Professional Documents
Culture Documents
PERDOMO
Important: Please make sure you read all the information presented in this document carefully before
you complete this form.
A. Your details
First name(s)
Lina
Paola
07/10/1991
Date of birth
For example 06/12/1968
Current address
46 Street # 16 - 224
Postcode
051022
Contact/correspondence
or safe address (if different
from above)
Contact telephone
3165000
numbers(s)
Email address
linap.geo09@gmail.com
Yes
No
Female
Male
Prefer not to say
Buddhist
Christian
Muslim Sikh
None
Hindu
Jewish
Other
(please specify)
B. Employment information
If you are working, please tell us:
Yes
No
I am Geologist
2nd
3rd
Last name
Perdomo
Tovar
Perdomo
First name
Gabriel
Maria Eugenia
Natalia
Date of birth
16/10/1959
27/06/1966
14/10/1998
Gender
Male
Female
Female
Relationship
Father
Mother
Sister
to you (wife,
son, etc.)
House
Trailer
Hostal
Flat/apartment
condominium
Hotel
Bungalow
Cottage
Terraced house
X
Detached house
Semi-detached house
No fixed address
Cottage
Number of rooms
Number of bathrooms
Location
Suburb
Price
F. Special requirements
Write a more detailed description of the kind of house you want to have.
Backyard, garden front of house, two garages, one or two floor house, waste disposal.
G. Applicants signature
Name
Date
08/08/2015