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{\pntxtb (}{\pntxta )}}\pard\plain \s15\qc \li0\ri0\widctlpar\faauto\adjustright\rin0\lin0\itap0 \b\f1\fs36\lang1033\langfe1033\cgrid\langnp1033\langfenp1033 {\f0\lang3082\langfe1033\langnp3082\insrsid15810328\charrsid15810328 Formulario de reposici\'f3
n de la \'93Smart Card\'94
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\f1\fs18\lang1036\langfe1033\langnp1036\insrsid15810328\charrsid15810328 Nombre en la \'93Smart Card\'94:}{\f1\fs18\cf1\lang1036\langfe1033\cgrid0\langnp1036\insrsid15810328\charrsid15810328 
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\f1\fs18\lang3082\langfe1033\langnp3082\insrsid15810328\charrsid15810328 N\'famero de la \'93Smart Card\'94:  }{\f1\fs18\cf1\lang3082\langfe1033\cgrid0\langnp3082\insrsid15810328\charrsid15810328                                        }{
\f1\fs18\lang3082\langfe1033\langnp3082\insrsid15810328\charrsid15810328 Motivo por el que solicita otra \'93Smart Card\'94 (p.ej: p\'e9rdida, deterioro, etc.) 
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\f1\fs18\lang3082\langfe1033\langnp3082\insrsid15810328\charrsid15810328 
\par Por razones de seguridad se solicita, por favor, que proporcione: }{\b\f1\fs18\lang3082\langfe1033\langnp3082\insrsid15810328\charrsid15810328 Fecha de nacimiento: }{\f1\fs18\lang3082\langfe1033\langnp3082\insrsid15810328\charrsid15810328 ______(d\'ed
a) ______ (mes) _______ (a\'f1o); }{\b\f1\fs18\lang3082\langfe1033\langnp3082\insrsid15810328\charrsid15810328 foto tama\'f1o carnet }{\f1\fs18\lang3082\langfe1033\langnp3082\insrsid15810328\charrsid15810328 y }{
\b\f1\fs18\lang3082\langfe1033\langnp3082\insrsid15810328\charrsid15810328 antigua informaci\'f3n }{\f1\fs18\lang3082\langfe1033\langnp3082\insrsid15810328\charrsid15810328 que consta en los ficheros de la oficina de la \'93Smart Card\'94. }{
\f1\fs18\insrsid15810328 Por favor, actualice tambi\'e9n cualquier cambio de esa informaci\'f3n.}{\f1\fs16\insrsid15810328 
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\cltxlrtb\clftsWidth3\clwWidth4285\clshdrawnil \cellx10080\row }\trowd \irow3\irowband3\ts11\trgaph108\trrh90\trleft0\trkeep\trbrdrt\brdrs\brdrw20 \trbrdrl\brdrs\brdrw20 \trbrdrb\brdrs\brdrw20 \trbrdrr\brdrs\brdrw20 \trbrdrh\brdrs\brdrw10 \trbrdrv
\brdrs\brdrw10 \trftsWidth3\trwWidth10080\trautofit1\trpaddl108\trpaddr108\trpaddfl3\trpaddfr3 \clvertalt\clbrdrt\brdrs\brdrw10 \clbrdrl\brdrs\brdrw20 \clbrdrb\brdrs\brdrw10 \clbrdrr\brdrs\brdrw20 \cltxlrtb\clftsWidth3\clwWidth1628\clshdrawnil \cellx1728
\clvertalt\clbrdrt\brdrs\brdrw10 \clbrdrl\brdrs\brdrw20 \clbrdrb\brdrs\brdrw10 \clbrdrr\brdrs\brdrw20 \cltxlrtb\clftsWidth3\clwWidth4167\clshdrawnil \cellx5846\clvertalt\clbrdrt\brdrs\brdrw10 \clbrdrl\brdrs\brdrw20 \clbrdrb\brdrs\brdrw10 \clbrdrr
\brdrs\brdrw20 \cltxlrtb\clftsWidth3\clwWidth4285\clshdrawnil \cellx10080\pard\plain \s3\ql \li-720\ri0\keepn\widctlpar\intbl\faauto\outlinelevel2\adjustright\rin0\lin-720 \f1\fs26\cf1\lang1033\langfe1033\cgrid\langnp1033\langfenp1033 {
\fs20\cf0\insrsid15810328 City,St   }{\fs20\insrsid15810328 Ciudad}{\fs20\cf0\insrsid15810328  \cell }\pard\plain \ql \li0\ri0\widctlpar\intbl\nooverflow\faroman\rin0\lin0 \fs20\lang1033\langfe1033\cgrid\langnp1033\langfenp1033 {\f1\cf2\insrsid15810328 
\cell 
\par \cell }\pard \ql \li0\ri0\widctlpar\intbl\aspalpha\aspnum\faauto\adjustright\rin0\lin0 {\f1\insrsid15810328 \trowd \irow3\irowband3\ts11\trgaph108\trrh90\trleft0\trkeep\trbrdrt\brdrs\brdrw20 \trbrdrl\brdrs\brdrw20 \trbrdrb\brdrs\brdrw20 \trbrdrr
