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			<td><strong>Fecha:&nbsp;</strong></td>
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			<td><strong>Nombre y apellido&nbsp;</strong></td>
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			<td><strong>Apodo</strong></td>
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			<td><strong>No. Cedula</strong></td>
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			<td><strong>Direccion</strong></td>
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			<td><strong>Referencia Dmiciliaria</strong></td>
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			<td><strong>Estadi civil</strong></td>
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			<td><strong>Telefono y/o Celular</strong></td>
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			<td><strong>Edad</strong></td>
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			<td><strong>Lugar de trabajo</strong></td>
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			<td>&nbsp; &nbsp; &nbsp; Direccion de trabajo</td>
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			<td>&nbsp; &nbsp; &nbsp; Ocupacion</td>
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			<td>&nbsp; &nbsp; &nbsp;Ingreso Mensual</td>
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			<td>&nbsp; &nbsp; &nbsp;Otros ingresos</td>
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			<td>&nbsp; &nbsp; &nbsp;Tiempo laboral</td>
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			<td>&nbsp; &nbsp; &nbsp;Tel. de trabajo</td>
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			<td><strong>Vivienda propia&nbsp;<input type="radio" value="0" />&nbsp; Alquilada&nbsp;<input type="radio" value="0" />&nbsp;Pagop mensual______</strong></td>
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			<p>&nbsp; &nbsp; &nbsp; &nbsp;Otro tipo de vivienda ______ Justifique__________</p>
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			<td><strong>Referencia Bancaria o Comercial</strong></td>
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			<td>&nbsp; &nbsp; &nbsp; Telefono</td>
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			<td>&nbsp;</td>
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	</tbody>
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<div><strong><span style="font-size:20px"><u>DATOS DEL PRESTAMO</u></span></strong></div>

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<div><span style="font-size:14px">Cantidad solicitada __________ Prestamo nuevo&nbsp;<input name="nuevo" type="radio" value="0" />&nbsp; &nbsp;Renovacion<input name="renovado" type="radio" value="0" />&nbsp;</span></div>

<div><span style="font-size:14px">Forma de pago: Diario<input name="diario" type="checkbox" />&nbsp;Semanal<input name="semanal" type="checkbox" />&nbsp;Quincenal&nbsp;<input name="quincenal" type="checkbox" />&nbsp;Mensual&nbsp;<input name="mensual" type="checkbox" /></span></div>

<div><span style="font-size:14px">Plazo ____________, Proposito _______________________________________________</span></div>

<div><span style="font-size:14px">Tipo de prestamo: Solidario&nbsp;<input type="checkbox" />&nbsp; &nbsp; Hipotecario<input type="checkbox" />&nbsp; &nbsp;Prendatario</span></div>

<div><span style="font-size:14px">Otra garantia(Tarjeta)&nbsp;<input name="tarjeta" type="checkbox" /></span>, Clave tarjeta&nbsp;<span style="font-size:16px">___________________</span></div>

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<div><strong>REGLAS QUE DEBE SEGUIR EL CLIENTE CUANDO SOLICITA UN PRESTAMO</strong></div>

<div>1. No retirar los valores de la tarjeta hasta saldar la deuda: puede tener consecuencias legales&nbsp;</div>

<div>2. Cuando se le conceda un prestamo no se le dara prestamos adicioanales hasta saldar el mismo.</div>

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<div>SI ES PRESTAMO SOLIDARIO, DATOS DEL GARANTE</div>

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<div>
<table align="left" border="0" cellpadding="0" cellspacing="1" style="width:0px">
	<tbody>
		<tr>
			<td><strong>Fecha:&nbsp;</strong></td>
		</tr>
		<tr>
			<td><strong>Nombre y apellido&nbsp;</strong></td>
		</tr>
		<tr>
			<td><strong>Apodo&nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp;</strong></td>
		</tr>
		<tr>
			<td><strong>No. Cedula</strong></td>
		</tr>
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			<td><strong>Direccion</strong></td>
		</tr>
		<tr>
			<td><strong>Referencia Dmiciliaria</strong></td>
		</tr>
		<tr>
			<td><strong>Estadi civil</strong></td>
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		<tr>
			<td><strong>Telefono y/o Celular</strong></td>
		</tr>
		<tr>
			<td><strong>Edad</strong></td>
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		<tr>
			<td><strong>Lugar de trabajo</strong></td>
		</tr>
		<tr>
			<td>&nbsp; &nbsp; &nbsp; Direccion de trabajo</td>
		</tr>
		<tr>
			<td>&nbsp; &nbsp; &nbsp; Ocupacion</td>
		</tr>
		<tr>
			<td>&nbsp; &nbsp; &nbsp;Ingreso Mensual</td>
		</tr>
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			<td>&nbsp; &nbsp; &nbsp;Otros ingresos</td>
		</tr>
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			<td>&nbsp; &nbsp; &nbsp;Tiempo laboral</td>
		</tr>
		<tr>
			<td>&nbsp; &nbsp; &nbsp;Tel. de trabajo</td>
		</tr>
		<tr>
			<td>&nbsp;</td>
		</tr>
	</tbody>
</table>

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<div>____________________________________&nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; __________________________________</div>

<div>&nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; Firma del solicitante&nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp;Firma del garante</div>

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