eosayeasero Seersakeaes FORMULARIO DE AFILIACION Dreeser, ‘To DE AFILIADO Teves Donen) Haze Comat Tine itepeeree 2 TOATOE BETA EMPREEA 3 Rin Sono Tab nsepensente 0.6%. FEERCETSR TR coggern sworn ‘careo Brevémeo (ObIGSTET TOATOT OF TRATION TTT H8i 70 Pee] 0864644101 INFO@HOSPITACSANRAFAEL.GOV.CO "RAMIREZ SSLAVA [“ECKUDIA LORENA, ee ay aaa eo —————— Tes Pete oe melt | val xleas! ow) eer wu! Joo rare [x] ws CT Poo Tia eipeats pms |B Sane tonitar ~Pssvoe 2020 | 05 | 05 |: 1132000 cr [aw _ | OTRO PERSONAL DE LIMPIEZA NO CLASIF reasoners oa sae ren sano eae a loess CL VICENTE DEL CAGUAN BAR EL CENTE n laa aay AN x Tass] [Eons Raa] [Fence wee tives haa tiesa sanes| | Povairaun lise airs Duemnocee NGL Eos? TooeeV Pepa X fevin( Jardin hosts] 2. ACTOR OF YOULERABIIOAD Seonmer sheen] — [SORES Sf DA) Grae] —] —eeesomnras aa] — tipi erm cmen oe Cotes cn‘nna| |p ane demovisdes eRenceaces|_| Camntentoceare ata] Patton Sows hevereacerses posal Tresican de casa fs a Fanta ne 4 Shentaciow 0A ao RS m Na BE fesse Faas] eon ge aver He Baro ios 1. ons OFA ConToot@cotranen A peertaee ea oo [Prener Ape : Cegurde Apelide [Nomares Tai ates eae SENATE a a 7 fn aan naan oom Tae IpRa TERT 7. DATOS DEL PADRE DE (A MADRE FURRA BELA WON Fis teense Tee [ee [rime aoarae "TDATOE CLAS PERSONAE A CARGO ops pales Tee seb | tunmnas bonmmna | Tone Eatin Stes Ri Fans oom] = 10» dependan ecorémicamente del Trabajador) cond — ne | lee, we toenso | ado.petios | nombes |r| mfavo| mes} oa] | & ii £ 2l$liil2 I = els t ice erty ater ik tee teete erm peng ccs oe eS Ley] lead ace Escaneado con Camscanne