\brdrs\brdrw20 \trbrdrh\brdrs\brdrw10 \trbrdrv\brdrs\brdrw10 \trftsWidth3\trwWidth10080\trautofit1\trpaddl108\trpaddr108\trpaddfl3\trpaddfr3 \clvertalt\clbrdrt\brdrs\brdrw10 \clbrdrl\brdrs\brdrw20 \clbrdrb\brdrs\brdrw10 \clbrdrr\brdrs\brdrw20 
\cltxlrtb\clftsWidth3\clwWidth1628\clshdrawnil \cellx1728\clvertalt\clbrdrt\brdrs\brdrw10 \clbrdrl\brdrs\brdrw20 \clbrdrb\brdrs\brdrw10 \clbrdrr\brdrs\brdrw20 \cltxlrtb\clftsWidth3\clwWidth4167\clshdrawnil \cellx5846\clvertalt\clbrdrt\brdrs\brdrw10 
\clbrdrl\brdrs\brdrw20 \clbrdrb\brdrs\brdrw10 \clbrdrr\brdrs\brdrw20 \cltxlrtb\clftsWidth3\clwWidth4285\clshdrawnil \cellx10080\row }\trowd \irow4\irowband4\ts11\trgaph108\trrh884\trleft0\trkeep\trbrdrt\brdrs\brdrw20 \trbrdrl\brdrs\brdrw20 \trbrdrb
\brdrs\brdrw20 \trbrdrr\brdrs\brdrw20 \trbrdrh\brdrs\brdrw10 \trbrdrv\brdrs\brdrw10 \trftsWidth3\trwWidth10080\trautofit1\trpaddl108\trpaddr108\trpaddfl3\trpaddfr3 \clvertalt\clbrdrt\brdrs\brdrw10 \clbrdrl\brdrs\brdrw20 \clbrdrb\brdrs\brdrw10 \clbrdrr
\brdrs\brdrw20 \cltxlrtb\clftsWidth3\clwWidth1628\clshdrawnil \cellx1728\clvertalt\clbrdrt\brdrs\brdrw10 \clbrdrl\brdrs\brdrw20 \clbrdrb\brdrs\brdrw10 \clbrdrr\brdrs\brdrw20 \cltxlrtb\clftsWidth3\clwWidth4167\clshdrawnil \cellx5846\clvertalt\clbrdrt
\brdrs\brdrw10 \clbrdrl\brdrs\brdrw20 \clbrdrb\brdrs\brdrw10 \clbrdrr\brdrs\brdrw20 \cltxlrtb\clftsWidth3\clwWidth4285\clshdrawnil \cellx10080\pard \ql \li0\ri0\widctlpar\intbl\nooverflow\faroman\rin0\lin0 {\f1\insrsid15810328 Provincia/C\'f3
digo postal/Pa\'eds}{\f1\fs18\insrsid15810328 
\par }{\f1\insrsid15810328 
\par 
\par \cell }\pard\plain \s3\ql \li-720\ri0\keepn\widctlpar\intbl\faauto\outlinelevel2\adjustright\rin0\lin-720 \f1\fs26\cf1\lang1033\langfe1033\cgrid\langnp1033\langfenp1033 {\fs20\cf2\insrsid15810328 Lllll\cell \cell }\pard\plain 
\ql \li0\ri0\widctlpar\intbl\aspalpha\aspnum\faauto\adjustright\rin0\lin0 \fs20\lang1033\langfe1033\cgrid\langnp1033\langfenp1033 {\f1\insrsid15810328 \trowd \irow4\irowband4\ts11\trgaph108\trrh884\trleft0\trkeep\trbrdrt\brdrs\brdrw20 \trbrdrl
\brdrs\brdrw20 \trbrdrb\brdrs\brdrw20 \trbrdrr\brdrs\brdrw20 \trbrdrh\brdrs\brdrw10 \trbrdrv\brdrs\brdrw10 \trftsWidth3\trwWidth10080\trautofit1\trpaddl108\trpaddr108\trpaddfl3\trpaddfr3 \clvertalt\clbrdrt\brdrs\brdrw10 \clbrdrl\brdrs\brdrw20 \clbrdrb
\brdrs\brdrw10 \clbrdrr\brdrs\brdrw20 \cltxlrtb\clftsWidth3\clwWidth1628\clshdrawnil \cellx1728\clvertalt\clbrdrt\brdrs\brdrw10 \clbrdrl\brdrs\brdrw20 \clbrdrb\brdrs\brdrw10 \clbrdrr\brdrs\brdrw20 \cltxlrtb\clftsWidth3\clwWidth4167\clshdrawnil \cellx5846
\clvertalt\clbrdrt\brdrs\brdrw10 \clbrdrl\brdrs\brdrw20 \clbrdrb\brdrs\brdrw10 \clbrdrr\brdrs\brdrw20 \cltxlrtb\clftsWidth3\clwWidth4285\clshdrawnil \cellx10080\row }\trowd \irow5\irowband5\ts11\trgaph108\trrh428\trleft0\trbrdrt\brdrs\brdrw20 \trbrdrl
\brdrs\brdrw20 \trbrdrb\brdrs\brdrw20 \trbrdrr\brdrs\brdrw20 \trbrdrh\brdrs\brdrw10 \trbrdrv\brdrs\brdrw10 \trftsWidth3\trwWidth10080\trautofit1\trpaddl108\trpaddr108\trpaddfl3\trpaddfr3 \clvertalt\clbrdrt\brdrs\brdrw10 \clbrdrl\brdrs\brdrw20 \clbrdrb
\brdrs\brdrw10 \clbrdrr\brdrs\brdrw10 \cltxlrtb\clftsWidth3\clwWidth1628\clshdrawnil \cellx1728\clvertalt\clbrdrt\brdrs\brdrw10 \clbrdrl\brdrs\brdrw10 \clbrdrb\brdrs\brdrw10 \clbrdrr\brdrs\brdrw10 \cltxlrtb\clftsWidth3\clwWidth4167\clshdrawnil \cellx5846
