINCENAL)<\/label><input name=\"number-12\" value=\"19500\" placeholder=\"(MIN: $ 19.500)\" id=\"forminator-field-number-12_6723188e7ef7b\" class=\"forminator-input forminator-number--field\" inputmode=\"decimal\" data-required=\"\" data-decimals=\"0\" aria-required=\"false\" data-inputmask=\"&#039;groupSeparator&#039;: &#039;&#039;, &#039;radixPoint&#039;: &#039;&#039;, &#039;digits&#039;: &#039;0&#039;\" type=\"number\" step=\"any\" min=\"19500\" max=\"20000000\" aria-describedby=\"forminator-field-number-12_6723188e7ef7b-description\" \/><span id=\"forminator-field-number-12_6723188e7ef7b-description\" class=\"forminator-description\">(MIN: $ 19.500)<\/span><\/div><\/div><div id=\"number-13\" class=\"forminator-field-number forminator-col forminator-col-6 \"><div class=\"forminator-field\"><label for=\"forminator-field-number-13_6723188e7ef7b\" id=\"forminator-field-number-13_6723188e7ef7b-label\" class=\"forminator-label\">AHORRO VOLUNTARIO: (PERIODICIDAD | QUINCENAL)<\/label><input name=\"number-13\" value=\"10000\" placeholder=\"0\" id=\"forminator-field-number-13_6723188e7ef7b\" class=\"forminator-input forminator-number--field\" inputmode=\"decimal\" data-required=\"\" data-decimals=\"0\" aria-required=\"false\" data-inputmask=\"&#039;groupSeparator&#039;: &#039;&#039;, &#039;radixPoint&#039;: &#039;&#039;, &#039;digits&#039;: &#039;0&#039;\" type=\"number\" step=\"any\" min=\"0\" max=\"20000000\" \/><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"signature-2\" class=\"forminator-field-signature forminator-col forminator-col-6 \"><div class=\"forminator-field forminator-field-signature\"><label for=\"forminator-field-ctlSignature6723188e9a2f2\" id=\"forminator-field-ctlSignature6723188e9a2f2-label\" class=\"forminator-label\">Firma Cliente <span class=\"forminator-required\">*<\/span><\/label><div class=\"forminator-signature\" data-elementheight=\"180\"><span id=\"ctlSignature6723188e9a2f2_placeholder\" class=\"forminator-signature--placeholder\" aria-hidden=\"true\">Escribe tu frima aqu\u00ed<\/span><div id=\"ctlSignature6723188e9a2f2_Container\" class=\"forminator-signature--container\"><canvas id=\"ctlSignature6723188e9a2f2\" class=\"forminator-signature-canvas\" height=\"180\" tabindex=\"-1\"><p>Your browser does not support e-Signature field.<\/p><\/canvas><\/div><\/div><input type=\"hidden\" name=\"field-signature-2\" value=\"6723188e9a2f2\" class=\"signature-prefix\"><\/div><\/div><div id=\"upload-1\" class=\"forminator-field-upload forminator-col forminator-col-6 \"><div class=\"forminator-field\"><label for=\"forminator-field-upload-1_6723188e7ef7b\" id=\"forminator-field-upload-1_6723188e7ef7b-label\" class=\"forminator-label\">Subir Archivo Adjunto<\/label><div class=\"forminator-file-upload \" data-element=\"upload-1_6723188e7ef7b\" aria-describedby=\"forminator-field-upload-1_6723188e7ef7b-description\"><input type=\"file\" name=\"upload-1\" id=\"forminator-field-upload-1_6723188e7ef7b\" class=\"forminator-input-file\" accept=\".webp,.svg,.svgz,.pdf,.docx,.doc\"><button id=\"forminator-field-upload-1_6723188e7ef7b_button\" class=\"forminator-button forminator-button-upload\" data-id=\"forminator-field-upload-1_6723188e7ef7b\">Choose File<\/button><span data-empty-text=\"No file chosen\">No file chosen<\/span><button class=\"forminator-button-delete\" style=\"display: none;\"><i class=\"forminator-icon-close\" aria-hidden=\"true\"><\/i><span 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