7/21/2019 Ficha de Inscripcion Estudiantil

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CompaaDe Transporte Jvenes Del Futuro

Transjodefu S. A.

FICHA DE INSCRIPCION ESTUDIANTILUNIDAD EDUCATIVA CARDENAL SPELLMAN

AO LECTIVO 2014 - 2015

DATOS DE FILIACIN ESTUDIANTE:

NOMBRES com!"#o$: %%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%APELLIDOS com!"#o$: %%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%EDAD: %%%%%%%%% &RADO: %%%%%% PARALELO: %%%%%%

DIRECCION DOMICILO:

SECTOR: %%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%BARRIO: %%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%CIUDADELA: %%%%%%%%%%%%%%%%%%%%%%%%%%%%%REFERENCIA: %%%%%%%%%%%%%%%%%%%%%%%%%%%%%CALLES: PRINCIPAL: %%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%CASA N':%%%%%%%%% SECUNDARIA: %%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%

NOMBRE CON(UNTO HABITACIONAL: %%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%% BLO)UE N': %%%%%%%%%DEPARTAMENTO N': %%%%%%% CASA N': %%%%%%%%%%%%%%%%%

REPRESENTANTE ESTUDIANTE:

Nom*+" , N' " RUC ./O C! " I"3# + "m#+ 6c#+$7%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%

NOMBRES com!"#o$: %%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%APELLIDOS com!"#o$: %%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%N' CELULAR: %%%%%%%%%%%%%%N' CELULAR: %%%%%%%%%%%%%%%%N' CELULAR: %%%%%%%%%%%%%%%TEL8FONO OFICINA: %%%%%%%%%%%%%%% TEL8FONO RESIDENCIA: %%%%%%%%%%%%%%%%%%%D+"cc93 R"$"3c:%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%

N' DE RUTA UNIDAD: %%%%%%%% ENTRADA . SALIDA: %%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%SERVICIO DE TRANSPORTE )UE UTILIA:

ENTRADA: %%%%%% RUTA N'%%%%% SALIDA: %%%%%% RUTA N': %%%%%%

)UE MODALIDAD DE TRANSPORTE SOLICITA:

PERSONALIADO PUERTA A PUERTA: SI: %%%% NO: %%%%&ENERALIADO BUS: SI: %%%% NO: %%%%COSTOS: S"+;co T+3$o+#" &"3"+!5000 9!+"$ S"+;co T+3$o+#" P"+#/P"+#====>?500 9!+"$

Se solicita adjuntar croquis de ubicacin domicilio

Firma Representante

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