\clvertalt\clbrdrt\brdrs\brdrw10 \clbrdrl\brdrs\brdrw10 \clbrdrb\brdrs\brdrw10 \clbrdrr\brdrs\brdrw20 \cltxlrtb\clftsWidth3\clwWidth4285\clshdrawnil \cellx10080\pard \ql \li-108\ri0\widctlpar\intbl\nooverflow\faroman\rin0\lin-108 {\f1\insrsid15810328 
  Tel\'e9fono de  
\par   casa\cell }\pard\plain \s3\ql \li0\ri0\keepn\widctlpar\intbl\faauto\outlinelevel2\adjustright\rin0\lin0 \f1\fs26\cf1\lang1033\langfe1033\cgrid\langnp1033\langfenp1033 {\fs20\insrsid15810328 \cell 
\par }\pard\plain \ql \li0\ri0\widctlpar\intbl\nooverflow\faroman\rin0\lin0 \fs20\lang1033\langfe1033\cgrid\langnp1033\langfenp1033 {\f1\insrsid15810328 \cell }\pard \ql \li0\ri0\widctlpar\intbl\aspalpha\aspnum\faauto\adjustright\rin0\lin0 {
\f1\insrsid15810328 \trowd \irow5\irowband5\ts11\trgaph108\trrh428\trleft0\trbrdrt\brdrs\brdrw20 \trbrdrl\brdrs\brdrw20 \trbrdrb\brdrs\brdrw20 \trbrdrr\brdrs\brdrw20 \trbrdrh\brdrs\brdrw10 \trbrdrv\brdrs\brdrw10 
\trftsWidth3\trwWidth10080\trautofit1\trpaddl108\trpaddr108\trpaddfl3\trpaddfr3 \clvertalt\clbrdrt\brdrs\brdrw10 \clbrdrl\brdrs\brdrw20 \clbrdrb\brdrs\brdrw10 \clbrdrr\brdrs\brdrw10 \cltxlrtb\clftsWidth3\clwWidth1628\clshdrawnil \cellx1728\clvertalt
\clbrdrt\brdrs\brdrw10 \clbrdrl\brdrs\brdrw10 \clbrdrb\brdrs\brdrw10 \clbrdrr\brdrs\brdrw10 \cltxlrtb\clftsWidth3\clwWidth4167\clshdrawnil \cellx5846\clvertalt\clbrdrt\brdrs\brdrw10 \clbrdrl\brdrs\brdrw10 \clbrdrb\brdrs\brdrw10 \clbrdrr\brdrs\brdrw20 
\cltxlrtb\clftsWidth3\clwWidth4285\clshdrawnil \cellx10080\row }\trowd \irow6\irowband6\ts11\trgaph108\trleft0\trbrdrt\brdrs\brdrw20 \trbrdrl\brdrs\brdrw20 \trbrdrb\brdrs\brdrw20 \trbrdrr\brdrs\brdrw20 \trbrdrh\brdrs\brdrw10 \trbrdrv\brdrs\brdrw10 
\trftsWidth3\trwWidth10080\trautofit1\trpaddl108\trpaddr108\trpaddfl3\trpaddfr3 \clvertalt\clbrdrt\brdrs\brdrw10 \clbrdrl\brdrs\brdrw20 \clbrdrb\brdrs\brdrw10 \clbrdrr\brdrs\brdrw10 \cltxlrtb\clftsWidth3\clwWidth1628\clshdrawnil \cellx1728\clvertalt
\clbrdrt\brdrs\brdrw10 \clbrdrl\brdrs\brdrw10 \clbrdrb\brdrs\brdrw10 \clbrdrr\brdrs\brdrw10 \cltxlrtb\clftsWidth3\clwWidth4167\clshdrawnil \cellx5846\clvertalt\clbrdrt\brdrs\brdrw10 \clbrdrl\brdrs\brdrw10 \clbrdrb\brdrs\brdrw10 \clbrdrr\brdrs\brdrw20 
\cltxlrtb\clftsWidth3\clwWidth4285\clshdrawnil \cellx10080\pard\plain \s3\ql \li0\ri0\keepn\widctlpar\intbl\faauto\outlinelevel2\adjustright\rin0\lin0 \f1\fs26\cf1\lang1033\langfe1033\cgrid\langnp1033\langfenp1033 {\fs20\insrsid15810328 Tel\'e9
fono del trabajo\cell \cell 
\par }\pard\plain \ql \li0\ri0\widctlpar\intbl\nooverflow\faroman\rin0\lin0 \fs20\lang1033\langfe1033\cgrid\langnp1033\langfenp1033 {\f1\insrsid15810328 \cell }\pard \ql \li0\ri0\widctlpar\intbl\aspalpha\aspnum\faauto\adjustright\rin0\lin0 {
\f1\insrsid15810328 \trowd \irow6\irowband6\ts11\trgaph108\trleft0\trbrdrt\brdrs\brdrw20 \trbrdrl\brdrs\brdrw20 \trbrdrb\brdrs\brdrw20 \trbrdrr\brdrs\brdrw20 \trbrdrh\brdrs\brdrw10 \trbrdrv\brdrs\brdrw10 
\trftsWidth3\trwWidth10080\trautofit1\trpaddl108\trpaddr108\trpaddfl3\trpaddfr3 \clvertalt\clbrdrt\brdrs\brdrw10 \clbrdrl\brdrs\brdrw20 \clbrdrb\brdrs\brdrw10 \clbrdrr\brdrs\brdrw10 \cltxlrtb\clftsWidth3\clwWidth1628\clshdrawnil \cellx1728\clvertalt
\clbrdrt\brdrs\brdrw10 \clbrdrl\brdrs\brdrw10 \clbrdrb\brdrs\brdrw10 \clbrdrr\brdrs\brdrw10 \cltxlrtb\clftsWidth3\clwWidth4167\clshdrawnil \cellx5846\clvertalt\clbrdrt\brdrs\brdrw10 \clbrdrl\brdrs\brdrw10 \clbrdrb\brdrs\brdrw10 \clbrdrr\brdrs\brdrw20 
\cltxlrtb\clftsWidth3\clwWidth4285\clshdrawnil \cellx10080\row }\pard\plain \s3\ql \li0\ri0\keepn\widctlpar\intbl\faauto\outlinelevel2\adjustright\rin0\lin0 \f1\fs26\cf1\lang1033\langfe1033\cgrid\langnp1033\langfenp1033 {\fs20\insrsid15810328 N\'fa
mero de fax\cell \cell 
\par }\pard\plain \ql \li0\ri0\widctlpar\intbl\nooverflow\faroman\rin0\lin0 \fs20\lang1033\langfe1033\cgrid\langnp1033\langfenp1033 {\f1\insrsid15810328 \cell }\pard \ql \li0\ri0\widctlpar\intbl\aspalpha\aspnum\faauto\adjustright\rin0\lin0 {
\f1\insrsid15810328 \trowd \irow7\irowband7\ts11\trgaph108\trleft0\trbrdrt\brdrs\brdrw20 \trbrdrl\brdrs\brdrw20 \trbrdrb\brdrs\brdrw20 \trbrdrr\brdrs\brdrw20 \trbrdrh\brdrs\brdrw10 \trbrdrv\brdrs\brdrw10 
\trftsWidth3\trwWidth10080\trautofit1\trpaddl108\trpaddr108\trpaddfl3\trpaddfr3 \clvertalt\clbrdrt\brdrs\brdrw10 \clbrdrl\brdrs\brdrw20 \clbrdrb\brdrs\brdrw10 \clbrdrr\brdrs\brdrw10 \cltxlrtb\clftsWidth3\clwWidth1628\clshdrawnil \cellx1728\clvertalt
\clbrdrt\brdrs\brdrw10 \clbrdrl\brdrs\brdrw10 \clbrdrb\brdrs\brdrw10 \clbrdrr\brdrs\brdrw10 \cltxlrtb\clftsWidth3\clwWidth4167\clshdrawnil \cellx5846\clvertalt\clbrdrt\brdrs\brdrw10 \clbrdrl\brdrs\brdrw10 \clbrdrb\brdrs\brdrw10 \clbrdrr\brdrs\brdrw20 
\cltxlrtb\clftsWidth3\clwWidth4285\clshdrawnil \cellx10080\row }\trowd \irow8\irowband8\lastrow \ts11\trgaph108\trleft0\trbrdrt\brdrs\brdrw20 \trbrdrl\brdrs\brdrw20 \trbrdrb\brdrs\brdrw20 \trbrdrr\brdrs\brdrw20 \trbrdrh\brdrs\brdrw10 \trbrdrv
\brdrs\brdrw10 \trftsWidth3\trwWidth10080\trautofit1\trpaddl108\trpaddr108\trpaddfl3\trpaddfr3 \clvertalt\clbrdrt\brdrs\brdrw10 \clbrdrl\brdrs\brdrw20 \clbrdrb\brdrs\brdrw20 \clbrdrr\brdrs\brdrw10 \cltxlrtb\clftsWidth3\clwWidth1628\clshdrawnil \cellx1728
\clvertalt\clbrdrt\brdrs\brdrw10 \clbrdrl\brdrs\brdrw10 \clbrdrb\brdrs\brdrw20 \clbrdrr\brdrs\brdrw10 \cltxlrtb\clftsWidth3\clwWidth4167\clshdrawnil \cellx5846\clvertalt\clbrdrt\brdrs\brdrw10 \clbrdrl\brdrs\brdrw10 \clbrdrb\brdrs\brdrw20 \clbrdrr
\brdrs\brdrw20 \cltxlrtb\clftsWidth3\clwWidth4285\clshdrawnil \cellx10080\pard\plain \s3\ql \li0\ri0\keepn\widctlpar\intbl\faauto\outlinelevel2\adjustright\rin0\lin0 \f1\fs26\cf1\lang1033\langfe1033\cgrid\langnp1033\langfenp1033 {\fs18\insrsid15810328 
Direcci\'f3n de correo electr\'f3nico\cell }{\fs20\insrsid15810328 \cell 
\par }\pard\plain \ql \li0\ri0\widctlpar\intbl\nooverflow\faroman\rin0\lin0 \fs20\lang1033\langfe1033\cgrid\langnp1033\langfenp1033 {\f1\insrsid15810328 \cell }\pard \ql \li0\ri0\widctlpar\intbl\aspalpha\aspnum\faauto\adjustright\rin0\lin0 {
\f1\insrsid15810328 \trowd \irow8\irowband8\lastrow \ts11\trgaph108\trleft0\trbrdrt\brdrs\brdrw20 \trbrdrl\brdrs\brdrw20 \trbrdrb\brdrs\brdrw20 \trbrdrr\brdrs\brdrw20 \trbrdrh\brdrs\brdrw10 \trbrdrv\brdrs\brdrw10 
\trftsWidth3\trwWidth10080\trautofit1\trpaddl108\trpaddr108\trpaddfl3\trpaddfr3 \clvertalt\clbrdrt\brdrs\brdrw10 \clbrdrl\brdrs\brdrw20 \clbrdrb\brdrs\brdrw20 \clbrdrr\brdrs\brdrw10 \cltxlrtb\clftsWidth3\clwWidth1628\clshdrawnil \cellx1728\clvertalt
\clbrdrt\brdrs\brdrw10 \clbrdrl\brdrs\brdrw10 \clbrdrb\brdrs\brdrw20 \clbrdrr\brdrs\brdrw10 \cltxlrtb\clftsWidth3\clwWidth4167\clshdrawnil \cellx5846\clvertalt\clbrdrt\brdrs\brdrw10 \clbrdrl\brdrs\brdrw10 \clbrdrb\brdrs\brdrw20 \clbrdrr\brdrs\brdrw20 
\cltxlrtb\clftsWidth3\clwWidth4285\clshdrawnil \cellx10080\row }\pard \ql \li0\ri0\sl-280\slmult0\widctlpar\nooverflow\faroman\rin0\lin0\itap0 {\f1\fs18\lang3082\langfe1033\langnp3082\insrsid15810328\charrsid15810328 El coste de la reposici\'f3n de la 
\'93Smart Card\'94 es aproximadamente de 25}{\f1\fs18\lang3082\langfe1033\langnp3082\insrsid15810328  }{\f1\fs18\lang3082\langfe1033\langnp3082\insrsid15810328\charrsid15810328 $. 
Sin embargo, entendemos que puede haber personas que no puedan pagar esa cantidad. Por favor indique aqu\'ed la cantidad que va a pagar: ________
\par }{\b\f1\lang3082\langfe1033\langnp3082\insrsid15810328\charrsid15810328 La \'fanica forma de pago para la reposici\'f3n de la \'93Smart Card\'94 es con tarjeta de cr\'e9dito. 
\par }\pard \ql \li0\ri0\widctlpar\nooverflow\faroman\rin0\lin0\itap0 {\lang1024\langfe1024\noproof\langnp3082\langfenp3082\insrsid208703 
{\shp{\*\shpinst\shpleft-15\shptop160\shpright9960\shpbottom3898\shpfhdr0\shpbxcolumn\shpbxignore\shpbypara\shpbyignore\shpwr3\shpwrk0\shpfblwtxt0\shpz14\shplid1031{\sp{\sn shapeType}{\sv 1}}{\sp{\sn fFlipH}{\sv 0}}{\sp{\sn fFlipV}{\sv 0}}
{\sp{\sn fillColor}{\sv 65535}}{\sp{\sn fFilled}{\sv 0}}{\sp{\sn fLayoutInCell}{\sv 1}}{\sp{\sn fLayoutInCell}{\sv 1}}}{\shprslt{\*\do\dobxcolumn\dobypara\dodhgt8206\dprect\dpx-15\dpy160\dpxsize9975\dpysize3738
\dpfillfgcr255\dpfillfgcg255\dpfillfgcb255\dpfillbgcr255\dpfillbgcg255\dpfillbgcb0\dpfillpat0\dplinew15\dplinecor0\dplinecog0\dplinecob0}}}}{\b\f1\lang3082\langfe1033\langnp3082\insrsid15810328\charrsid15810328 
\par     Para autorizar el pago con tarjeta de cr\'e9dito por favor rellene la siguiente informaci\'f3n.}{\f1\lang3082\langfe1033\langnp3082\insrsid15810328\charrsid15810328  
\par    }{\b\f1\lang3082\langfe1033\langnp3082\insrsid15810328\charrsid15810328 El cargo en su tarjeta lo efectuar\'e1 Elan Vital, Inc., PO Box 2220, Agoura Hills, CA 91376 USA.
\par 
\par }\pard\plain \s16\ql \li0\ri0\sl360\slmult1\widctlpar\faauto\adjustright\rin0\lin0\itap0 \fs20\lang1033\langfe1033\cgrid\langnp1033\langfenp1033 {\b\f1\lang3082\langfe1033\langnp3082\insrsid15810328\charrsid15810328    Clase de Tarjeta de Cr\'e9dito:}{
\f1\lang3082\langfe1033\langnp3082\insrsid15810328\charrsid15810328     }{\f1\cf1\lang3082\langfe1033\langnp3082\insrsid15810328\charrsid15810328       ____Visa     ____Mastercard     ____Discover     ____American Express       
\par }\pard\plain \ql \li0\ri0\sl360\slmult1\widctlpar\nooverflow\faroman\rin0\lin0\itap0 \fs20\lang1033\langfe1033\cgrid\langnp1033\langfenp1033 {\lang1024\langfe1024\noproof\langnp3082\langfenp3082\insrsid208703 
{\shp{\*\shpinst\shpleft3600\shptop153\shpright9420\shpbottom153\shpfhdr0\shpbxcolumn\shpbxignore\shpbypara\shpbyignore\shpwr3\shpwrk0\shpfblwtxt0\shpz3\shplid1032{\sp{\sn shapeType}{\sv 20}}{\sp{\sn fFlipH}{\sv 0}}{\sp{\sn fFlipV}{\sv 0}}
{\sp{\sn shapePath}{\sv 4}}{\sp{\sn fFillOK}{\sv 0}}{\sp{\sn fFilled}{\sv 0}}{\sp{\sn fArrowheadsOK}{\sv 1}}{\sp{\sn fLayoutInCell}{\sv 1}}{\sp{\sn fLayoutInCell}{\sv 1}}}{\shprslt{\*\do\dobxcolumn\dobypara\dodhgt8195\dpline\dpptx0\dppty0\dpptx5820\dppty0
\dpx3600\dpy153\dpxsize5820\dpysize0\dplinew15\dplinecor0\dplinecog0\dplinecob0}}}}{\b\f1\cf1\lang3082\langfe1033\cgrid0\langnp3082\insrsid15810328\charrsid15810328    }{\lang1024\langfe1024\noproof\langnp3082\langfenp3082\insrsid208703 
{\shp{\*\shpinst\shpleft3620\shptop148\shpright9400\shpbottom148\shpfhdr0\shpbxcolumn\shpbxignore\shpbypara\shpbyignore\shpwr3\shpwrk0\shpfblwtxt0\shpz4\shplid1033{\sp{\sn shapeType}{\sv 20}}{\sp{\sn fFlipH}{\sv 0}}{\sp{\sn fFlipV}{\sv 0}}
{\sp{\sn shapePath}{\sv 4}}{\sp{\sn fFillOK}{\sv 0}}{\sp{\sn fFilled}{\sv 0}}{\sp{\sn fArrowheadsOK}{\sv 1}}{\sp{\sn fLayoutInCell}{\sv 1}}{\sp{\sn fLayoutInCell}{\sv 1}}}{\shprslt{\*\do\dobxcolumn\dobypara\dodhgt8196\dpline\dpptx0\dppty0\dpptx5780\dppty0
\dpx3620\dpy148\dpxsize5780\dpysize0\dplinew15\dplinecor0\dplinecog0\dplinecob0}}}}{\f1\lang3082\langfe1033\langnp3082\insrsid15810328\charrsid15810328 Nombre tal como figura en la tarjeta:
\par }\pard \ql \fi-1080\li0\ri0\sl360\slmult1\widctlpar\nooverflow\faroman\rin0\lin0\itap0 {\lang1024\langfe1024\noproof\langnp3082\langfenp3082\insrsid208703 
{\shp{\*\shpinst\shpleft6200\shptop143\shpright9390\shpbottom143\shpfhdr0\shpbxcolumn\shpbxignore\shpbypara\shpbyignore\shpwr3\shpwrk0\shpfblwtxt0\shpz6\shplid1034{\sp{\sn shapeType}{\sv 20}}{\sp{\sn fFlipH}{\sv 0}}{\sp{\sn fFlipV}{\sv 0}}
{\sp{\sn shapePath}{\sv 4}}{\sp{\sn fFillOK}{\sv 0}}{\sp{\sn fFilled}{\sv 0}}{\sp{\sn fArrowheadsOK}{\sv 1}}{\sp{\sn fLayoutInCell}{\sv 1}}{\sp{\sn fLayoutInCell}{\sv 1}}}{\shprslt{\*\do\dobxcolumn\dobypara\dodhgt8198\dpline\dpptx0\dppty0\dpptx3190\dppty0
\dpx6200\dpy143\dpxsize3190\dpysize0\dplinew15\dplinecor0\dplinecog0\dplinecob0}}}{\shp{\*\shpinst\shpleft3600\shptop143\shpright6210\shpbottom143\shpfhdr0\shpbxcolumn\shpbxignore\shpbypara\shpbyignore\shpwr3\shpwrk0\shpfblwtxt0\shpz5\shplid1035
{\sp{\sn shapeType}{\sv 20}}{\sp{\sn fFlipH}{\sv 0}}{\sp{\sn fFlipV}{\sv 0}}{\sp{\sn shapePath}{\sv 4}}{\sp{\sn fFillOK}{\sv 0}}{\sp{\sn fFilled}{\sv 0}}
{\sp{\sn fArrowheadsOK}{\sv 1}}{\sp{\sn fLayoutInCell}{\sv 1}}{\sp{\sn fLayoutInCell}{\sv 1}}}{\shprslt{\*\do\dobxcolumn\dobypara\dodhgt8197\dpline\dpptx0\dppty0\dpptx2610\dppty0\dpx3600\dpy143\dpxsize2610\dpysize0
\dplinew15\dplinecor0\dplinecog0\dplinecob0}}}}{\f1\lang3082\langfe1033\langnp3082\insrsid15810328\charrsid15810328                       N\'famero de la tarjeta
\par }{\lang1024\langfe1024\noproof\langnp3082\langfenp3082\insrsid208703 {\shp{\*\shpinst\shpleft6060\shptop163\shpright7920\shpbottom163\shpfhdr0\shpbxcolumn\shpbxignore\shpbypara\shpbyignore\shpwr3\shpwrk0\shpfblwtxt0\shpz16\shplid1036
{\sp{\sn shapeType}{\sv 20}}{\sp{\sn fFlipH}{\sv 0}}{\sp{\sn fFlipV}{\sv 0}}{\sp{\sn shapePath}{\sv 4}}{\sp{\sn fFillOK}{\sv 0}}{\sp{\sn fFilled}{\sv 0}}
{\sp{\sn fArrowheadsOK}{\sv 1}}{\sp{\sn fLayoutInCell}{\sv 1}}{\sp{\sn fLayoutInCell}{\sv 1}}}{\shprslt{\*\do\dobxcolumn\dobypara\dodhgt8208\dpline\dpptx0\dppty0\dpptx1860\dppty0\dpx6060\dpy163\dpxsize1860\dpysize0
\dplinew15\dplinecor0\dplinecog0\dplinecob0}}}{\shp{\*\shpinst\shpleft3615\shptop184\shpright5340\shpbottom184\shpfhdr0\shpbxcolumn\shpbxignore\shpbypara\shpbyignore\shpwr3\shpwrk0\shpfblwtxt0\shpz15\shplid1037
{\sp{\sn shapeType}{\sv 20}}{\sp{\sn fFlipH}{\sv 0}}{\sp{\sn fFlipV}{\sv 0}}{\sp{\sn shapePath}{\sv 4}}{\sp{\sn fFillOK}{\sv 0}}{\sp{\sn fFilled}{\sv 0}}
{\sp{\sn fArrowheadsOK}{\sv 1}}{\sp{\sn fLayoutInCell}{\sv 1}}{\sp{\sn fLayoutInCell}{\sv 1}}}{\shprslt{\*\do\dobxcolumn\dobypara\dodhgt8207\dpline\dpptx0\dppty0\dpptx1725\dppty0\dpx3615\dpy184\dpxsize1725\dpysize0
\dplinew15\dplinecor0\dplinecog0\dplinecob0}}}}{\f1\lang3082\langfe1033\langnp3082\insrsid15810328\charrsid15810328                       Fecha de caducidad de la tarjeta:                                        Mes                                       A
\'f1o
\par }{\lang1024\langfe1024\noproof\langnp3082\langfenp3082\insrsid208703 {\shp{\*\shpinst\shpleft3620\shptop158\shpright8440\shpbottom158\shpfhdr0\shpbxcolumn\shpbxignore\shpbypara\shpbyignore\shpwr3\shpwrk0\shpfblwtxt0\shpz7\shplid1038
{\sp{\sn shapeType}{\sv 20}}{\sp{\sn fFlipH}{\sv 0}}{\sp{\sn fFlipV}{\sv 0}}{\sp{\sn shapePath}{\sv 4}}{\sp{\sn fFillOK}{\sv 0}}{\sp{\sn fFilled}{\sv 0}}
{\sp{\sn fArrowheadsOK}{\sv 1}}{\sp{\sn fLayoutInCell}{\sv 1}}{\sp{\sn fLayoutInCell}{\sv 1}}}{\shprslt{\*\do\dobxcolumn\dobypara\dodhgt8199\dpline\dpptx0\dppty0\dpptx4820\dppty0\dpx3620\dpy158\dpxsize4820\dpysize0
\dplinew15\dplinecor0\dplinecog0\dplinecob0}}}}{\f1\lang3082\langfe1033\langnp3082\insrsid15810328\charrsid15810328                       Firma del titular de la tarjeta:                         
\par }{\lang1024\langfe1024\noproof\langnp3082\langfenp3082\insrsid208703 {\shp{\*\shpinst\shpleft5320\shptop173\shpright9440\shpbottom173\shpfhdr0\shpbxcolumn\shpbxignore\shpbypara\shpbyignore\shpwr3\shpwrk0\shpfblwtxt0\shpz9\shplid1039
{\sp{\sn shapeType}{\sv 20}}{\sp{\sn fFlipH}{\sv 0}}{\sp{\sn fFlipV}{\sv 0}}{\sp{\sn shapePath}{\sv 4}}{\sp{\sn fFillOK}{\sv 0}}{\sp{\sn fFilled}{\sv 0}}
{\sp{\sn fArrowheadsOK}{\sv 1}}{\sp{\sn fLayoutInCell}{\sv 1}}{\sp{\sn fLayoutInCell}{\sv 1}}}{\shprslt{\*\do\dobxcolumn\dobypara\dodhgt8201\dpline\dpptx0\dppty0\dpptx4120\dppty0\dpx5320\dpy173\dpxsize4120\dpysize0
\dplinew15\dplinecor0\dplinecog0\dplinecob0}}}}{\f1\lang3082\langfe1033\langnp3082\insrsid15810328\charrsid15810328                       Tel\'e9fono durante el d\'eda del titular:
\par }{\lang1024\langfe1024\noproof\langnp3082\langfenp3082\insrsid208703 {\shp{\*\shpinst\shpleft5320\shptop148\shpright9440\shpbottom148\shpfhdr0\shpbxcolumn\shpbxignore\shpbypara\shpbyignore\shpwr3\shpwrk0\shpfblwtxt0\shpz8\shplid1040
{\sp{\sn shapeType}{\sv 20}}{\sp{\sn fFlipH}{\sv 0}}{\sp{\sn fFlipV}{\sv 0}}{\sp{\sn shapePath}{\sv 4}}{\sp{\sn fFillOK}{\sv 0}}{\sp{\sn fFilled}{\sv 0}}
{\sp{\sn fArrowheadsOK}{\sv 1}}{\sp{\sn fLayoutInCell}{\sv 1}}{\sp{\sn fLayoutInCell}{\sv 1}}}{\shprslt{\*\do\dobxcolumn\dobypara\dodhgt8200\dpline\dpptx0\dppty0\dpptx4120\dppty0\dpx5320\dpy148\dpxsize4120\dpysize0
\dplinew15\dplinecor0\dplinecog0\dplinecob0}}}}{\f1\lang3082\langfe1033\langnp3082\insrsid15810328\charrsid15810328                       Direcci\'f3n donde se reciben las notificaciones de la tarjeta:\tab 
\par }{\lang1024\langfe1024\noproof\langnp3082\langfenp3082\insrsid208703 {\shp{\*\shpinst\shpleft5360\shptop123\shpright9480\shpbottom123\shpfhdr0\shpbxcolumn\shpbxignore\shpbypara\shpbyignore\shpwr3\shpwrk0\shpfblwtxt0\shpz10\shplid1041
{\sp{\sn shapeType}{\sv 20}}{\sp{\sn fFlipH}{\sv 0}}{\sp{\sn fFlipV}{\sv 0}}{\sp{\sn shapePath}{\sv 4}}{\sp{\sn fFillOK}{\sv 0}}{\sp{\sn fFilled}{\sv 0}}
{\sp{\sn fArrowheadsOK}{\sv 1}}{\sp{\sn fLayoutInCell}{\sv 1}}{\sp{\sn fLayoutInCell}{\sv 1}}}{\shprslt{\*\do\dobxcolumn\dobypara\dodhgt8202\dpline\dpptx0\dppty0\dpptx4120\dppty0\dpx5360\dpy123\dpxsize4120\dpysize0
\dplinew15\dplinecor0\dplinecog0\dplinecob0}}}}{\f1\lang3082\langfe1033\langnp3082\insrsid15810328\charrsid15810328 
\par }{\lang1024\langfe1024\noproof\langnp3082\langfenp3082\insrsid208703 {\shp{\*\shpinst\shpleft5340\shptop78\shpright9460\shpbottom78\shpfhdr0\shpbxcolumn\shpbxignore\shpbypara\shpbyignore\shpwr3\shpwrk0\shpfblwtxt0\shpz11\shplid1042
{\sp{\sn shapeType}{\sv 20}}{\sp{\sn fFlipH}{\sv 0}}{\sp{\sn fFlipV}{\sv 0}}{\sp{\sn shapePath}{\sv 4}}{\sp{\sn fFillOK}{\sv 0}}{\sp{\sn fFilled}{\sv 0}}
{\sp{\sn fArrowheadsOK}{\sv 1}}{\sp{\sn fLayoutInCell}{\sv 1}}{\sp{\sn fLayoutInCell}{\sv 1}}}{\shprslt{\*\do\dobxcolumn\dobypara\dodhgt8203\dpline\dpptx0\dppty0\dpptx4120\dppty0\dpx5340\dpy78\dpxsize4120\dpysize0
\dplinew15\dplinecor0\dplinecog0\dplinecob0}}}}{\f1\lang3082\langfe1033\langnp3082\insrsid15810328\charrsid15810328 
\par }\pard \ql \fi-86\li-101\ri0\widctlpar\nooverflow\faroman\rin0\lin-101\itap0 {\f1\cf2\lang3082\langfe1033\langnp3082\insrsid15810328\charrsid15810328    }{\f1\lang3082\langfe1033\langnp3082\insrsid15810328\charrsid15810328 Una vez que obtenga su \'93
Smart Card\'94 de reposici\'f3n}{\b\f1\lang3082\langfe1033\langnp3082\insrsid15810328\charrsid15810328 , le pedimos que destruya toda \'93Smart Card\'94}{\f1\lang3082\langfe1033\langnp3082\insrsid15810328\charrsid15810328  que Ud.        
\par    posea en la actualidad o las que se encontraban perdidas y que posteriormente recupere.
\par }\pard\plain \s1\qc \fi-86\li-101\ri0\sl-280\slmult0\keepn\widctlpar\nooverflow\faroman\outlinelevel0\rin0\lin-101\itap0 \b\f1\fs22\lang1033\langfe1033\cgrid\langnp1033\langfenp1033 {\fs20\lang3082\langfe1033\langnp3082\insrsid15810328\charrsid15810328 
Por favor env\'ede por fax este formulario con una foto tama\'f1o carnet, al N\'ba: 1-818-707-6378 
\par }\pard\plain \ql \li0\ri0\widctlpar\nooverflow\faroman\rin0\lin0\itap0 \fs20\lang1033\langfe1033\cgrid\langnp1033\langfenp1033 {\f1\lang3082\langfe1033\langnp3082\insrsid15810328\charrsid15810328 
                                                              }{\f1\insrsid15810328 O por correo postal, a:}{\f1\cf6\insrsid15810328  }{\f1\cf17\insrsid15810328  }{\b\f1\lang2057\langfe1033\langnp2057\insrsid15810328 Smart Card Office
\par }\pard\plain \s5\ql \li0\ri0\keepn\widctlpar\nooverflow\faroman\outlinelevel4\rin0\lin0\itap0 \b\fs20\lang2057\langfe1033\cgrid\langnp2057\langfenp1033 {\f1\insrsid15810328 \tab \tab \tab 
                                                         P.O. Box 2278
\par }\pard\plain \ql \li0\ri0\widctlpar\nooverflow\faroman\rin0\lin0\itap0 \fs20\lang1033\langfe1033\cgrid\langnp1033\langfenp1033 {\b\f1\lang2057\langfe1033\langnp2057\insrsid15810328 \tab \tab \tab                                                         }{
\b\f1\lang3082\langfe1033\langnp3082\insrsid15810328\charrsid15810328 Agoura Hills, CA 91376 USA
\par }\pard \ql \li0\ri0\sl-280\slmult0\widctlpar\nooverflow\faroman\rin0\lin0\itap0 {\f1\lang3082\langfe1033\langnp3082\insrsid15810328\charrsid15810328 Se tarda aproximadamente cuatro semanas en emitir una reposici\'f3n de la \'93Smart Card\'94
. Cualquier consulta puede dirigirse a la siguiente direcci\'f3n electr\'f3nica:   info@smartcardoffice.org               }{\f1\fs16\lang3082\langfe1033\langnp3082\insrsid15810328\charrsid15810328 
\par }}